Tonsillectomia versus tonsillotomia

Összefoglaló. Bevezetés és célkitűzés: A szerzők a posztoperatív fájdalom és a sebgyógyulás tekintetében prospektív vizsgálattal hasonlították össze gyermekeken (67 fő, 1–12 év) a hagyományos hidegeszközzel történő extracapsularis tonsillectomiát (23 fő) a microdebriderrel (23 fő) és a coblatorral (21 fő) végzett intracapsularis tonsillotomiával. Módszer: A vizsgálatok a betegek által kitöltött kérdőívek, valamint prospektív klinikai adatgyűjtés alapján történtek. Eredmények: Az intracapsularis tonsillotomia gyógyulási idejét 50%-kal rövidebbnek találtuk, és az első 13 napban szignifikánsan kevesebb fájdalommal és fájdalomcsillapító igénnyel járt, mint az extracapsularis tonsillectomia eseteiben. A tonsillotomiás csoporton belül egyedül a posztoperatív első napi fájdalom tekintetében észleltünk szignifikáns különbséget a két különböző módszer között a coblator javára (p<0,05). A vizsgálatokat retrospektív áttekintéssel is kiegészítettük, 4 évi gyermek- (1–15 éves) tonsillaműtéten átesett beteganyagunk (1487 fő) eredményeinek feldolgozásával. Tonsillectomia (1253 fő) után 7,7%-os utóvérzési arányt észleltünk, műtéti vérzéscsillapításra 1,3%-ban volt szükség. Tonsillotomia esetén (234 fő) 0,43%-os utóvérzési arányt regisztráltunk. Ebben a csoportban vérzés miatt nem, de 2 esetben ismételt obstrukciót okozó hypertrophia, 1 esetben góctünetek miatt reoperációt végeztünk (1,28%). Következtetés: Eredményeiket a szerzők a nemzetközi ajánlások tükrében elemezték. Az intracapsularis tonsillotomia kisebb fájdalommal, kisebb vérzéssel és kisebb megterheléssel jár. A közösségbe való aktív visszatérés akár egy hét után lehetséges a tonsillectomiára jellemző 3 héttel szemben, mindez jelentős szocioökonómiai előnyökkel járhat. Orv Hetil. 2020; 161(45): 1920–1926. Summary. Introduction and objective: Examining operated children in this prostective study inditerscompared (67 pts, 1–12 yrs) the extracapsular tonsillectomy with conventional cold-knife (23 pts) to extracapsular tonsillotomy with microdebrider (23 pts) and coblator (21 pts) for postoperative pain and wound-healing disorders. Method: The study was based on patient-completed questionnaires as well as prospective clinical data collection. Results: The recovery time of intracapsular tonsillotomy was found less than 50%, with less pain than in the cases of extracapsular tonsillectomy. Postoperative pain was significantly less in the tonsillototomy group than the tonsillectomy group. Within the tonsillotomy group, a significant difference was observed between the two different methods in favor of the coblator for only the postoperative first-day pain. The studies were supplemented with a retrospective review by processing the 4 yrs results of their pediatric (1–15-yrs) patients who underwent tonsillectomy (1487 pts). After tonsillectomy (1253 pts), a postoperative bleeding rate of 7.7% was observed, and surgical hemostasis was required in 1.3%. In the case of tonsillotomy (234 pts), a postoperative bleeding rate of 0.43% was recorded. In this group, reoperation was not performed due to bleeding, whereas it was neccesary in 2 cases due to hypertrophy causing repeated obstruction, in 1 case due by virtue of focal symptomes (1.28%). Conclusion: Our results were analyzed on the basis of international recommendations. Intracapsular tonsillotomy is associated with less pain, less bleeding, and less strain. Active return to the community is possible after up to a week compared to the 3 weeks typical of tonsillectomy, all of which can have significant socioeconomic benefits. Orv Hetil. 2020; 161(45): 1920–1926.

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Comparison between Tissue Adhesive Cyanoacrylate and Suture for Palatal Fibromucosa Healing: A Randomized Controlled Study

Materials ◽

10.3390/ma14227009 ◽

2021 ◽

Vol 14 (22) ◽

pp. 7009

Author(s):

Carlota Castro-Gaspar ◽

Maria Victoria Olmedo-Gaya ◽

Maria Nuria Romero-Olid ◽

Maria Jesús Lisbona-Gonzalez ◽

Marta Vallecillo-Rivas ◽

...

