ABSTRACT
Objectives: The objective of this study was to compare the outcome of diathermy incisions v/s surgical scalpel incisions in general surgery
Study Design: Cross sectional study
Place and Duration of Study: This study was conducted at surgical unit 7, Sindh Govt. Lyari General Hospital and Dow University of Health Sciences between January to December 2009
Methodology: 100 consecutive patients for elective general surgery were randomly assigned to either group A incision with cutting diathermy [n=50] or group B cold steel scalpel [n=50]. Data including demographic details, hospital stay, infection rate and non-infective complications like swelling, bleeding, dehiscence and seroma formation were recorded in both groups to compare the final surgical outcome compared
Results: A total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male [n = 61, 76.3%]. The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively. In Diathermy [Group A] total 20% patients developed complications and these were seroma formation [n=4, 8%], wound dehiscence [n=3, 6%] and wound infection [n=3, 6%]. In Scalpel [Group B] total 26% patients developed complications [P-value=0.370] in which seromas was noted [n=5, 10%] then wound infection [n=4, 8%], then wound bleeding [n=3, 6%] and lastly seroma formation [n=1, 2%]. Hospital stays were also almost similar with mean value 8.24 days in diathermy group and 10.54 days in scalpel group. No remarkable difference in demographics, characteristics and in other variables of patients was noted
Conclusion: We conclude that no significant difference in surgical outcome of both groups [cutting diathermy Vs. steel scalpel]. Therefore, use of either technique to create surgical wound merely depends upon preference of surgeon
ABSTRACT
Objectives: the objective of this study was to compare the efficacy of Clinical Evaluation and modified Alvarado scoring system in diagnosing acute appendicitis
Study Design: cross sectional study
Place and Duration of Study: this study was conducted at Surgical Unit III of Civil Hospital Karachi from May 2010 to October 2010
Methodology: this study consisted of eighty patients. Patients were divided in two groups. Group A for complete clinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring system comprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea, vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively and undergoing emergency appendectomy during this period, age >12 years and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant female patients and those who did not give written consent
Results: a total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male [n = 61, 76.3%]. The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively
Conclusion: we conclude that modified Alvarado score can be used safely and effectively in diagnosing acute appendicitis in adult males especially as the score increases from seven to nine
ABSTRACT
To compare the complications of laparoscopic versus open appendectomy. Retrospective study. This study was conducted at Dow University Hospital from June 2012 to June 2014. Data was analyzed by reviewing patient records, patients bills records and patient discharge sheet. Each data was double checked and thoroughly supervised by author himself to assure quality and validation of the data collected. The information reviewed of patients with diagnosis of acute appendicitis included, age, sex, time taken for bowel function restoration, use of analgesia, postoperative stay and its clinical evaluation and confirmed by USG of abdomen requiring operation and total charges. Patients included who were operated in surgical unit I. Patients who were identified with associated gynecological disease, to be at high risk for general anaesthesia, had a past history of lower abdominal surgeries, appendicular abscess were excluded. Data was analyzed through SPSS software. 73 patients who underwent appendicectomy. Out of which 24 [32.87%] patients operated laparoscopically and 49 [67.12%] patients by open method. The mean age for open appendectomy was 26.53 +/- 12.3 years whereas, for laparoscopic appendectomy it was 29.9 +/- 13.3 years. Intraoperative findings were normal appendix 4[16.66%] in OA group and 2[4.08%] in LA group, Acute appendicitis 12[50%] in OA group and 31[63.26%] in LA group, Gangrenous appendicitis 3[12.5%] in OA group and [14.28%] in LA group, Appendiceal abscess 4[16.66%] in OA group and 5[10.20%] in LA group, Peritonitis 1[4.16%] in OA group and 3[6.12%] in LA group. Post operative complications were observed in both groups. Wound infection 5[20.83%] in OA group and 2[4.08%] in LA group, Intra-abdominal abscess 1[4.16%] in OA group and 1[2.04%] in LA group, Bowel obstruction 3[12.5%] in OA group and 2[4.08%] in LA group, Respiratory infection 2[8.33%] in OA group and 1[2.04%] in LA group. This retrospective comparative assessment indicates that the patient chart reduces the incidence of complications in LA was wound infection, intestinal damage, intra-abdominal abscesses, intestinal obstruction and respiratory infections