Abdominal Wound Problem after Hysterectomy using Scalpel Versus Electrocautery for Skin and Subcutaneous Dissection

Objective: To evaluate the postoperative abdominal wound problem after hysterectomy with scalpel versus electrocautery for skin and subcutaneous dissection. Material and Methods: A total of 516 post-menopausal women having age 40 to 65 years who were planned for elective hysterectomy were included in this study. Patients having only benign disorders were included. In group E (N=258); Skin incision and tissue dissection was done using electrocautery by setting the electrocautery machine at cutting mode at 30 to 50 watts’ power. In group S (N=258); conventional scalpel was used for skin incision. Scalpel number 23 was used for skin and subcutaneous tissue dissection. Post-operative wound complications such as seroma, hematoma, wound dehiscence and wound infections were primary study endpoints. Results: Mean age was 48.6±6.9 years in electrocautery and 49.2±6.3 years in scalpel group (p-value 0.30). Seroma formation was diagnosed in 98 (37.98%) patients in electrocautery group and in 52 (20.1%) patients in scalpel group (p-value <0.0001). Wound infections were diagnosed in 50 (19.3%) patients in electrocautery group versus in 87 (33.7%) patients in scalpel group (p-value 0.0002). Hematoma was diagnosed in 10 (3.87%) patients in electrocautery group and in 19 (7.4%) in scalpel group (p-value 0.08). Conclusion: The use of electrocautery is associated with lower rate of post-operative wound infections and hematoma formation. The present study advocates the use of electrocautery for skin and subcutaneous tissue dissection in patients undergoing abdominal hysterectomy. Keywords: Abdominal hysterectomy, electrocautery, scalpel, wound complications.

Optimizing pediatric histrelin implantation to improve success rates in clinic without sedation

Objectives The purpose of this study was to review our success rate performing the histrelin implant procedure in clinic without sedation. Methods A retrospective study was performed for histrelin implant procedures done at our institution from 2008 to 2020. Wilcoxon rank-sum test or Fisher’s exact test was utilized to identify significant differences (p<0.05). Results A total of 73 patients underwent 184 histrelin implant procedures from 2008 to 2020. In the past few years, there has been a decrease in procedures for precocious puberty and an increase for gender dysphoria. The majority of procedures were performed in clinic without sedation (82%). The only risk factor associated with requiring sedation was younger age (median 9 vs. 10 years; p<0.003). Complications (i.e. implant fracture or need for counter-incision) were noted in 10 of the procedures (5%). The only risk factor identified for a procedural complication during implant removal/replacement was interval time from insertion (21 vs. 13 months; p<0.01). The only documented wound problem reported was dermatitis in 1 patient (no suture granuloma, dehiscence, or implant extravasation). Conclusions Procedural refinements and distraction therapy have enabled us to perform the majority of procedures in clinic without sedation. In our experience, procedural difficulty and complications appear to increase with prolonged implant duration. Histrelin implantation is increasingly being performed for gender dysphoria.

PS01.155: ANALYSIS ON THE INCIDENCE AND RISK FACTOR OF READMISSION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR ESOPHAGEAL CANCER

Background Esophageal complications consensus group (ECCG) recommended that readmissions to primary or secondary hospital within 30 days of discharge after esophagectomy can be an important quality outcome indicator for esophagectomy. This retrospective study was performed to investigate the frequencies and risk factors for readmission after esophagectomy. Methods We retrospectively reviewed 291 patients who received the esophagectomy and mediastinal lymphadenectomy for curative aim from January 2006 to June 2017. Results The mean age was 63.02 ± 8.02 years and male patients were 264 (90.7%). Thirty-nine (13.4%) patients readmit within 30 days after discharge. The mean readmission day after discharge was 14.76 ± 8.84. The common causes of readmission were anastomotic stricture requiring the ballooning (12, 30.7%), wound problem (7, 17.9%), pneumonia (6, 15.4%), and poor oral intake (4, 10.2%). Other causes of readmission were delayed gastric emptying (3), jejunostomy tube problem (2), ileus (2), pain (1), pneumothorax (1) and pleural effusion (1). On multivariate analysis, anastomotic leakage (odd ratio = 2.872, P = 0.022) were related to readmission, whereas age, pathologic stage, vocal cord palsy and neoadjuvant therapy were not related to readmission. In 30 patients with postoperative anastomotic leakage, the frequency of readmission due to wound problem (13.3% vs. 1.1%, P = 0.003) and anastomotic stricture (13.3% vs. 3.4%, P = 0.034) were significantly higher. Conclusion The incidence of readmission within 30 days after discharge was 13.4% and postoperative anastomotic leakage was related to the readmission, and it might be related to the wound problem and anastomotic stricture. Disclosure All authors have declared no conflicts of interest.

A comparative study of scalpel versus no scalpel vasectomy

Background: The objective of this study was to compare the standard vasectomy method and no scalpel vasectomy and complications, effectiveness, safety and acceptability of standard vasectomy (SV) versus no-scalpel standard vasectomy (NSV).Methods: Informed man who does not want to become father of any children and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization, explain to patient and his wife regarding both procedure, semen analysis done after 3 months in every patient. Results: In NSV 72% patients required 10 to 20 minutes and in SV 100% required 20 to 35 minutes operative time. NSV, out of which 28% and in SV performed 60% having perioperative pain. NSV only 8% and 40% in SV having pain during follow up. In NSV average analgesic requirement was 2-3 days while among SV average analgesic requirement was 6-8 days. NSV, average antibiotic requirement was 5 days while among SV average antibiotic requirement was 7-10 days. In NSV 8% and in SV 32% were having infection during follow up. In NSV8% having wound problem during follow-up. In SV 32% having wound problem during follow-up. NSV 0% and in SV4% having vasectomy failure.Conclusions: Compared to the standard vasectomy technique, the no-scalpel vasectomy approach to the vas resulted in less bleeding, less pain during or after the procedure, and infection, as well as a shorter operative time, no longer day’s analgesic and antibiotic requirement and a more rapid resumption of sexual activity.

Bilateral Olecranon Tophaceous Gout Bursitis

In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.