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Operative Time ◽

Tissue Adhesive ◽

Controlled Study ◽

Randomized Controlled ◽

Significant Difference ◽

Donor Area ◽

Group A ◽

Gingival Graft

Cyanoacrylate tissue adhesive is proposed to promote soft tissue healing in oral surgery and minimize complications (pain, inflammation, and bleeding) associated with wound healing by secondary intention. The objective was to compare cyanoacrylate tissue adhesive (test group) with suture (control group) in terms of postoperative complications, operative time, and wound healing in the palatal donor area after harvesting a de-epithelialized gingival graft. A randomized controlled clinical trial was performed in 24 patients randomly assigned to one of two study groups. Data were gathered on wound bleeding, operative time, postoperative pain, inflammation, hyperesthesia, necrosis, and donor area healing time. Operative time was almost 50% shorter in the tissue adhesive cyanoacrylate group, a significant between-group difference (p = 0.003). Spontaneous bleeding in the donor area during the first 24 h was observed in 11.1% of the tissue adhesive cyanoacrylate group versus 88.9% of the suture group—a significant difference. No significant between-group difference was observed in postoperative pain, inflammation, or degree of healing over time. There were no cases of hyperesthesia or wound necrosis. Utilization of tissue adhesive cyanoacrylate rather than suture in palatal de-epithelialized gingival graft harvesting reduces postoperative bleeding during the first 24 h, as well as the operative time.

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Monopolar Diathermy Tonsillectomy Versus Dissection Method Tonsillectomy

KYAMC Journal ◽

10.3329/kyamcj.v10i1.41478 ◽

2019 ◽

Vol 10 (1) ◽

pp. 21-24

Author(s):

Md Abdus Salam ◽

Md Mahbub Alam ◽

Rezwan Ahmed ◽

Md Sultan Mahmud

Keyword(s):

Postoperative Pain ◽

Postoperative Bleeding ◽

Throat Pain ◽

Medical College ◽

Advantages And Disadvantages ◽

Case Surgery ◽

Group A ◽

The Difference ◽

Group B ◽

Dissection Method

Background: Tonsillectomy is one of the most common surgical procedures performed worldwide by otorhinolaryngologists for different indications. Tonsillectomy is often performed as day-case surgery, which increases the demands of a satisfactory postoperative pain control and a low risk of early postoperative bleeding. Objective: The aim of the study was to compare the Monopolar diathermy and Dissection methods of tonsillectomy and evaluate their advantages and disadvantages during surgery, convalescence. Materials and Methods: Two hundred children were recruited for this study during the period of five years from January, 2014 to December, 2018 at Otolaryngology department of Khwaja Yunus Ali Medical College and Hospital (KYAMCH). Subjects between the age of 5 and 25 years listed for tonsillectomy were included. Subjects were recommended not to have aspirin within the 2 weeks before surgery. Results: The mean duration of operation was found 10.6±0.4 minutes in group A and 17.0±0.7 minutes in group B. The difference was statistically significant (p<0.05) between two groups. At 1st day, 11(11.0%) patients had throat pain in group A and 23(23.0%) in group B. At 2nd day, 14(14.0%) patients had throat pain in group A and 25(25.0%) in group B. Which were statistically significant (p<0.05) between two groups. Conclusion: The monopolar diathermy tonsillectomy appears to cause less bleeding, postoperative pain and less time consuming in compare with the dissection tonsillectomy although patients experience slightly more pain than dissection Method. KYAMC Journal Vol. 10, No.-1, April 2019, Page 21-24

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

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

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.

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Comparison of Recovery Time of Propofol and Midazolam with Propofol Alone for Sedation in Endoscopic Retrograde Cholangiopancreatography

10.53350/pjmhs211551024 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1024-1027

Author(s):

Asma Samreen ◽

Aamir Waseem ◽

Muhammad Azam ◽

Itrat Hussain Kazmi ◽

Aamir Bashir ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Recovery Time ◽

Controlled Trial ◽

P Value ◽

Time Data ◽

Endoscopic Retrograde ◽

Intravenous Anesthetic ◽

Significant Difference ◽

Group A ◽

Group B

Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP. Keywords: Propofol, midazolam, sedation outside operation theatre.

