Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.
Malignant peripheral nerve sheath tumour (MPNST) is an extremely rare soft tissue sarcoma which usually arises from peripheral nerves or somatic soft tissue with an incidence of 0.001%. It’s most common anatomical sites are the proximal portions of the upper and lower extremities and the trunk and it’s extremely rare for such a tumour to occur elsewhere in the body. We report a rare case of such a tumour over the left posterior aspect of neck in a 28-year-old female patient. We have reviewed this case in terms of clinical presentation, investigations, surgical treatment and adjuvant therapy and have shortly described our experience. MRI and CT neck supported the diagnosis of this tumour. Fine needle aspiration cytology taken from the swelling revealed a low-grade spindle cell tumour with a possibility of MPNST. Excision of the tumour was done and the excised specimen was sent for histopathological examination which revealed MPNST. Adjuvant radiotherapy was given postoperatively. At a 6-month follow-up, patient is doing well with no evidence of recurrence. Suspicion of this tumour should be raised in a rapidly growing painless tumour in and around a nerve tissue. Diagnosis is made by assessing a combination of clinical, pathological and immunohistochemistry features. Complete surgical removal should be the goal of treatment with definitive histological diagnosis. A regular follow up is recommended to confirm any recurrence or metastasis.
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