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

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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ELECTIVE MIDLINE LAPAROTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1869 ◽

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.

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Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20183734 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3124

Author(s):

Vikranth S. Nandukar ◽

Mohan Kumar K. ◽

Prakash M. ◽

Suma S.

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Randomized Study ◽

Wound Complications ◽

P Value ◽

Elective Abdominal Surgery ◽

Tissue Healing ◽

Group A ◽

Group B

Background: Scalpel incisions produce little damage to surrounding tissues. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. Use of diathermy in skin incisions reduces bleeding and makes the incision quicker, but there are no differences in wound burst strength. Objective of the study was to compare the use of diathermy and scalpel incisions in elective abdominal surgery’s to see the variations in incisional time, blood loss during incision, postoperative pain and wound complicationsMethods: This was a prospective randomized study, which included patients above 18 years who underwent elective abdominal surgery. The patients were randomly included into Group A or Group B. In Group A incision was made with a scalpel and in group B with diathermy. Data was analyzed for incisional time, blood loss during incision, postoperative pain and wound complications.Results: There was a significant increase in mean time taken for incision in Group A when compared to Group B. Mean incision blood loss was found to be significantly higher in group A compared to group B patients. Postoperative pain was significantly higher in group A (p value <0.05) on postoperative day 1. Among wound complications, no statistically significant differences were seen between the two groups.Conclusions: Electrocautery incisions were safe, less time consuming, reduced blood loss and had less postoperative pain. We conclude that diathermy could be accepted as an alternative method for surgical skin incisions.

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Outcome of thyroid lobectomies undergone with and without drains

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203438 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2919

Author(s):

Sahrish Bachani ◽

Shahid N. Memon ◽

Muhammad R. Pathan ◽

Rehmat Sehrish Shah ◽

Aneeta Kumari ◽

...

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Pain Score ◽

Thyroid Nodules ◽

University Hospital ◽

P Value ◽

Thyroid Lobectomy ◽

Significant Difference ◽

Group A ◽

Group B

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

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A comparative study of inguinal hernia repair: Shouldice versus Lichtenstein repair

International Surgery Journal ◽

10.18203/2349-2902.isj20182229 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2238

Author(s):

Ram Sagar Shah ◽

Ajay Kumar

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Wound Infection ◽

Operating Time ◽

Cost Effective ◽

Lichtenstein Repair ◽

Shouldice Repair ◽

Significant Difference ◽

Group A ◽

Group B

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma 8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair. However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.

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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

International Surgery Journal ◽

10.18203/2349-2902.isj20171519 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1521 ◽

Cited By ~ 3

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.

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Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures

10.53350/pjmhs211571657 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1657-1760

Author(s):

Muhammad Akram ◽

Ali Muqadas ◽

Arif Mahmood ◽

Faheem Mubashir Farooqi ◽

Shumaila Jabbar

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Dynamic Hip Screw ◽

Control Group ◽

P Value ◽

Intertrochanteric Fractures ◽

Significant Difference ◽

Group A ◽

Hip Screw ◽

Group B

Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss

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Antibiotic prophylaxis before skin incision versus after cord clamping in the prevention of maternal and neonatal infectious morbidity after cesarean section

QJM ◽

10.1093/qjmed/hcaa056.036 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

W H Eltantawy ◽

K M Labib ◽

A M Farag

Keyword(s):

Cesarean Section ◽

Antibiotic Prophylaxis ◽

Wound Infection ◽

Gestational Age ◽

Skin Incision ◽

Infectious Morbidity ◽

Cord Clamping ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background the purpose of antibiotic prophylaxis in surgical procedures is not to sterilize tissues but to reduce colonisation pressure of microorganisms introduced at the time of the operation to a level that can be overcome by the patient’s immune system. Aim of the study to compare the effects of antibiotic prophylaxis administered in cesarean section preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate. Patients and Methods This comparative study was carried out between August 2017 and February 2018, at Ain Shams maternity hospital and Al-Galaa teaching hospital, a prospective randomized control comparativestudy of 874 pregnant ladies undergoing cesarean section after obtaining the approval of the local ethical committee and a fully-informed written consent. Results Of 874 pregnant ladies undergoing cesarean section, mean gestational age in group A (38.71±1.09); while in group B mean gestational age (38.86±1.06). In group A, wound infection 8 cases (1.6%), endometritis 25 cases (5.7%), UTI 18 case (4.1%). In group B, wound infection 16 cases (3.7%), endometritis 35 cases (8%), UTI 28 case (6.4%). No cases suffered from early or long term neonatal complications. Conclusion there is no significant difference between timing of antibiotic either before skin incision or after cord clamping, however there are risk factors that increase the maternal, fetal infectious morbidity as high BMI, low gestational age, previous section, general anaesthesia.

