Diathermy Group Research Articles

Post-Tonsillectomy Pain:Is Cold Steel Dissection Method or Bipolar Diathermy Dissection Method is less Painful?

Background: Pain is one of the sequel of tonsillectomy, as reported in various studies. Tonsillectomy can be done by various methods, so aim of the present study is to evaluate pain of tonsillectomy comparing cold steel dissection method with bipolar diathermy method.Objective: To evaluate post-tonsillectomy pain comparing cold steel dissection method with bipolar diathermy method.Material and Methods: This prospective, randomized, controlled trial was conducted in ENT Department, from 18th January 2021 to January 30th 2022. Post tonsillectomy pain was measured by using visual analogue scale which consists of a 10 cm line with score of 10 means worse pain and score of zero means no pain. In this study a total sample size was 186 patients (i.e. 93 in each group), who were observed by taking the following parameters. Mean ± SD of group A (bipolar diathermy group) = 2.27 ± 1.25. Mean ± SD of group B (cold steel dissection group) = 1.59 ± 1.59. Confidence interval (2-sided) =95%. Power=90%. More over consecutive (nonprobability) sampling technique was used for sample collection.Results: In bipolar dissection group (38%) patients were male and (62%) patients were female. Where as in cold dissection group (40%) patients were male and (60%) patients were female. The mean pain score at 24 hours, 2ndpost operative day, 7th post operative day among two groups was analyzed. In bipolar dissection group, mean pain score at 24 hours was 3.5 ± 0.66, mean pain score at 2nd post operative day was 2.93 ± 0.73 and mean pain score at 7th post operative was 1.59 ± 1.02. Where as in cold dissection group, mean pain score at 24 hours was 3.33 ± 0.53 with a p value of 0.0543, mean pain score at 2ndpost operative day was 2.34 ± 0.60 with a p value of 0.0001and mean pain score at 7th post operative was 1.46 ± 0.82 with a p value of 0.3394.Conclusion: Our study concludes that mean pain score is less in cold steel dissection tonsillectomy as compared to bipolar diathermy tonsillectomy.Keywords: Analogue pain scale, Surgical Diathermy, Tonsillectomy.

Safety and Efficacy of Hook Diathermy in the Dissection of the Mesocolorectum During Laparoscopic-Assisted Pull-Through for Hirschsprung Disease in Low-Resource Settings.

Background: Surgical correction is the main line of treatment for the congenital disorder Hirschsprung's disease (HD). Laparoscopic techniques proved their safety and efficacy in previous studies. LigaSure™ is the gold standard for colorectal dissection. However, other sealing methods could be used during the unavailability of LigaSure. Purpose: This study aimed to assess the safety profile of the hook diathermy technique compared to LigaSure in colorectal dissection during laparoscopic-assisted pull-through for HD. Materials and Methods: This case-control study was held in the pediatric surgery department at Assiut University Hospitals between September 2017 and January 2023. The study included 57 HD patients who were surgically operated on during a laparoscopic-assisted pull-through. They were divided into 2 groups according to the sealing methods: the ligasure group included 25 patients, and the hook diathermy group included 32 patients. Results: Both groups had no statistically significant differences regarding age, sex, or weight. The transition zone was present in all patients, and most transition zones were rectosigmoid. No cases reported intraoperative blood transfusion or conversion to an open or transanal approach. Minimum intraoperative blood loss was reported in both groups, with no significant differences. As regards postoperative complications, including bleeding, leakage, perianal excoriation, and enterocolitis, no significant differences between both groups were found. Conclusion: The LigaSure and hook diathermy techniques are safe and effective sealing methods for colorectal dissection during laparoscopic-assisted pull-through for HD.

Comparison of Postoperative Secondary Haemorrhage Rates and Pain Threshold between Conventional Cold Dissection, Bipolar, Monopolar Electrocautery and Laser Tonsillectomy, Meta Analysis Study

Abstract Background Tonsil surgery is one of the most common surgical procedures performed in otorhinolaryngology. The earliest known removal of tonsils was performed by Celsius in the first century A.D. Aim of the Work To compare the postoperative secondary haemorrhage rates and pain threshold between conventional cold dissection, bipolar, monopolar electrocautery and laser tonsillectomy. Patients and Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. An initial search will be carried out using the PubMed, Cochrane library Ovid, Scopus & Google scholar using the following keywords: Dissection, Diathermy, Laser electrocautery, Tonsillectomy. Results Highly significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to diathermy group (p < 0.01). Significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to laser electrocautery group (p = 0.024). Nonsignificant difference in mean 7-day post-operative pain score, in diathermy group compared to laser electrocautery group (p > 0.05). Non-significant difference in revision or re-operation rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to laser electrocautery group (p > 0.05). Conclusion Based on the findings of the present study, all the methods used in the study are safe but there was significant decrease in mean 7-day post-operative pain score using conventional dissection method compared to diathermy and laser electrocautery methods with no difference found in secondary haemorrhage rates between different methods used.