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Effect of Over the Counter Ibuprofen Dosing after Sinus Surgery for Chronic Rhinosinusitis: A Prospective Cohort Pilot Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420906179 ◽

2020 ◽

Vol 129 (7) ◽

pp. 677-683

Author(s):

Craig Miller ◽

Ian M. Humphreys ◽

Greg E. Davis

Keyword(s):

Pilot Study ◽

Prospective Cohort ◽

Postoperative Bleeding ◽

Bleeding Risk ◽

Sinus Surgery ◽

Level Of Evidence ◽

Over The Counter ◽

Bleeding Rate ◽

Significant Difference ◽

Opioid Medications

Introduction: Management of pain following endoscopic sinus surgery (ESS) often involves intermittent use of opioid medications. Given the current opioid crisis, many surgeons aim to minimize opioid prescriptions. However, surgeons often avoid the use of NSAIDs following ESS out of concern for increased bleeding risk. We sought to evaluate the effectiveness and safety of over the counter dosing of ibuprofen on pain and bleeding rates following ESS. Methods: Prospective cohort pilot study of patients undergoing ESS. Patients self-selected either control arm (acetaminophen and PRN oxycodone) or intervention arm (alternating ibuprofen with acetaminophen, and PRN oxycodone). Outcome measures included pain (10-point visual analog scale [VAS]), bleeding rate (10-point VAS), and number of opiate pills consumed. Results: Thirty-nine patients completed the study (15 control and 24 intervention). Overall, patients in the intervention arm reported decreased pain levels at days 1 (−0.9 [95%CI: −2.2, 0.5], 3 (−0.9 [95%CI: −2.3, 0.5]), and 7 (−0.6 [95%CI: −1.8, 0.6]), as well as decreased postoperative bleeding at those same days −0.9 [95%CI: −2.1, 0.4], −0.9 [95%CI: −2.1, 0.4], and −0.7 [95% CI: −1.2, −0.7], compared to controls. Opiate consumption was similar between groups with patients consuming on average four opiate pills (oxycodone 5 mg). Conclusions: Over the counter dosing of ibuprofen along with acetaminophen may yield better pain control after sinus surgery compared to acetaminophen alone. Additionally, there was no significant difference in epistaxis in the ibuprofen cohort compared to the cohort who did not take ibuprofen. Furthermore, this study showed very few opioid pills were consumed after routine ESS regardless of pain regimen prescribed. A larger trial is needed to make definitive statements on safety and efficacy. Level of Evidence: 2b

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Comparing the Effects of Dexmedetomidine and Midazolam on Sedation in Children with Head Trauma to Perform CT in Emergency Department / Upoređivanje efekata deksmedetomidina i midazolama na sedaciju dece sa povredom glave radi snimanja CT-om na Odeljenju urgentne medicine

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2015-0006 ◽

2015 ◽

Vol 32 (1) ◽

pp. 59-65

Author(s):

Hojjat Derakhshanfar ◽

Farzad Bozorgi ◽

Adel Hosseini ◽

Shamila Noori ◽

Abolfazl Mostafavi ◽

...

Keyword(s):

Emergency Department ◽

Head Trauma ◽

Recovery Time ◽

Vital Signs ◽

Loading Dose ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Pediatric Sedation ◽

Group B

Summary Many of the children referred to the emergency complain of head trauma. Children usually require sedition to reduce their failure and fear because of high activity and fear of performing computed tomography (CT). Dexmedetomidine and Midazolam belong to short-acting drugs for this purpose. This study aimed to compare the effect of the above mentioned drugs on sedition in children. Children referred to the emergency department were randomly divided into two groups. Group A was sedated with 0.05 mg/kg IV Midazolam and group B with 2μg/kg IV Dexmedetomidine over 10 minutes (loading dose), and then repeat boluses 2μg/kg IV over 10 minutes. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug and vital signs and RAMSY scale. SPSS V.20 was used for data analysis. p<0.05 was considered statistically significant. Totally, 100 patients participated in the current study (44 girls and 56 boys). The mean and standard deviation of age was 5.3 ± 2.5 years. During the study, just 5 patients (10%) from group A did not have appropriate sedition following the injection of first dose of Midazolam and received the second dose. However, in B group patients no such case was reported. No significant difference was observed among blood pressure, heart rate, respiration and RAMSY Scale among the groups. No significant difference was seen between efficacy of Midazolam and Dexmedetomidine in pediatric sedation. More research should be done for generalization of our findings .

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Post-Cholecystectomy Pulmonary Function following Interpleural Bupivacaine and Intramuscular Pethidine

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700407 ◽

1989 ◽

Vol 17 (4) ◽

pp. 440-443 ◽

Cited By ~ 16

Author(s):

D. C. Oxorn ◽

G. S. Whatley

Keyword(s):

Postoperative Pain ◽

Pulmonary Function ◽

Postoperative Analgesia ◽

The Other ◽

Pulmonary Mechanics ◽

Postoperative Pulmonary Function ◽

Pain Scores ◽

Significant Difference ◽

Group A ◽

To Receive

Twenty-four patients who were to undergo cholecystectomy were randomised into two groups, one to receive postoperative analgesia with interpleural bupivacaine, 20 ml of a 0.5% solution with adrenaline 5 μg/ml, and the other to receive intramuscular pethidine, 1 mg/kg. Preoperative and postoperative pulmonary function, postoperative pain scores, and days from operation to hospital discharge were recorded and statistically compared. There was no significant difference in pain scores, nor in days to discharge; however, postoperative pulmonary mechanics were significantly poorer in the interpleural group. A hypothesis to explain the differences is offered.

