Background: Closure of wound depends on the location, length of the wound and the age of the patient. Ideally, wound closure device should be easy to enable rapid closure, painless and provide excellent cosmetic appearance and it should be cost effective. Optimal closure technique is necessary for cosmesis and avoiding infection, scarring and adequate wound healing. Proper evasion of wound edges, minimal suture marks, adequate tensile strength and optimal approximation of skin edges should be learnt. Materials and Methods: The present study is a randomized study conducted at Sir Sayajirao General Hospital and Medical College, Vadodara from June 2017 to October 2018 on 100 patients with a follow up period of 1 month. Patients were evaluated postoperatively with respect to closure time, pain, cosmesis and complications like seroma, infection, wound dehiscence, etc.Results: Adhesive tape is better in terms of short closure time, post-operative pain and price as compare to suture material for closure of surgical site incisions but more number of randomized control trials and multicenter trials need to be undertaken with long term follow up for scar assessment.

Background: Post-operative pain and bleeding are two major dilemmas associated with haemorrhoidectomy. Recent advances in energy sources have provided an alternative in reducing both the issues. This study was conducted with an aim to compare use of ultrasonic scalpel (Harmonic Scalpel) and bipolar diathermy in reducing post-operative pain and bleeding in Milligan-Morgan haemorrhoidectomy (MMH).Methods: Sixty patients with grade III and IV haemorrhoids underwent MMH, after being randomized into two groups, one half of them using Harmonic Scalpel and other group, using Bipolar diathermy scissors over a period of one year at Department of General Surgery at Sir Sayajirao Gaekwad (SSG) Hospital, Baroda. Operative data were recorded, and the patients were followed-up accordingly. Independent assessors were assigned to obtain blood loss, post-operative pain scores, analgesic requirements and other secondary outcomes.Results: Intra-operative bleeding, post-operative pain scores and duration of hospital stay were significantly lower with Harmonic scalpel as compared to bipolar diathermy scissors. However, there was no significant difference in both the groups with respect to first bowel movement and early or late complications.Conclusions: Harmonic scalpel can be used as an alternative to bipolar diathermy, in view of its good haemostatic capability, reduced post-operative pain and analgesic requirements.

Background: Many laparotomy may require relaparotomy due to post-operative complication as life-saving procedure. Incidence of relaparotomy and post-operative outcome defers from patient to patient. The objectives of our study were to evaluate the indication of relaparotomy, outcome of the relaparotomy and factors affecting mortality.Methods: Data was collected between March 2017 and November 2019 in SSG hospital, Vadodara. Patient’s demographics, indication and intra-operative findings of initial surgery and relaparotomy with morbidity and mortality were studied. Patients from department general surgery and obstetrics and gynecology were included. Consent was taken in a pre-validated form.Results: Out of total 5684 laparotomy performed, 146 (2.58%) patients underwent relaparotomy. Male to female ratio was 1.5:1. Incidence was highest in 31-40 years age group (median age: 37 years). Dirty wound in initial laparotomy had highest conversion rate (3.21%) to relaparotomy. Mean interval between initial laparotomy and relaparotomy was 8.57±5.62 days. The major indication of relaparotomy was burst abdomen (39.52%) followed by leak from previously sutured site (24.65%). 50.68% patients were shifted to ICU following relaparotomy. Average days of ICU admission were 4.16±2.25 days. Mortality rate was 23.29%. Maximum mortality was noted in case of leak from anastomotic or perforation site. 14 (38.88%) deaths occurred during postoperative day second to fourth with mean hospital stay of 21.85±8.65 days.Conclusions: Although relaparotomy is life-saving procedure, it has high mortality rate. The possibility of efficiently lowering relaparotomy depends on success of the first laparotomy, patient’s status, early re-exploration with proper surgical techniques and thorough postoperative care.

Background: Diabetic foot ulcer is estimated to affect 15% of all diabetic individuals during their lifetime. Management requires a multisystem approach. Various techniques have been tried to treat chronic ulcers, but none was proved to be ideal.Methods: This is a prospective randomised comparative study, where 56 patients with diabetic foot ulcers admitted in dept of surgery SSG hospital, Baroda, india were divided into two comparable groups. Of which 28 underwent topical phenytoin dressings, remaining 28 underwent Betadine dressing (5% w/v povidone – iodine solution). The variables were compared after 14 days based on rate of granulation tissue formation as percentage of ulcer surface area, wound culture-sensitivity and duration of hospital stay. Chi square test was used to compare the data at each of the assessment point in both groups. Results: In Phenytoin group, the mean rate of healthy granulation tissue formation was 60.71%, and mean hospital stay was 23.96 days with negative culture sensitivity was 54%. The Betadine group showed, the mean rate of granulation tissue formation was 11%, and mean hospital stay was 35 days with negative culture sensitivity was 18%.Conclusions: Topical phenytoin dressing considered as superior and cost effective in management of diabetic ulcers.