Assessment of the protective role of submucosal saline injection of the inferior turbinates prior to submucosal diathermy or coblation techniques

BackgroundInferior turbinate hypertrophy is a common cause of chronic nasal obstruction with many procedures for management including submucosal diathermy and coblation with a variation in their techniques. The aim of this study was to assess the protective role of submucosal saline injection in the inferior turbinates prior to submucosal diathermy or coblation techniques. A prospective cohort study was conducted on 80 patients diagnosed with bilateral hypertrophied inferior turbinates causing persistent nasal obstruction and not responding to medical treatment. The patients were distributed randomly and equally between 2 groups. Group I included 40 patients operated on with coblation of the inferior turbinates. Group II included 40 patients operated on with submucosal diathermy of the inferior turbinates. The right side of the nose of both groups had a saline injection of the inferior turbinates before the procedure and the left side of the nose did not have such injection. Each side of the nose in every patient was assessed for the degree of nasal crusting at 1 week postoperative, the presence of turbinate gangrene at 3 weeks postoperative, and the visual analog scale (VAS) of four symptoms (nasal discomfort, nasal pain, nasal obstruction, and thick nasal discharge) at 1 week postoperative.ResultsIn the coblation group, there was a significant difference between the right and left sides regarding the degree of crusting at 1 week postoperative, and a non-significant difference between the two sides regarding the presence of gangrene at 3 weeks postoperative. In the diathermy group, there was a significant difference between the right and left sides regarding the same parameters. Comparison between the injection and non-injection sides in each group regarding the nasal symptoms showed a highly significant difference between the two sides in each group favoring the injection side.ConclusionSaline injection prior to inferior turbinate coblation or submucosal diathermy had a protective effect against crusting with both techniques and gangrene formation with submucosal diathermy. This was reflected on better postoperative nasal symptoms.

Mean Postoperative Pain in patients with Elective Midline Laparotomies Using Either Scalpel or Diathermy for Incision

Background: During a laparotomy, the midline incision is frequently made with an electrocautery or scalpel. According to studies, there is no difference between these procedures' rates of complications. Aim : To assess the average postoperative pain in patients who underwent elective midline laparotomies at the Hayatabad Medical Complex Peshawar using either a scalpel or diathermy for incision. Methodology: This was a randomized controlled trial, which included 60 laparotomies patients who were divided into two groups at random. One group of patients had diathermy, whilst the other group underwent scalpel incisions. On the second postoperative day, a follow-up was conducted. Results: In diathermy group we had 63.3% males and 36.7% females while in the scalpel group we had 17 males and 13 females. 40% patients in diathermy group were hypertensive, this ratio was 36.7% in the scalpel group, diabetic patients were 26.7% in diathermy group and 16.7% in scalpel group. Practical implication: Cutting by diathermy is simpler, quicker, and results in less blood loss. Furthermore using diathermy to make an incision is no more likely to result in complications than using a scalpel Conclusion: For an elective laparotomy, skin incision with diathermy provides superior postoperative pain management than a scalpel. Keywords: Diathermy, incision, Laparotomy, woundpain, scalpel

Comparison of Diathermy versus Surgical Scalpel for Skin Incisions in Elective General Surgical Procedures

