Randomized, clinical trial on diathermy and scalpel incisions in elective general surgery.

BACKGROUND: Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables. OBJECTIVES: The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision. PATIENTS AND METHODS: A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1(st) of December 2009 to 30(th) of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications. RESULTS: A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm(2) for group A and 7.3057 sec/cm(2) for group B patients. Mean blood loss during incision making was 1.8262 mL/cm(2) and 1.1346 mL/cm(2) for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications were noticed in 26 (18.18%) patients of group A and 22 (15.71%) patients of group B. CONCLUSIONS: Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery.

Congenital extrusion of testis (scrotoschisis).

A one-day, full term newborn, born to a healthy mother presented with exposed right testicle out of right hemiscrotum since birth. Physical examination showed normal looking testicle and spermatic cord, which was stained with meconium. All baseline investigations and ultrasound of abdomen were within normal limits. There was no visible associated anomaly. Scrotum was explored and viable testis was repositioned. Postoperative recovery was uneventful. At three months follow-up, testicle was good in size and normal in position.

Role of laparoscopy in peritonitis.

OBJECTIVE: Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. METHODS: This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. RESULTS: Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. CONCLUSION: Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery.

Congenital soft tissue Ewing's sarcoma.

A 15 days old female baby presented with a 6 x 7 cm reddish lump with irregular margins on her right scapular region, since birth. Histopathology and immunohistochemistry of excised tissue revealed it to be soft tissue Ewing's sarcoma. Postoperatively, she received only one dose of chemotherapy but could not survive and expired at the age of one month.

Obstructed Bochdaleck diaphragmatic hernia in a child girl.

A five-year-old female child presented with intestinal obstruction. X-ray abdomen and chest showed multiple air-fluid levels in abdomen and a single gas shadow with air-fluid level in left hemithorax. Ultrasound confirmed the presence of gut loop in left side of chest. Laparotomy was carried out with repositioning of intestinal loops in abdominal cavity and closure of posterolateral diaphragmatic defect with non-absorbable suture. Patient recovery was uneventful. As soon as diagnosis of diaphragmatic hernia is made, surgical intervention should be made to prevent fatal complications.

Umbilical perforation: a rare complication of entriculoperitoneal shunt.

A female baby of one-and-a-half-year old presented with extrusion of ventriculoperitoneal (VP) shunt through umbilicus. On exploration, the urachal remnant was found perforated by VP shunt and the tube exteriorized through umbilicus. Child was managed successfully with excision of urachal remnant, removal of VP shunt, antibiotic treatment and re-insertion of shunt.

Tuberculosis of transverse testicular ectopic testis associated with persistent mullerian duct syndrome.

A 10-month-old male infant presented with bilateral inguinal hernia and left un-descended testis. During right herniotomy, both gonads were found on same side with mullerian duct structures. On naked eye examination, both gonads were normal looking. Excision of mullerian duct remnant and fixation of ectopic testis was made. Histopathological examination revealed that gonads were testicles. Presence of multiple granulomas composed of Langhans cells and epithelioid cells in ectopic testicle suggested tuberculosis. Patient was kept on antituberculous therapy and was on regular follow-up without any complication.

Segmental defect of intestinal musculature: a rare cause of intestinal obstruction in children.

A 3 years old female child was brought to the emergency department with acute abdomen. Laparotomy disclosed multiple segmental dilatations in the middle third of the ileum which was resected and anastomosed. Post-operative recovery was uneventful. Histopathological findings showed lack of smooth and longitudinal muscles in dilated segments of the intestine with intact mucosa without any evidence of necrosis and inflammation.

Persistent mullerian duct syndrome with transverse testicular ectopia.

A case report of a 3 months old male child is presented, who had right inguinal hernia with left impalpable testis. During herniotomy we found both testes on right side (transverse testicular ectopia) with presence of mullerian duct structures.