A Prospective Study Comparing Diathermy and Scalpel Incisions in Tension-Free Inguinal Hernioplasty

2005 ◽  
Vol 71 (4) ◽  
pp. 326-329 ◽  
Author(s):  
Emmanuel Chrysos ◽  
Elias Athanasakis ◽  
Sokratis Antonakakis ◽  
Evaghelos Xynos ◽  
Odysseas Zoras
Keyword(s):  
Wound Healing ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Wound Infection ◽  
Skin Incision ◽  
Prosthetic Material ◽  
Complication Rates ◽  
Inguinal Hernioplasty ◽  
Tension Free ◽  
Tissue Dissection

Although still controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rates or postoperative pain are reported with the use of electrocautery. However, these studies include operations without the use of prosthetic materials during abdominal wall closure. The purpose of this study was to investigate the hypothesis that a) application of extreme heat may result in significant postoperative pain and poor wound healing because of excessive tissue damage and scarring respectively, and b) skin incision with the use of diathermy entails increased risk of wound infection in the presence of an underlying prosthetic material. One hundred twenty-five consecutive patients submitted to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either scalpel (n = 60), or diathermy (n = 57) groups. Eight patients had bilateral hernias. Five of them were allocated to the scalpel group and three to the diathermy group. According to the study protocol, they received both approaches for skin and underlying tissues incision, thus resulting in a total of 68 scalpel and 65 diathermy individual hernioplasties. Parameters measured included blood loss during the skin incision and underlying tissue dissection, postoperative pain and requirements for analgesics, the presence of wound dehiscence in the absence of infection, and postoperative wound infection on the day of discharge, on the day staples were removed, and 1 month after surgery. The two groups of patients were similar in relation to patient demographics, type of hernias, and operation details. Blood loss was minimal, and the amount of blood lost did not differ between the two groups. Diathermy group patients required less parenteral analgesics on the first postoperative day. A higher proportion of patients in the scalpel group continued to need oral analgesics on the second postoperative day compared to patients in the diathermy group. There was no difference between the two groups in terms of wound strength. Infectious complications were totally absent. The use of diathermy for skin incision during inguinal hernioplasty is as safe as the use of scalpel in terms of wound healing and reduces the analgesics requirements in the postoperative period.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals Evaluating Clinical Outcomes for Determining the Optimal Delay to Skin Incision under WALANT: A Prospective Series of 34 Patients from a Low-Resource Tertiary Setting

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Alvin Hernandez ◽  
Mamer Rosario ◽  
Romina Mendoza-Torres ◽  
Carl Ryan Marino Taguba ◽  
Abigail Garcia ◽  
...  
Keyword(s):  
Time Delay ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Local Anesthesia ◽  
Skin Incision ◽  
Optimal Time ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Pain Scores

Background. Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods. Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher’s exact test. Results. The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7-min and 30-min groups. Conclusion. The authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT.

scholarly journals ELECTIVE MIDLINE LAPAROTOMY

2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Wound Infection ◽  
Visual Analogue Score ◽  
P Value ◽  
Midline Laparotomy ◽  
Pain Scores ◽  
Group A ◽  
Insignificant Difference ◽  
Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

scholarly journals Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial

2019 ◽  
Vol 101 (7) ◽  
pp. 472-478 ◽  
Author(s):  
M Anan ◽  
SH Emile ◽  
H Elgendy ◽  
M Shalaby ◽  
A Elshobaky ◽  
...  
Keyword(s):  
Wound Healing ◽  
Postoperative Pain ◽  
Anal Fistula ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Operation Time ◽  
Complication Rates ◽  
Group I ◽  
Group Ii ◽  
Fistula Track

Background Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula. Methods This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications. Results Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001). Conclusion Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.

scholarly journals Full-Endoscopic Procedures Versus Traditional Discectomy Surgery for Discectomy: A Systematic Review and Meta-analysis of Current Global Clinical Trials

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 103-118
Author(s):  
Chun-Ming Huang
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Return To Work ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Complication Rates ◽  
Pooled Data ◽  
Vas Score ◽  
Matching Criteria

