Objective Postthyroidectomy hypoparathyroidism remains a significant challenge. Truncal ligation of the inferior thyroid arteries (ITAs) may lead to an increased risk of hypoparathyroidism; however, dissection along the thyroid capsule with branch ligation of the thyroid arteries could be a safer option. This study’s objective was to compare the effect of truncal versus branch ligation of the ITAs on the rate of postoperative hypoparathyroidism. Study Design Randomized prospective trial in line with the CONSORT guidelines. Setting The study was conducted at a high-volume tertiary care setting. Methods We randomized 319 patients into 2 groups: truncal ITA ligation (n = 157) and branch ITA ligation (n = 162). The primary outcomes were serum calcium and parathormone levels on the second postoperative day, followed by the levels on months 1, 3, 6, and 12. The need for exogenous replacements was noted. The secondary outcomes, such as operative time, blood loss, and other complications, were also recorded. Results Our study revealed a significant difference in the incidence of transient hypocalcemia in patients undergoing truncal ITA ligation and branch ITA ligation (22.9% vs 3.1%, P < .05). The results showed that the levels of serum calcium and parathormone dropped on the second postoperative day and that 36 patients from the truncal ITA ligation group required exogenous calcium and vitamin D replacement. In contrast, only 5 patients from the branch ITA ligation group required the same. Conclusions This is the largest randomized trial of patients undergoing thyroidectomy, and it shows that dissection along the thyroid capsule with branch ligation of the ITAs is more likely to preserve parathyroid function as opposed to truncal ligation of ITAs.
Objectives: To compare conventional hemorrhoidectomy with harmonic scalped hemorhoidectomy for Ferguson hemorrhoidectomy is traditional closed procedure for 3rd and 4th degree hemorrhoids that is being practiced since centuries. With new innovations and technology, harmonic scalpel is an ultrasonic device which has shown to have promising results. With these two techniques a comparison study variables of pain outcome as a patient perceives, time taken for operation and length of stay in hospital. Study Design: Randomized controlled trial. Setting: Services hospital Lahore. Period: From August 2015 to February, 2016. Material & Methods: Patients were divided into two equal groups: Group A: conventional hemorrhoidectomy and Group B: Harmonic Scalpel. The study was performed by a single surgical operating team. Patient’s selection criteria were male and female between 20 to 80 ages with III and IV degree hemorrhoids. The outcomes were operative time, post-operative pain and duration of stay in the hospital. Results: One hundred patients with mean age 40.86+10.26 were included and randomly assigned. This came out significant difference in operative time 28.4+11.004, postoperative pain 3.73+1.96, and length of hospital stay 2.43+1.795. There were equal distribution in age and gender in both groups. Conclusions: It is concluded that harmonic scalpel technique in hemorrhoidectomy is better than conventional closed hemorrhoidectomy in 3rd and 4th degree hemorrhoids.
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