Objective: To compare diathermy versus surgical scalpel in skin incisions in elective general surgical procedures regarding incision time, post-operative pain and surgical site infection.
 Study Design: Quasi-experimental study.
 Place and Study Duration: Department of Surgery, Combined Military Hospital, Peshawar Pakistan, from Feb to Jul 2020.
 Methodology: A total of 106 patients undergoing general elective procedures aged 20-60 years belonging to either gender were included in the study. They were divided into two equal groups of 53 patients each. Patients with ischemic heart disease, diabetes mellitus, hypertension, and dirty and contaminated procedures were excluded. Group-A patients underwent skin incisions with diathermy, while Group-B patients underwent skin incisions with a surgical blade on a scalpel. The incision time was noted for both groups. All patients were followed for post-operative pain per visual analogue score and development of surgical site infection. 
 Results: Mean incision time in Group-A (Diathermy-Group) was 46.58±8.03 seconds, while in Group-B (Scalpel-Group), it was 54.75±7.91 seconds (p<0.001). The mean post-operative pain score in Group-A (Diathermy Group) was 2.25±0.76, while in Group-B (Scalpel Group), it was 3.58±0.91 (p<0.001). Wound infection was found in 3.77% of patients in Group-A, while in Group- B, it was found in 15.09% (p=0.046).
 Conclusion: Incision with Diathermy is better than scalpel skin incisions regarding incision time, post-operative pain and postoperative surgical site infection.

O079 Randomised controlled trial of LigaSure use versus monopolar diathermy in mastectomy

Abstract Introduction LigaSure is an electrothermal bipolar vessel-sealing system shown to decrease blood loss and drainage volume compared to electrocautery in axillary node dissection. This prospective randomised controlled trial aimed to assess whether using LigaSure improved perioperative outcomes when compared with monopolar diathermy alone in performing mastectomy without axillary dissection. Methods Mastectomy was performed with the LigaSure device and compared with mastectomy using conventional monopolar diathermy in a prospective randomised trial. Patients were recruited over 39 months and were aged from 33 to 86 years of age. Block randomisation (44 in the Ligasure group and 42 in the diathermy group) was performed. The primary outcome measures include total volume in drain output (ml), time to drain volume less than 30mls in 24 hours and operating time. Results Drain output volume was measured to the day the drain yielded less than 30mls in a 24 hour period in both groups (484 mls in the monopolar group v 494 mls in Ligasure group). This time point was also used to calculate time to drain removal in both groups (Monopolar 7.2 days and Ligasure 7.3 days). Drain output volume and number or days to drain removal did not show any significant difference in both groups (p=0.05). The operative time in both groups was similar (106mins in monopolar group and 112.5 mins in LigaSure group). Conclusion Use of the LigaSure device is feasible in performing mastectomy. It is not associated with reduced drain volume or shorter operative time compared with monopolar diathermy.

Scalpel versus Electrocautery for Surgical Skin Incision in Open Carpal Tunnel Release.

Background: Electrocautery is an option for skin incision for the neck, abdominal or inguinal surgery, but is not generally used for hand surgery. The aim of this study was to clarify whether electrocautery skin incision would be beneficial in open carpal tunnel release (OCTR). Methods: A total of 16 patients with carpal tunnel syndrome underwent skin incision for OCTR using either a scalpel (n = 9) or a microdissection diathermy needle (n = 7). Postoperative pain was assessed using a visual analogue scale (VAS 0-100 mm) daily from postoperative days 1 till 7. Results: The diathermy group reported higher VAS scores (mean 80 mm) on the first postoperative day versus the scalpel group mean of 35 mm (p < 0.001). We continued measuring pain for 7 days after the surgery and found higher VAS scores for the diathermy group in the first 6 days. Conclusions: The use of electrocautery is associated with greater pain score in the first postoperative 6 days following OCTR. Level of Evidence: Level III (Therapeutic).

Comparison of Ligasure versus Bipolar Diathermy Tonsillectomy

Aim: To compare the operational time, blood loss and consequences of tonsillectomy with Ligasure versus bipolar diathermy. Methods: A total of 106 individuals were randomized to have their Tonsillectomy done with either Ligasure or bipolar diathermy in this prospective trial. The length of procedure, amount of blood lost during it, degree of post-operative pain and the outcomes all were documented and studied. Results: In total, 106 cases were studied, with 53 cases in to the Ligasure Group and 53 cases to Bipolar Tonsillectomy Group. During surgery, bipolar diathermy group lost more amount of blood. The Ligasure group had an average operative time of 4 minutes less. Both groups had similar degrees of postoperative pain. Despite the fact that the Ligasure group had less postoperative hemorrhages than the diathermy group, there was no statistically significant difference. Conclusions: Study concluded that tonsillectomies using ligasure took longer than those with bipolar diathermy. Both groups had similar perioperative hemostasis. The rate of postoperative bleeding was higher than anticipated. Keywords: Ligasure, bipolar diathermy hemorrhage, hemostasis, blood loss during surgery

Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.

