Diathermy incisions v/s surgical scalpel incisions; outcome in general surgery

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

prospective study of outcome from rubber band ligation in third degree haemorrhoids

To evaluate the efficacy and effectiveness of rubber band ligation on 3rd degree haemorrhoids. Study was done at Surgical Unit, Civil Hospital Karachi, during a period of 19 months from December 2006 to July 2008. Out of 344 patients 80 patients were included in the study with 3rd degree internal haemorrhoids and were treated with Rubber band ligation [RBL]. Outcome data was recorded for success of treatment. Among 80 patients, 77 [96.25%] were symptom free. After completion of treatment, 1 [16.66%] out of 5 patients had the complaint of pain, 2 [2.85%] out of 70 had complaints of constipation. Before start of treatment 5 [6.25%] patients complained of bleeding per rectum and 73 [91.25%] complained of manually reducible/prolapsed haemorrhoids. Both complaints were cured 100% after treatment. RBL is an efficient, cost-effective and simple out patient procedure for symptomatic third degree haemorrhoids with minimum complications. RBL is a reliable, safe procedure requiring no hospitalization and no use of any anaesthetic drugs

Abdominal tuberculosis: Clinical presentation and outcome

To study the clinical presentation and outcome of cases of Abdominal Tuberculosis. Prospective cross-sectional study from January 2005 to December 2006. Surgical Unit II and V, Civil Hospital, Karachi. Fifty four patients of Abdominal Tuberculosis were seen during the study period Four patients were lost to follow-up, which were excluded. Detailed information of all the patients including age, sex, symptoms, signs, investigations and management was recorded, analyzed and compared with local and international data. Out of the 50 patients with Abdominal Tuberculosis, 31 were females and 19 males. Their ages ranged from 17 to 63 years, with a mean age 425.1 years. Thirty five cases were admitted through Emergency and 15 through Outpatients departments. Abdominal pain was the most common symptom found in 44 [88%] patients followed by vomiting in 33 [66%]. Abdominal tenderness was seen in 22 [44%] patients, while 16 [32%] patients had rigidity and other features of peritonitis. Surgery was performed in all these patients, limited right hemicolectomy in 17 [34%], segmental resection and anastomosis in 12 [24%], ileostomy and strictureplasty in six [12%] each, repair of perforation in five [10%] and adhesiolysis in four [8%] patients. Overall mortality was 8% due to septicaemia and multiorgan Abdominal Tuberculosis is a significant clinical entity with lethal complications in neglected cases. It affects a younger age group and is more common in females. Clinical features are rather non-specific but vague ill health, low grade fever, weight loss and anorexia may help to diagnose the case

Application of modified Alvardo score in the diagnosis of acute appendicitis in our setup

The study was undertaken to assess the accuracy of the Modified Alvarado score in predicting appendicitis for patients with right iliac fossa pain admitted in our hospital. This is a prospective study of patients Admitted with suspected appendicitis. This study was conducted at Surgical Unit V Civil Hospital Karachi over one year period front Jan. 2003 to Jan 2004. For every patient suspected of appendicitis the Modified Alvarado score was computed on admission, as laboratory facility for shift of Neutrophils to left was not available. The Modified Alvarado score was recorded on the admission sheet and did not effect the management of the patients. The patients discharged without surgery were reviewed in the out patients clinic to ascertain that they did not need surgery. Sixty two patients underwent appendicectomy. Out of these, 30 patients [48.38%] has a Alvarado score 1-4, 10 patients [16.12%] had a Alvarado score 5-6, 18 patients [29.03%] had a Alvarado score 7-8 and only 2. Patients [3.22%] had a maximum Alvarado score 9, where appendix was found perforated and gangrenous on operative findings. The Alvarado score was not found to be a useful complementary method in the diagnosis of suspected case of acute appendicitis patients in Department of Surgery CHK