Terminal Cis Research Articles

Comparison of Electrocautery and Scalpel Incision in Midline Abdominal Surgery

Background: With the advancement of surgical techniques, the comparison of electrocautery and scalpel incisions in midline abdominal surgeries has become an essential area of study. Traditional scalpel incisions have been known for their precision but carry risks of excessive blood loss and sharp injuries. Electrocautery, offering a potentially safer and more efficient alternative, has been gaining attention in surgical practices. Objective: The primary objective of this study was to compare the effectiveness, safety, and outcomes of electrocautery versus scalpel incisions in midline abdominal surgeries, with a focus on incision time, blood loss, wound infection, and postoperative pain. Methods: A randomized controlled trial was conducted at the Military Hospital, Rawalpindi, over 12 months from June 2021 to June 2022. A total of 150 patients, split evenly into electrocautery and scalpel groups, were evaluated. Patients aged 20-75 years, undergoing midline abdominal surgery, were included. The main parameters measured were incision time, blood loss, wound infection, and postoperative pain. Data were analyzed using SPSS version 25.0, employing independent samples t-tests and chi-square tests. Results: The electrocautery group exhibited a significantly shorter incision time (13.73 ± 2.45 seconds) compared to the scalpel group (18.67 ± 3.02 seconds, p < 0.001). Blood loss was also lower in the electrocautery group (11.47 ± 2.49 ml) than in the scalpel group (27.27 ± 4.13 ml, p < 0.001). Wound infection rates were 6.7% for electrocautery and 13.3% for scalpel, though this was not statistically significant (p = 0.174). Remarkably, 100% of the electrocautery group reported postoperative pain, in contrast to none in the scalpel group (p = 0.000). Conclusion: The study concluded that electrocautery is more effective than scalpel incision in terms of incision time and blood loss, making it a preferable method for midline abdominal surgeries. However, the higher incidence of postoperative pain in the electrocautery group warrants further investigation.

A PROSPECTIVE STUDY TO COMPARE THE POST-OPERATIVE PAIN AND POST-OPERATIVE COMPLICATIONS IN CONVENTIONAL GRID IRON AND TRANSVERSE CREASE COSMETIC INCISION APPENDECTOMY

Objective: The objective of our study is to compare the conventional grid iron incision with transverse crease cosmetic incision in terms of post-operative pain, mean operating time, duration of hospital stay, and post-operative complications. Methods: This is a prospective and comparative study and was carried out between December 2021 and November 2022. During the study period, 50 patients presented to surgical outdoor and emergency at PBM hospital, Bikaner, with clinical presentation and eventual radiological diagnosis of acute appendicitis were enrolled in the study and were randomly allocated to two groups including grid iron=25 and transverse crease=25. All patients were contacted 1 week and 2 months after surgery and the efficacy of grid iron and transverse crease incision in terms of post-operative pain, mean operating time, duration of stay in hospital, and post-operative complications. Results: Post-operative pain, duration of stay in hospital (mean stay for grid iron group=4.32 vs. transverse crease group=2.16 days), and operating time (mean operating time for grid iron group=33 min vs. transverse crease group was 20.3 min) were significantly lower in cases of transverse crease incision as compared to grid iron cases. Post=operative complications were lesser in transverse crease incision but were not very significant as compared to grid iron incision. Conclusion: Open appendectomy using transverse crease cosmetic incision was superior to conventional grid iron incision in terms of post-operative pain, operating time, duration of hospital stay, blood loss, and post-operative complications.

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

In minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)-guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options. To demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group. In this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS). PVB-VATS or PVB-US. The primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications. A total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: -5.4 mg; 95% CI, -∞ to -0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups. PVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours. ClinicalTrials.gov Identifier: NCT04579276.

Fleur-de-lis-like incision for Wise pattern superior-pedicle oncoplastic breast cancer surgery

Background: Wise pattern is one of the most common oncoplastic approaches to breast conserving surgery, particularly in large and ptotic breast. However, it results in long dermal flaps with a possible risk of skin necrosis or even wound dehiscence, most likely at the T-junction area. The aim of this study was to evaluate a modification of the Wise pattern incision in terms of T-junction protection.