To Compare the Blood Loss in Bipolar Diathermy Versus Suture Ligation for Hemostasis in Patients Presented with Chronic Tonsillitis

Objective: To compare the blood loss in bipolar diathermy versus suture ligation for hemostasis in patients presented with chronic tonsillitis Material and methods: We conducted this randomized controlled at ENT Department Sheikh Zayed Hospital Rahim Yar Khan from April, 2022 to September, 2022. Total 70 patients presenting with chronic tonsillitis divided in two groups equally. Patients were treated with two procedures bipolar diathermy and ligation. Mean blood loss and operative time was compared between both groups. T-Test was used for comparison keeping P &lt; 0.05 as statistically significant. Results: Mean age of the patient was 22.86±9.31 years in group A and 22.89±7.29 years in group B. The mean blood loss in group A and group B was 27.71±7.10 ml vs 43.40±16.63 ml. Procedure time in group A and group B was 7.69±1.85 mins vs 9.91±2.09 mins. Conclusion: We conclude that bipolar diathermy group had statistically lower amount of blood loss and post-operative time when compared with ligation group. Keywords: bipolar diathermy, ligation, chronic tonsillitis, hemostasis

Comparison of the outcome of diathermy versus scalpel skin incision in surgical cases

Aim and Objectives: The present study compared the outcome of diathermy versus scalpel skin incision in surgical cases. Materials and Method: The present Prospective interventional study was done at Santosh Medical College &amp; Hospital for a period of 1.5 years. Group A included 100 patients treated with Scalpel and Group B included 100 patients treated with Diathermy. Results: The mean Incision time (s), Incision time (s/cm2) and Pain VRS score at day 1 and 2 was significantly more among Scalpel group compared to Diathermy group. The mean Blood loss in incision (ml) was significantly more among Diathermy group compared to Scalpel group. Conclusion: Due to shorter incision times, less blood loss, and less early postoperative discomfort, diathermy incisions have substantial benefits over scalpels in both elective and emergency general surgery.

Randomized Clinical Trial Comparing Mean Postoperative Pain Score in Hemorrhoidectomy using a Bipolar Vessel Sealing System Ligasure with Conventional open Diathermy Hemorrhoidectomy

Background: Hemorrhoids are one of the most frequent anorectal disorders and are responsible for considerable patient suffering and disability. Excisional hemorrhoidectomy is considered the gold standard1 for grade 3 and 4 haemorrhoids. Milligan Morgan haemorrhoidectomy by LigaSure is being investigated by a number of studies in the literature for its comparison with conventional diathermy method in terms of post-operative pain scores. Many studies favor the use of LigaSure in haemorrhoidectomy while other studies have found conventional methods to be either comparable or even superior to Ligasure. The purpose of this study was to know which method is superior, so that the better method would be preferred over the other one to minimize the post-operative pain, the major cause of post-operative morbidity and also to reduce the post-operative analgesia requirement, an important factor influencing the cost-effectiveness of the proposed method. Objective: To compare mean postoperative pain score in patients undergoing hemorrhoidectomy using Ligasure bipolar vessel sealing system with conventional open diathermy hemorrhoidectomy Methods: Patients aged between 20 to 60 years with symptomatic, third or fourth degree haemorrhoids were included in the study. Randomization to Group A (LigaSure group) or Group B (Diathermy group) was done using sealed envelopes with allocations to either procedure determined just prior to surgery. Perioperative medical treatment was standardized. Operative time was recorded. Patients were inquired about the pain score by using Visual analogue score at 24 hours post-operatively. Numbers of doses of analgesia required in 24 hours were also recorded. Results: Mean age of the patients was 42.05 ± 10.82 years. Study population consisted of 60 % males and 40% females. Mean operative time was significantly lower in Group A (17.10 ± 2.15 min) than Group B (24.63 ± 3.17 min) (P-value ˂ 0.001). Mean VAS score at 24 hours post-operatively was also significantly lower in Group A (2.07± 2.13) versus Group B (4.67± 1.62) (P-value ˂ 0.001). Mean number of doses of analgesia requirement in 24 hours post-operatively was also found to be significantly lower in Group A (0.97± 0.41) compared to Group B (2.17± 0.53) (P-value ˂ 0.001). Conclusion: LigaSure haemorrhoidectomy is significantly better than conventional method of open diathermy haemorrhoidectomy in terms of post-operative pain scores and post-operative analgesia requirement and it can be preferred over the conventional method due to its effect on reducing the morbidity and reducing the cost of analgesia requirement. Keywords: Hemorrhoids, LigaSure, Hemorrhoidectomy, Milligan-Morgan

