Outcome of mesh anchoring using stainless steel skin staples versus polypropylene suturing in Lichtenstein's tension free inguinal hernia repair

Objective: to find out the effectiveness of anchoring mesh using stainless steel skin staples versus polypropylene sutures in inguinal hernia surgery with Lichtenstein's technique in terms of operation time, postoperative pain and recurrence of disease

Study design: randomized controlled trial

Place and Duration of study: department of Surgery ward 26 surgery, Jinnah Postgraduate Medical Centre Karachi, from February 2014 to January 2016

Methodology: patients above 18 year of age who underwent inguinal hernia repair using mesh were included. They were randomly assigned in to Group A in which the mesh was secured using stainless skin staples and Group B where mesh was anchored using polypropylene [Prolene] 2/0 sutures. The operative time was recorded in both the groups. All the patients were followed up in outpatient department for recording the postoperative pain on the visual analogue scale [VAS]

Results: sixty-four patients fulfilling the inclusion criteria were included. They were randomly divided into two groups of 32 patients each. The mean age of Group A and B patients was 45.85 +/- 13.50 year and 48.56 +/- 14.56 year respectively. Total operation time and from mesh placement to skin closure was found significant in favor of group A [p <0.001]. At 7[th] postoperative day in Group A twelve patients had no pain, Fifteen had mild, four with moderate and one patient had severe pain. In Group B ten patients reported no pain, fourteen had mild, five moderate and three with severe pain. Three patients in group A and four in Group B developed seroma postoperatively. Wound infection developed in one patient in group B. There was neither mesh related infection nor recurrence of hernia in either of the groups

Conclusion: operation time was shorter in patients where staples were used. Postoperative pain was also less in intensity in this group

Scalpel versus diathermy for midline abdominal incisions

To compare the incision time, blood loss, post-operative complications [wound infection] and post-operative pain in midline laparotomies incisions made using scalpel versus diathermy. Randomised controlled trial. Department of General Surgery Ward 26, Jinnah Postgraduate Medical Center [JPMC] Karachi, from June 2012 to June 2013. A total of 220 patients were enrolled in the study after taking informed consent. These patients were randomly assigned to Group A [Scalpel incision group] and Group B [Diathermy incision group] using opaque labeled envelopes. The surgeon was informed of the type of incision before the surgery started. There was a significant statistical difference in terms of incision time [p = 0.001], blood loss [p=0.014], post-operative pain [p=0.001, 0.012 and 0.021 on day 1, 2 and 3 respectively] and post-operative analgesics requirement [p=0.021]. On the other hand there was no significant statistical difference in terms of postoperative complications [wound infection] and length of hospital stay. Diathermy incision in midline laparotomy was significantly superior to the scalpel because of reduced incision time, less blood loss, less early postoperative pain and reduced analgesic requirements

Comparison of modified radical mastectomy using harmonic scalpel and electrocautery

To compare the intraoperative and postoperative outcome of modified radical mastectomy [MRM] using harmonic scalpel versus electrocautery. Comparative study. Department of Surgery, Jinnah Postgraduate Medical Center [JPMC] Karachi, Surgical ward 26, from December 2010 to June 2012. This study included fifty females undergoing modified radical mastectomy. Twenty-five were operated with harmonic scalpel and twenty-five with electrocautery. Operative time, blood loss, total drainage volume [axillary and flap drains] and days for which the drains were placed, pain score, volume of sermoa, hematoma, frequency of flap necrosis and lymphedema were compared. There were no statistical differences between the two groups as regard to operative time [p=0.264], seroma [p=0.247], hematoma [p=0.235], flap necrosis [p=1.000] and lymphedema [p=1.000]. Furthermore there was no statistically significant difference in terms of pain relief [p=0.197]. There was a highly significant difference [p<0.001] in relation to blood loss, drainage volume of flap drain and duration of placement of flap drain only. Hospital stay was not shortened because all patients were routinely discharged after three days following removal of the drains. Use of harmonic scalpel in mastectomy significantly reduced blood loss, total drainage volume and days but did not lower operative time, seroma formation, postoperative pain and total hospital stay.