To compare the use of ultrasonic dissector and suture ligation for mesoappendix in laparoscopic appendectomy in terms of mean operative time and per-operative bleed. MethodologyThis was a randomized controlled trial conducted at Surgical Unit II, Holy Family Hospital over a period of six months. All patients with the diagnosis of acute appendicitis who presented in the emergency department of Holy Family Hospital on the call days of Surgical Unit II undergoing laparoscopic appendectomy were included in the study. After taking informed consent about the respective procedure, patients were allocated to two groups using computer-generated random numbers. Group A was operated using harmonic scalpel and in Group B suture ligation was done. Total time required to ligate the mesoappendix or to cauterize it using the harmonic scalpel was measured in minutes. Data was entered and analyzed in SPSS version 21.0 (IBM Corp., Armonk, NY). ResultsA total of 110 patients were enrolled in the study according to the inclusion criteria of the study. Patients were randomly divided into two equal groups. Patients in Group A were operated using harmonic scalpel whereas patients in Group B were operated by suture ligation for dealing the mesoappendix in laparoscopic appendectomy. Mean operative time to ligate the mesoappendix for Group A patients was 1.56 (SD = 0.68) minutes while that of Group B was 21.07 (SD = 2.84) minutes. There was no per-operative bleeding in case of Group A while its incidence was 24% of patients in Group B. Results were statistically significant. ConclusionThe conclusion of the study is that the use of harmonic scalpel was better than suture ligation for ligating the mesoappendix in laparoscopic appendectomy in terms of mean operative time and per operative bleed, hence it's preferable over the later in laparoscopic appendectomy.
Background Changes in hematological parameters, such as neutrophils, leukocytes, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume, have been observed during laparoscopic surgeries. Objectives The objectives of this research were to assess the changes in hematological parameters and liver enzymes during laparoscopic cholecystectomy (LC). Methods This prospective observational study included patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Patients with comorbidities, including hepatitis, diabetes, and where laparoscopic cholecystectomy was converted to open cholecystectomy, were excluded. Preoperative and postoperative baseline hematological parameters and liver function tests (LFTs) were recorded. Characteristics like age, gender, body mass index (BMI), indication for surgery, duration of surgery, the pressure of pneumoperitoneum, and the duration of hospital stay were noted. A paired sample t-test was applied to assess the difference between the mean pre and postoperative values of different hematological parameters. Results It was observed that hemoglobin (Hb), hematocrit (Hct), platelets, and alkaline phosphatase (ALP) decreased postoperatively. However, mean corpuscular volume (MCV), mean platelet volume (MPV), leukocytes, and alanine transaminase (ALT) increased postoperatively. The difference in mean Hb, MCV, Hct, leukocytes, MPV, and ALT was statistically significant (p<0.05). Conclusion There were significant changes in the levels of hematological parameters and liver enzymes during LC.
Objective: To compare the outcomes of excision of pseudo aneurysm along with ligation and local debridement with the outcomes of excision of pseudo aneurysm along with ligation and revascularization in the management of infected femoral pseudo aneurysm among drug addicts. Study Design: Retrospective Analytic study. Setting: Surgical Unit-1, Benazir Bhutto Hospital, Rawalpindi. Period: July 2010 to July 2019. Material & Method: Among patients presented with pseudo aneurysm in Surgical Emergency and out patients department. Data was collected through medical record of the hospital. P-value less than 0.05 was set statistically significant. Results: Mean age and duration of addiction for study population were 36.50 years with SD of ±6 years and 2.80 years with SD of ±0.90 years respectively. All enrolled participants were males (100%). Heroine (76%) was the most common used by addicts while other drugs included benzodiazepine (12%), amphetamine (8%), and cocaine (4%). Left sided femoral artery (70%) was more involved in pseudo aneurysm as compare to right sided femoral artery (30%). Post operative adverse events percentage for ligation without revascularization was 22.72%, whereas, it was 100% for ligation with revascularization. Mortality was 0% for excision with ligation and local debridement while it was 50% for excision with ligation and revascularization. Conclusion: For the optimal management of infected femoral pseudo aneurysm, excision with ligation and local debridement is effective in comparison to excision with ligation and revascularization among addicts.
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