Background: Traditional discectomy surgery (TDS) provides good or excellent results in clinical surgical discectomy but may induce neural adhesion, spinal structural damage, instability, and other complications. The potential advantages of full-endoscopic (FE) procedures over standard TDS include less blood loss, less postoperative pain, shorter hospitalization, and an earlier return to work. However, more evidence is needed to support this new technology in clinical applications. Objective: The aim of this systematic review and meta-analysis was to compare the safety and efficacy of FE and TDS. Study Design: Comprehensive systematic review and meta-analysis of the literature. Methods: Electronic databases, including PubMed, EMBASE, SinoMed, and Cochrane Library, were searched to identify clinical therapeutic trials comparing FE to TDS for discectomy. Results: Six trials comprising 730 patients were included, and the overall quality of the literature was moderate, including 4 Grade I levels of evidence (4 randomized controlled trials, [RCTs]) and 2 Grade II levels (2 non-RCTs). The pooled data revealed no difference in reoperation rates between FE and TDS (P = 0.94), but the complication rate was significantly lower in the FE group (3.86%) than in the TDS group (11.4%). Perioperative parameters (operation time, blood loss, hospitalization time, and return to work days) were significantly lower in the FE group (P < 0.05 for all groups using either score). Postoperative pain and neurology score assessments were conducted at 4 different time points at 3 months, 6 months, 12 months, and 24 months. Significant differences were detected in the following: lumbar North American Spine Society (NASS) pain at 6 months (P = 0.008); cervical NASS neurology at 6 months (P = 0.03); visual analog scale (VAS) score in leg at 3 months (P < 0.001); VAS score in arm at 24 months (P = 0.002); VAS score in neck at 3 months, 6 months, and 12 months after therapy (P = 0.003, P = 0.004, P = 0.01); and VAS score in neck at 3 months and 6 months (P = 0.01, P = 0.004). Moreover, the pooled data revealed no statistically significant differences in improvements in the Oswestry disability index (ODI), instability (X-ray), and Hilibrand criteria (P > 0.05 for all groups). Limitations: Only 6 studies were included, 4 of which had the same authors. Between-study heterogeneity due to differences in socioeconomic factors, nutrition, and matching criteria is difficult to avoid. Conclusions: Based on this meta-analysis of 24 months of clinical results, we conclude that the FE procedure is as effective as TDS but has the additional benefits of lower complication rates and superior perioperative parameters. In addition, patients may experience less pain with FE techniques due to a smaller incision and less operative injury. However, large-volume, well-designed RCTs with extensive follow-up are needed to confirm and update the findings of this analysis. Key words: Full-endoscopic, minimally invasive, discectomy, meta-analysis

scholarly journals A study of use of bipolar cautery in thyroidectomy

2017 ◽  
Vol 4 (3) ◽  
pp. 1059
Author(s):  
Vasuki R. ◽  
Thanmaran N. B. ◽  
Malathi V. ◽  
Lizrose Kujur
Keyword(s):  
Blood Loss ◽  
Wound Infection ◽  
Morbidity Rate ◽  
Complication Rates ◽  
Knot Tying ◽  
Time Duration ◽  
Female Ratio ◽  
Bipolar Cautery ◽  
Duration Of Surgery ◽  
Knot Tying Technique

Background: Thyroidectomy is one of the most commonly performed surgeries throughout the world which has an extremely low morbidity rate. Nowadays with the advent of newer techniques the duration of surgery and complications have decreased. Conventionally Thyroidectomy was done by suture knot tying technique which needs large number of surgical ties and also time consuming. It decreases healing as well as increases wound infection, injury to neighboring structures and foreign body reaction.Methods: In this study, I selected 50 patients with thyroid swelling attending the surgery outpatient department from February 2015 to August 2015. Thyroid surgery was done using bipolar cautery. The results were analyzed.Results: This study shows most of the patients belong to 30-40 years followed by 40-50 years. The male: female ratio is 1:25. Time duration varies from 50 minutes to 135 minutes. The longer duration of surgery compared to other studies is attributed to learning curve. We started using bipolar diathermy since 2013. The blood loss ranges from 25-50 ml. Complication rates are also less with bipolar thyroidectomy, 2% had postoperative hemorrhage, 2% developed temporary RLN palsy, 2% developed minor degree of wound infection, and 6% developed signs and symptoms of hypocalcemia. The mean duration of hospital stay was 4 days.Conclusions: Thyroidectomy using bipolar cautery is safe and effective method and also less time consuming. The cost of the bipolar cautery is less compared to harmonic scalpel and LigaSure. Bipolar cautery is available in our government hospital. Blood loss using Bipolar Cautery is less compared to conventional Knot–tying technique. The post-operative complications are less with bipolar cautery.

scholarly journals Outcome of skin incision by cautery versus steel scalpel in hernia surgery: a prospective cohort study at a tertiary medical college hospital in South India

2017 ◽  
Vol 4 (5) ◽  
pp. 1521 ◽  
Author(s):  
Ragesh K. V. ◽  
Mahendran S. ◽  
Siddarth Mathad
Keyword(s):  
Postoperative Pain ◽  
Wound Infection ◽  
Infection Rate ◽  
Skin Incision ◽  
Wound Infection Rate ◽  
P Value ◽  
Hernia Surgery ◽  
College Hospital ◽  
Post Operative Pain ◽  
Group B

Background: Since a long time, skin incisions have routinely been made with scalpels. Now a days 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. The aim of the study was to compare the Diathermy versus Scalpel skin incision in elective hernia surgeries with regards to post-operative pain, post-operative wound infection rate and wound healing.Methods: A total of 200 patients were taken for this study. 100 patients underwent diathermy incision (group A) who were compared with 100 scalpel incision patients (group B). Variables used in this study were postoperative pain, wound infection and scar.Results: Patients with diathermy skin incision were having less post-operative pain which was assessed by visual analogue scale when compared with scalpel incision since the p value was 0.01 which is significant (<0.05). The postoperative infection rate and scar were comparable in both the groups since the p-value is >0.05 in each which is insignificant.Conclusions: Diathermy incisions are therefore less harmful to the skin. It has got more advantages than scalpel incisions like less postoperative pain.