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The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181bbc754 ◽

2009 ◽

Vol 4 (5) ◽

pp. 265-268 ◽

Cited By ~ 13

Author(s):

Emir Mujanovic ◽

Midhat Nurkic ◽

Jasmin Caluk ◽

Ibrahim Terzic ◽

Emir Kabil ◽

...

Keyword(s):

Artery Bypass ◽

Postoperative Bleeding ◽

Median Sternotomy ◽

Operation Time ◽

Graft Patency ◽

Off Pump ◽

Number Of Patients ◽

Significant Difference ◽

Group A ◽

Group B

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

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A comparative study of the effect of piroxicam versus diclofenac on wound healing in clean abdominal wounds

International Surgery Journal ◽

10.18203/2349-2902.isj20180827 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1041 ◽

Cited By ~ 2

Author(s):

Chandrashekar Reddy J. Madinur ◽

Prashant Tubachi ◽

A. S. Godhi ◽

A. S. Godhi

Keyword(s):

Wound Healing ◽

Controlled Trial ◽

Research Centre ◽

Female Ratio ◽

Factors Affecting ◽

Significant Difference ◽

Group A ◽

One Year ◽

Group B ◽

The Individual

Background: The primary function of the skin is to serve as a protective barrier against the environment. The process of wound healing constitutes an array of interrelated and concomitant events. Understanding these processes and various factors affecting these processes continue to expand. The present study was undertaken to compare and evaluate the effect of piroxicam versus diclofenac on wound healing in clean abdominal wounds.Methods: The present one year randomized controlled trial was conducted on all the patients undergoing appendicectomies for uncomplicated appendicitis and uncomplicated inguinal hernia repairs in the Department of Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during the period of one year. Based on the thumb rule a total of 60 patients divided into two groups of 30 each were studied. Based on the computer-generated randomization patients were allocated to two groups that is group A (Inj. Piroxicam) and Group B (Inj. Diclofenac).Results: In the present study, males outnumbered females with male to female ratio between of 1.72 to 2:1. The mean age in group A was30.9±7.86 years and in group B it was 30.3±7.97 years. Both the groups that is Group A and B were graded under grade I (Good wound healing) from the POD 3 onwards. Overall the individual score and total scores had no influence of the final grading (outcome) of the wound.Conclusions: Overall, better results were seen on wound healing in patients who received Inj piroxicam with significantly less post-operative redness and edema. However, this did not have significant difference in the final outcome of the grading of the wound.

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A prospective interventional study of postoperative pain, healing rates and incontinence rates following ligation of intersphincter fistula tract procedure

International Surgery Journal ◽

10.18203/2349-2902.isj20185029 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3976

Author(s):

Arunraj P. ◽

Viswanathan M. S. ◽

Anbazhagan R. ◽

Kulwant Singh

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Anal Fistula ◽

Fistula Tract ◽

Fistula In Ano ◽

Sphincter Function ◽

Incontinence Score ◽

Group A ◽

Complete Wound Healing ◽

Group B

Background: Fistula in ano is one of the oldest ailments known to us, troublesome both to the patient and also challenging to the treating surgeon. The treatment of fistula in ano has evolved so much, to reduce complications and to improve patient’s compliance. This study was conducted to compare the age old method of open fistulectomy to that of recently developed technique of ligation of intersphincter fistula tract (LIFT), in patients suffering from low fistula in ano.Methods: A totally of 80 patients, suffering from low anal fistula was divided randomly into two groups. Group A: undergoing LIFT procedure and Group B: undergoing open fistulectomy procedure .The two groups were compared in the postoperative period for wound healing, postoperative pain (by visual analog scale) and fecal incontinence (by Wexner incontinence score).Results: Group A patients who underwent LIFT at the end of 3rd postoperative week had a pain score of 0.43 when compared to group B patients (1.33) who underwent fistulectomy. Group A patients had 100% continence preservation, whereas a 17.5% of moderate incontinence was documented in Group B patients. About 97.5% of patients under Group A had complete wound healing by the 3rd postoperative week, as compared to group B patients, where100% complete wound healing was noted at 6 weeks, postoperatively.Conclusions: It was found that LIFT was a promising procedure in reducing the postoperative pain significantly, with better wound healing rates. It was effective in maintaining good sphincter function, thereby providing better faecal continence following surgery, in low anal fistula.

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