Comparative Study of Use of Diathermy Vs Scalpel for Incision Making in Midline Laparotomy With Respect to Blood Loss

Background: Scalpels are used by surgeons for making incisions. Modern cautery units are used nowadays for making incisions. Aim: To evaluate and compare use of diathermy and scalpel for incision making in midline laparotomy with respect to incision time and blood loss. Method: This prospective randomized study was conducted at Surgical Unit1 Fatima Memorial Hospital from January 2017 to December 2018. Patients were categorized into diathermy and scalpel groups and evaluated for incision time and blood loss. Results: A total of 50 patients were included in the study with 25 (50%) patients in both diathermy and scalpel groups. For incision time, there was no difference found to be statistically significant in the diathermy and scalpel groups but pertaining to blood loss, less blood loss was calculated in diathermy group than in scalpel group. Conclusion: Diathermy is a primary choice for making incision to minimize blood loss in patients than scalpel. However, considering these options for incision time, none is superior to other. Keywords: diathermy, scalpel, laparotomy, skin incision, blood loss

편도선 절제술 환자에서 사용하는 수술기구들의 효용성 비교

Background and Objectives: To compare the efficacy of three surgical methods in tonsillectomy patients; combination of monopolar and bipolar diathermy (diathermy), coblation dissection using Evac (coblation), Harmonic scalpel assisted dissection (harmonic). Materials and Methods: Ninety-seven patients underwent tonsillectomy in a single institute between January 2020 and May 2021. Postoperative pain was evaluated using visual analogue scale (VAS) on postoperative 1 day, 1 week, 2 weeks, and 4 weeks. Degree of epithelization (DOE) was measured to assess recovery state on follow up period. Lastly, we compared operative time among the three groups to evaluate surgical efficacy. Results: Significant differences have been observed among three groups in operative time, postoperative pain score and DOE evaluated on week 1, 2, and 4. Both Harmonic and coblation group had significantly lower VAS and higher DOE, when compared with diathermy group. As for operative time, coblation group showed shorter operative time compared to other two groups. Conclusion: Both coblation and harmonic group showed better postoperative results when compared to diathermy method. Coblation and harmonic assisted tonsillectomy may be a safe, and effective method for tonsillectomy.

Comparison Between Diathermy &amp; Stainless Steel Scalpel in Vestibular Incision for Anterior Mandibular Fracture

Objective: To compare efficacy of the diathermy versus stainless steel scalpel vestibular incision for anterior mandibular fracture. Methodology: Eighty patients having age between 18 to 50 years, irrespective of gender and with mandibular symphysis and parasymphyseal fractures were included and divided into two groups. Group A (diathermy group) and group B (stainless steel scalpel group) included 40 patients each. After selection of patient into either group, the standard protocol of preparation and draping was done and all surgeries were performed under the supervision of supervisor under general anesthesia. The duration of each operation, pain, edema and healing of tissues was noted on the proforma. Results: Male patients were 39 (97.5%) and 37 (92.5%) and female patients were 1 (2.5%) and 3 (7.5%) with mean age of 31.5± 10.7 (18-50) years and34.6± 10.1 (18-50) years in group A (diathermy group) and group B (stainless steel scalpel) respectively. Mean score of pain, edema and healing on Day 7 was significantly higher in Group B as compared to Group A. Conclusion: Diathermy method is more effective in post-operative pain management, edema control (superioinferiorly and mediolaterally) and healing of tissue as vestibular incision for anterior mandibular fracture as compared to stainless steel scalpel method. Keywords: Efficacy, Diathermy, Scalpel, Vestibular incision, Anterior Mandibular fracture.