scholarly journals Comparative study of postoperative complications of Lichtenstein Tension Free Repair and Pure Tissue Repairs like Modified Bassini or Shouldice at Nishtar Hospital Multan

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Muzaffar Aziz ◽  
Naveed Ahmad ◽  
Fakhra Anwar ◽  
Faizullah .
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Complication Rates ◽  
Tension Free ◽  
Group I ◽  
Separate File ◽  
Scrotal Edema ◽  
Quasi Experimental ◽  
Group Ii

The objective of this study is to compare the postoperative complications of Lichtenstein tension free repair and pure tissue repairs like modified Bassini or Shouldice. This was an interventional (quasi experimental) study. This study was carried out on 100 patients having primary inguinal hernia. After taking detail history, examination and necessary investigations, only tit patients were included in the study and rest were excluded. A separate file was maintained for each patient to note the complication rate of different hernia`s repairs. Patients in group I underwent modified Bassini (35%) and Shouldice repair (15%). Patients in group II underwent Lichtenstein repair (50%).30 (30%) complications were observed. Out of these 23(23%) were in group I and 7(7%) were in group II. All were managed conservatively. The main complications were wound hematoma (9%), Wound infection (3%), scrotal edema (1%), postoperative neuralgia (6%), retention of urine (8%) and recurrence (3%). Wound infection, wound hematoma and recurrence were seen more in group I. Post operative neuralgia was more common in group II. Although follow up was for a shorter period of time and complications like recurrence and post operative neuralgia could not be assessed accurately. It was concluded that Lichtenstein tension free repair is simple and effective method of repairing inguinal hernia, with low complication rates and low recurrence rate. The method is much easier and should be considered in majority of patients with inguinal hernia.

scholarly journals Comparative randomized controlled clinical trial of diathermy versus scalpel incision in midline laparotomy

2018 ◽  
Vol 6 (1) ◽  
pp. 28
Author(s):  
Bhavin P. Vadodariya ◽  
Nimish J. Shah ◽  
Mrudul Patel
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Midline Laparotomy ◽  
Medical College ◽  
Randomized Clinical Study ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Laparotomy incisions have traditionally been made using a scalpel. Diathermy, a latest technique, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that diathermy may offer likely advantages with respect to blood loss, incision time and postoperative pain. The aim of this study was to compare the efficacy and safety of surgical diathermy incisions versus conventional scalpel incisions for midline laparotomy in our hospital with an aim to evaluate diathermy as an operational alternative to scalpel incision.Methods: This was a prospective randomized clinical study which was conducted in the surgical wards of Medical College & SSG hospital, Vadodara, between December 2013 and December 2014.  Patients were randomly assigned to two groups i.e. Group A (scalpel group) and Group B (diathermy group).Results: A total of 148 patients were enrolled in the study. Of these, 74 patients were randomized to Group A (scalpel group) and 74 patients to Group B (diathermy group). The two groups did not vary significantly in relation to age and sex (p>0.001). Laparotomy skin incisions using diathermy were significantly quicker than scalpel incisions (p=0.624). There was significantly less blood loss in the diathermy group compared with the scalpel group (P=0.15). The mean visual analogue scale was significantly reduced more in the diathermy group than in scalpel group patients on postoperative day 1 (p=0.81), day 3 (p=0.71) and day 5 (p=0.79) respectively. Postoperative complication rates did not differ significantly between the scalpel and diathermy groups (p=0.624).Conclusions: We concluded that diathermy incision in midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and postoperative wound infection.

Comparison of LigaSure Vessel Sealing System, Harmonic Scalpel, and Cold Knife Tonsillectomy

2007 ◽  
Vol 137 (3) ◽  
pp. 385-389 ◽  
Author(s):  
Vassilios A. Lachanas ◽  
John K. Hajiioannou ◽  
George T. Karatzias ◽  
Dimitrios Filios ◽  
Stylianos Koutsias ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Complication Rates ◽  
Intraoperative Bleeding ◽  
Vessel Sealing System ◽  
Vessel Sealing ◽  
Ligasure Vessel Sealing System ◽  
Cold Knife

OBJECTIVE: We sought to compare LigaSure Vessel Sealing System tonsillectomy (LT), Harmonic Scalpel tonsillectomy (HST), and cold knife tonsillectomy (CKT). STUDY DESIGN: We conducted a prospective study on 161 adult patients undergoing tonsillectomy. Subjects were randomized to LT, HST, or CKT groups, and intraoperative bleeding, operative time, postoperative pain, and complication rates were assessed. RESULTS: The LT, HST, and CKT groups consisted of 50, 43, and 37 individuals, respectively. Intraoperative bleeding was significantly lower in the LT group, whereas bleeding in the HST group was significantly lower than that in the CKT group. Operative time and postoperative pain were significantly lower in the LT and HST groups. One primary hemorrhage occurred in the HST group, and one occurred in he CKT group. Secondary hemorrhage occurred in one, two, and one patients in the LT, HST, and CKT groups, respectively. CONCLUSION: LT and HST have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with CKT, both were associated with less intra-operative blood loss and pain.

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