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Observational study of scalpel versus electrocautery for subcutaneous incision in elective gynaecological surgeries

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170562 ◽

2017 ◽

Vol 6 (3) ◽

pp. 950 ◽

Cited By ~ 1

Author(s):

Vaibhav B. Patil ◽

Vidya D. Mule ◽

Ravi M. Raval ◽

Abhishek A. Kulkarni

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Subcutaneous Tissue ◽

Wound Complications ◽

P Value ◽

Abdominal Incision ◽

Postoperative Wound ◽

Tertiary Teaching ◽

Group A ◽

Group B

Background: Considering higher rate of postoperative wound complications in Government set up hospitals, this study was an attempt to compare incision time, incisional blood loss, hospital stay, post-operative pain and postoperative wound complications when subcutaneous tissue is opened with either scalpel or electrocautery in elective gynaecological surgeries after keeping all other clinical and surgical variables same i.e. age, BMI, haemoglobin, incision depth and hospital stay.Methods: This was a prospective observational comparative study conducted in one of the tertiary teaching hospital in Western Maharashtra, India over 12 months. All patients (n=100) were divided into 2 groups. Group A in which skin and subcutaneous tissue was dissected by using scalpel and Group B in which after skin, anterior abdominal wall was opened by using electrocautery. Data analyzed for indication, incisional blood loss, incision time, postoperative pain, wound complications and hospital stay.Results: There were no significant association between preoperative diagnosis and the development of a post-operative wound complications. Mean incision blood loss was found to be significantly higher in group A compared to group B patients. Postoperative pain was significantly higher in group A (P value <0.05). Among wound complications, no statistically significant differences were seen regarding wound complications for the two groups.Conclusions: Electrosurgical dissection for abdominal incision is safe, less time consuming and with less blood loss during subcutaneous incision and produces less postoperative pain. We conclude that the method of subcutaneous tissue incision was unrelated to the development of postoperative abdominal incision problems.

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Stapler versus handswen in small intestinal anastomosis

International Surgery Journal ◽

10.18203/2349-2902.isj20182054 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2054 ◽

Cited By ~ 1

Author(s):

Mohamed Abdelhady Mohamed ◽

Mohamed Leithy Ahmed ◽

Mahmoud Gamal Eldin Hagag ◽

Mohammed Nazeeh Shaker Nassar

Keyword(s):

Postoperative Complications ◽

Wound Infection ◽

Intestinal Anastomosis ◽

Controlled Study ◽

P Value ◽

Significant Difference ◽

Group A ◽

Stapler Anastomosis ◽

Group B ◽

Postoperative Leakage

Background: Intestinal anastomosis dates back to 1000, B.C but it accompanied with high rates of failure, sepsis, wound infection and mortality until the development of suture materials. Lembert described his seromuscular suture technique in 1826. Surgical Stapler was first introduced by Hultl in 1908. The development of modern devices over the past 30 years changes the surgical practice dramatically. The objective of present study is to compare the outcome between Stapler and handswen anastomosis in the small intestine.Methods: This study is a randome controlled study carried on 40 patients divided into two equal groups, 20 patients were treated by handswen suture method (group A) and the other 20 patients operated by stapling technique (group B).Results: In both elective and emergent cases as regard patient operative time, postoperative passing flatus, begin of oral intake, hospital stay duration and postoperative complications it was lower in Stapler (group B) comparing to handswen (group A) and P-value was statistically significant (P<0.05). In emergent cases postoperative leakage is equal in both handswen (group A) and Stapler (group B) and P-value was non-significant (P>0.05).Conclusions: In both elective and emergent cases the duration of operation, postoperative passing flatus, return of bowel sound, hospitalization days and postoperative complications including (intraoperative bleeding, prolonged ileus >4 days, patient stenosis and wound infection) in Stapler anastomosis it was lower comparing to handswen anastomosis and P-value was statistically significant (P<0.05). No significant difference in postoperative leakage between handswen anastomosis and Stapler anastomosis in emergency cases (P>0.05).

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Electrocautery versus cold steel tonsillectomy comparison study

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i1.73 ◽

2019 ◽

Vol 15 (1) ◽

pp. 26-29

Author(s):

Firas Baheej Abdul Aema

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Operative Time ◽

Late Onset ◽

Recurrent Tonsillitis ◽

Secondary Hemorrhage ◽

Significant Difference ◽

Group A ◽

Group B ◽

Cold Steel Dissection

Objective: the objective of this study was to compare the intraoperative blood loss, intraoperative time, postoperative pain and secondary hemorrhage between electrodissection and cold steel dissection tonsillectomy. Methods: One hundred and six patients were enrolled in this study, the patients were randomly allocated into electrodissection group A (n=51) and cold steel dissection tonsillectomy group B (n=53). All patients are above 7 years and had history of recurrent tonsillitis and/or tonsillar hypertrophy with obstructive symptoms. Intraoperative parameters and postoperative outcome were assessed. Results: In group A patients had statically significant less operative time and blood loss than group B early postoperative pain was not differ significantly between the two groups, however late onset pain (pain on the 7th day) was significantly higher in group A. There was no significant difference between the groups regarding secondary hemorrhage. Conclusion: Electrodissection tonsillectomy is rapid, safe and effective method of tonsillectomy with obvious advantage of minimum perioperative blood loss, lower operative time and without early post-operative pain difference when compared to cold steel dissection tonsillectomy. Although it has some disadvantage of late postoperative pain.

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