Comparison of spinal manipulation and short-wave diathermy on patients with chronic postural low back pain, in department of physical medicine at teaching hospital, Kandy, Sri Lanka

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic postural low back pain (CPLBP) is one of the common health problems worldwide. The aim of the study was to compare the spinal manipulation (SM) and short-wave diathermy (SWD) in patients with CPLBP in department of physical medicine at teaching hospital, Kandy, Sri Lanka.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Observational study was conducted. Patients diagnosed as CPLBP, who referred to the department of physical medicine (DPM), teaching hospital Kandy, were observed in the study (n=140). Seventy (70) patients were allocated for SWD and 70 for SM by the consultant. Two physiotherapists were routinely appointed for the treatments and SWD treatment by group 1 and SM was carried out by group 2. The two treatment sessions were continued once a week through four weeks. Outcomes were measured by numerical pain scale to compare with initial pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Group 1, SM consisted 39 females and 31 males, group 2, SWD 40 females and 30 males. After 4 sessions, the mean value of pain reduction from initial pain was significantly high (p&amp;lt;0.001) in SM group than the short-wave diathermy group in both genders. (Female: 6.410 (SM) and 4.625 (SWD), Male:6.710 (SM) and 4.333 (SWD). Further the mean values showed that there was a significant pain reduction during the initial treatment session than 2&lt;sup&gt;nd&lt;/sup&gt;, 3&lt;sup&gt;rd&lt;/sup&gt;and final sessions in both treatment groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pain reduction was more pronounced in the first treatment session in both methods. SM is more effective for the treatment of CPLBP irrespectively the age and gender when compare to the SWD in the study population. Therefore, SM could apply on CPLBP patients with higher effective treatment.&lt;/p&gt;

Comparison of Outcome of Bipolar Electrocautery versus Harmonic Scalpel in the Management of Third and Fourth Degree Hemorrhoids

Objective: To compare the outcome of bipolar electrocautery versus harmonic scalpel in the management of third degree hemorrhoids.&#x0D; Methodology: This is a comparative study performed at Different Private Clinics of Karachi from the duration of January 2020 to June 2020. Patients with symptomatic grade III hemorrhoids and grade IV hemorrhoids were randomly divided into two groups. . Either group had 64 patients. One group underwent hemorrhoidectomy using bipolar electrocautery (Group A), other group underwent hemorrhoidectomy using harmonic scalpel hemorrhoidectomy (Group B).&#x0D; Results: The total number of patients was 128 with 64 in either group. The mean operating time in group A was 22 ± 4.7 minutes, while that in group B was 35 ± 2.2 minutes. The mean duration of hospital stay among group A was 1.7 ± 0.5 days while among group B patients was 2.1 ± 1.2 days. Mean VAS score for pain at first post-operative day in group A patients was 7 ± 0.6 days while mean VAS score for pain among group B patients was 8.5 ± .2 days.&#x0D; Conclusion: Our study concludes that harmonic scalpel hemorrhoidectomy offers better post-operative patient satisfaction score as compared to bipolar diathermy. No significant difference in hospital stay was found. The number of patients with post-operative urinary retention were more in harmonic scalpel group while in diathermy group, more patients had post-operative hemorrhage.

Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy

Research questionIs there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? DesignThis was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3–8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes. ResultsThe significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55–18.38). No difference in reproductive outcomes was found between the two groups. ConclusionsApplying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.

Outcome comparison of submucous resection versus combined submucous diathermy and outfracture for treatment of inferior turbinate hypertrophy.

The aim of this study was to compare the outcome of submucous resection and combined submucous diathermy with outfracture technique in treatment of nasal obstruction caused by inferior turbinate hypertrophy. This study is a prospective randomized clinical trial involving 90 patients with hypertrophied inferior turbinate not responding to medical treatment. All patients were selected with equal or near equal mucosal and bony turbinate components using computed tomography (CT) and then randomly allocated into two groups; group A (n = 45): underwent submucous resection in both sides and group B (n = 45): underwent combined submucous diathermy and outfracture in both sides. Subjective (NOSE score) and objective (4-grades endoscopic classification system and PNIF evaluation) measures of nasal airflow were done preoperatively and postoperatively. Subjective assessment using NOSE scale proved that both techniques were effective in relieving nasal obstruction as it improved in both groups postoperatively compared to the preoperative data. However, resection technique was better than diathermy technique with a statistically significant difference (p < 0.05), while objective assessment of nasal obstruction showed better results in resection group than diathermy group, but with no statistically significant difference. Both techniques are effective in relief of nasal obstruction due to inferior turbinate hypertrophy. However, submucous resection showed marked improvement compared to diathermy technique especially at long-term follow-up.