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.

Phyllodes tumors of breast: a review of 30 cases

To describe clinical features, histopathology, treatment and prognosis of phyllodes tumor of breast. Descriptive case series. Department of Surgery, Jinnah Postgraduate Medical Centre Karachi, from 2005 to 2011. This is a retrospective review of the medical records of patients managed over a period of six years. The data of patients with phyllodes tumor [PT] of breast were analyzed for age at the time of diagnosis, the duration of the illness, tumor size, tumor localization, ultrasound features, preoperative diagnosis, surgical procedure, pathological grading and outcome. Grading of tumor was done according to the World Health Organization [WHO] classification. The age of the patients ranged from 19 year to 66 year [mean age 40 year]. The mean age of occurrence of benign, borderline and malignant tumors was 35.5, 44.5 and 45.6 year respectively. The mean time from onset of symptoms and pathological diagnosis of PT ranged from one to 36 months [mean 15 months]. Tumors occurred in the left breast in 12 cases, and on right side in 16 cases. The upper outer quadrant was involved in 11 [36.6%] cases. The resection margin was recorded as negative in 18 cases. Nine patients underwent postoperative radiation [3 borderline and 6 malignant PTs]. Local recurrence occurred in one benign, 3 borderline and 2 malignant cases. Treatment in the case of recurrent benign PT included lumpectomy. Mastectomy was done in 5 other recurrent cases. Phyllodes tumors of the breast have an unpredictable outcome. A wide local excision, with adequate margin of normal breast tissue, is the preferred initial therapy