Efficacy and Safety of LigaSure in Laparoscopic Sutureless Appendectomy.

Background The closure of the appendiceal stump is a crucial step during an appendectomy. The purpose of this study is to evaluate the LigaSure Vessel Sealing System in laparoscopic appendectomy (LA) for sealing and dividing the base of the appendix. Material and methods Laparoscopic appendectomy was performed using the 5-mm LigaSure Vessel Sealer in 53 patients, and the mesoappendix along with the base of the appendix was divided by LigaSure. Patient demographic details, operative time, return to oral feed, duration of hospital stay, and postoperative complications were recorded, and statistical analysis was done. Results Out of 53 patients (24 women and 29 men), no complications occur in 51 patients. The mean age and standard deviation (SD) were 26.50 ± 10.46 years. The mean operative time for 53 appendectomies by LigaSure was 27.8 ± 6.72 minutes. The mean duration of hospital stay after surgery was 3.3 ± 0.72 days. One patient developed mild subcutaneous emphysema over the abdomen (1.8%), and surgical site infection occurred in one patient (1.8%). Conclusion This study demonstrated that sealing and dividing the base of the appendix by the LigaSure Vessel Sealing System is safe and feasible. It is associated with low complication rate and may help in simplifying the operative procedure.

Sutureless Appendectomy by Using Harmonic Scalpel: Is It Possible?

Introduction: Laparoscopic appendectomy is a commonly performed procedure. The base of appendix is secured by various techniques (suture, LigaSure, endoloop, or hamlock clip). Harmonic scalpel (HS) may be used to seal the base of the appendix. The study was conducted to assess the efficacy of HS in laparoscopic appendectomy for sealing the base of the appendix. Materials and Methods: The patients were divided into two groups: group 1 in which base was secured by endoloop and group 2 in which base of the appendix was sealed by HS in a stepwise manner. We made a record of patients' age and gender, and operative time. The patients were followed for a period of 3 months from the time of discharge. Results: During the study period of 4.5 years, 102 patients were in group 1 and 108 patients in group 2. Both groups were age and gender matched. Mean operating time for group 1 was 43.34 ± 6.7 minutes and that for group 2 was 28.46 ± 7.19 minutes (P < .0001). Complications included postoperative ileus (group 1 = 8, group 2 = 10) and surgical site infection (group 1 = 4, group 2 = 4, P > .05). Conclusion: It appears that use of HS for laparoscopic appendectomy is feasible and safe. Its results appear to be comparable with other methods of laparoscopic appendectomy. Complications are minimal. Further studies at other centers may substantiate our efforts.

Role of platelet-rich plasma in healing diabetic foot ulcers: a prospective study.

OBJECTIVE: To evaluate the role of platelet-rich plasma (PRP) in healing diabetic fool ulcers (DFUs), and to compare the rate of healing and final outcome with conventional therapy. METHOD: A prospective study conducted between October 2013 and July 2015. Participants were divided in to two groups: a study group in which PRP was used and a control group receiving standard therapy. Wound assessment was carried out according to the Bates-Jensen Wound Assessment Tool at 0, 7, 14, 21 and 28 days. RESULTS: A total of 55 patients were recruited to the study. There were 29 patients in the study group and 26 patients in the control group. After application of PRP, there was significant improvement in mean wound score and significant percent improvement in wound score in the study group (p<0.0001). Complete healing occurred in all patients in the study group in (mean score and standard deviation) 36.7±3 days compared with 60.6±3.7 days in the control group (p<0.0001). There were no unwanted side effects in patients using the PRP in this study. CONCLUSION: PRP appears to be a promising agent in the management of DFUs. In this study, DFUs healed more quickly in the study group than in the control group. There was also significant percent improvement in wound score as compared with debridement and dressing only. If proper selection criteria are applied, PRP could be a useful aid to wound healing in people with DFUs.

Anoscrotal median raphe sinus in a child.

Anoscrotal median raphe sinus is an extremely rare entity in children. We report a pediatric patient and describe the management of this condition.

Malrotation with midgut volvulus associated with perforated ileal duplication.

Duplication of the alimentary tract is an important surgical condition. It may occur anywhere in the gastrointestinal tract. An important complication of this entity is perforation of the normal or abnormal gut. Malrotation with midgut volvulus can be a surgical emergency. We present a patient, who presented as malrotation with midgut volvulus associated with perforated ileal duplication. The patient was successfully managed.

Study on the use of T-tube for patients with persistent duodenal fistula: is it useful?

BACKGROUND: The commonest surgical treatment used for peptic ulcer perforation is omental patching. If, however, the perforation leaks, it rarely heals by itself due to persistence of duodenal fistula (DF). We present our experience with a T-tube placed into the DF for better outcome of the patients. METHODS: All patients in our hospital with DF following failure of surgery for duodenal perforation were included in this study. After identification of the perforation, a size 16 French T-tube was put in place. The patients were analyzed on basis of duration of hospital stay, complications related to the T-tube and overall complications, start of oral feeds, and follow-up. RESULTS: In this 3-year study, ten patients with DF were admitted. The mean age was 50 years. The T-tube was kept in place within the fistula for 20.5 days. The mean duration to start oral feeds was 8.8 days. The mean duration of hospital stay was 23.2 days, and the mean follow-up period was 6.3 months. The complications observed in the postoperative period were fever in four patients, wound dehiscence in four patients, and peritoneal collection in two patients, all of which were managed easily. There was no peritubal leakage and no failure of surgery as regards placement of a T-tube. There were no deaths in this study. CONCLUSIONS: Placement of a T-tube into a DF appears to be very effective procedure for managing this complication of surgical repair of a perforated peptic ulcer with an omental patch. The technique appears to be simple and rewarding. Further use of this method by other workers will substantiate our efforts.