Comparative Study of Surgically Section Induced Astigmatism in Manual Small Incision Cataract Surgery

Introduction: Various types of incisions have been adopted and applied in Manual Small Incision Cataract Surgery (MSICS) with the primary objective to attain minimum postoperative Surgically Induced Astigmatism (SIA). Aim: To evaluate and compare the postoperative visual acuity and to determine SIA in Batwing incision and Frown incision in MSICS. Materials and Methods: The present study was a prospective, cross-sectional, interventional, comparative descriptive study in which a total of 380 patients aged 40 years and above with senile, uncomplicated cataract, undergoing MSICS were included. Patients were randomly divided into: Group B (Batwing incision), and Group F (Frown incision). Patients were compared on 6th week postoperatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) and SIA (performed using SIA Calculator Version 2.1). The data was collected in terms of demographic, clinical and biochemical characteristics that were expressed as range, mean and median and subjected to statistical analysis to obtain results. Results: In group F, total 04 (2.11%) patients showed no astigmatism, 115 (60.53%) patients showed 0-0.5D of SIA, 64 (33.68%) were seen with 0.5-1D of SIA and 07 (3.68%) patients with 1-1.5 D SIA, no patient showed SIA more than 1.5 D. In Group B 01 (0.52%) patient showed no SIA, in 61 (32.11%) 0-0.5D of SIA was seen, in 79 (41.58%) patients 0.5- 1D of SIA was seen and 45 (23.68%) patients had presented with 1-1.5D of SIA while 04 (2.11%) patients with more than 1.5D of SIA. In group F, average preoperative astigmatism preoperatively was 0.55±0.36D and average astigmatism at six weeks postoperatively was 0.46±0.33D. In Group B, average preoperative astigmatism was 0.49±0.39D and average astigmatism six weeks postoperatively was 0.54±0.40D. Conclusion: The present study showed the superiority of Frown incision over Batwing incision in terms of less SIA and improved postoperative unaided visual results.

Comparison Of Midline Abdominal Surgery Using Scalpel Versus Electrocautery Incision in Rural Indian Population

The scalpel was considered a gold standard for making skin incisions until the inception of diathermy. Nowadays, electrodes used in making diathermy incisions generate a pure sinusoidal current which produces cleavage in the tissue planes without creating damage to surrounding areas, thus leading to minimal burn-related wound complications.4 Hence, this study was carried out to determine whether electrocautery is safe and effective for making skin incisions as compared to a scalpel for midline abdominal surgery. OBJECTIVE: The object of the study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection. The objective was to determine whether electrocautery is safe and effective for making skin incisions as compared to a scalpel for midline abdominal surgery. Methodology: Patients scheduled for midline abdominal surgeries and willing to participate in the study were randomized into two groups- group A (electrocautery group) and group B (scalpel group). Results: In this study, 52 patients were included and divided into two groups, of which 26 were in group A and 26 were in group B. Intraoperative blood loss and incision time are less while using electrocautery as compared to a scalpel. In terms of postoperative pain and wound complications, there was no discernible variance between the two groups. Conclusion: The use of electrocautery for making skin incisions in midline abdominal surgery was associated with less intraoperative blood loss and less incision time as compared to a scalpel. There was no variance in postoperative pain and wound complications between the two groups. With the above advantages of electrocautery, we conclude that electrocautery is a safe and effective alternative to a scalpel in making skin incisions in midline laparotomy.

Numbness Following Total Knee Arthroplasty: Role of Incision Length And Position - A Randomized Study.

One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.

Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

Medial Displacement Calcaneal Osteotomy for Unilateral Adult Acquired Flatfoot: Effects of Minimally Invasive Surgery on Pain, Alignment, Functioning, and Quality of Life

We aimed to assess the effects of medial displacement calcaneal osteotomy (MDCO) through a minimal skin incision in terms of pain, function, and alignment in patients with unilateral adult acquired flatfoot. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale and Numeric Pain Rating Scale (NPRS) were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. We analyzed data of 20 patients (7 male and 13 female), mean aged 46.6 ± 5.34 years, showed significant differences after 6 months in terms of AOFAS total score (44.30 ± 7.39 vs 96.50 ± 4.89; p = .0001), AOFAS subitems (p < .001), and pain (NPRS: 7.95 ± 1.36 vs 1.05 ± 1.05; p = .0001). At 1 year after surgery (T2), all outcome measures still significantly differ from baseline (p < 01). Therefore, percutaneous MDCO through a minimal skin incision seemed to be safe and effective in the middle and long term in reducing pain and improving function and alignment in patients with unilateral adult acquired flatfoot.

Development of a new skin incision for conduct of conventional autopsy

BackgroundSince the practice of conventional autopsy, one new method for skin incision as “fourth incision” has been added to the preexisting conventional methods of skin incisions, i.e., “I”/“Y”/modified “Y”. Reconstitution of conventional skin incisions leave visible defect (disfigurement) on the dead body which gets enhanced with invariable use of additional confirmatory or releasing incisions. Mutilation in form of disfigurement of the dead body is a major reason for legal heirs to withdraw the consent for pathological or clinical autopsy and is leading to worldwide significant drop in the rate of pathological autopsies. This study was formulated to develop a new course of skin incision for autopsy with the aim to minimize the visible defect and to obviate the need of extra incisions and so that it is time friendly for autopsy surgeons.ResultOn practicing this course of skin incision, the authors of study have noticed its advantages as it is cosmetically effective and time friendly and offers 100% operational area with single incision in continuity in comparison to other advocated methods.ConclusionIts acceptability with its inherent advantages to autopsy surgeons and legal heirs of the dead body may increase the tendency to give desired informed consent for pathological autopsy. However, the validation of our method of skin incision in terms of different surgical and observer components is required to remove any bias regarding noticed advantages.

Comparison of Szmyd incision over envelope incision during the surgical removal of impacted third molar for evaluating postoperative prognosis: a prospective randomized study

Background: Manipulation of both hard and soft tissues during the surgical removal of mandibular third molars is usually associated with a number of postoperative complications. This study was aimed to compare the effects of two types of flap designs used during the impacted mandibular third molar removal and the consequences of choosing Szmyd incision over envelope incision in terms of primary wound healing and periodondal healing.Methods: A prospective, randomized study was conducted in healthy 50 patients with partially or completely impacted mandibular third molars were selected. The patients were divided into two groups of 25 each. In one group envelope flap design was used and in the other group Szmyd flap design was used. The influence of these incisions on accessibility to third molar, primary wound healing and periodontal healing was evaluated and compared.Results: The incidence of wound dehiscence at 7th day follow-up is more in envelop incision (p=0.123) and 20% more at 14th day follow-up (p=0.087) when compared to Szmyd design. Significant differences were noted with respect to the periodontal healing distal to adjacent second molar. Distal periodontal pocket depth was significantly lower for the Szmyd incision as compared to the Envelop incision. Effect size of Envelop flap is 1.84 times more than Szmyd flap.Conclusions: The Szmyd flap design makes primary wound healing easier, less wound dehiscence and periodontal complication than envelop flap design.

SURGICAL INCISION;

Objectives: To compare the outcome variables among patients undergoinglaparoscopic cholecystectomy using horizontal and vertical incisions for epigastric port incision.Study Design: Randomized control trial. Place and Duration of Study: Department of Surgery,Shalamar Hospital, Lahore from July 2016 to December 2016. Methodology: A total of 100patients undergoing laparoscopic cholecystectomy were selected and equally divided intotwo groups. Epigastric port insertion was done using horizontal incision (group A) and verticalincision (group B). Electrocautery use, incision extension, use of secondary intervention forbleeding control, blood loss and patient satisfaction regarding scar were noted in both groupsand compared. Results: In this study, we found that 15 out of 50 required electrocautery ingroup A while only 4 patients required in group B. Incision extension was needed in 8% ofpatients in group A while only 2% patients needed it in group B. Blood loss was 4.62 ± 2.64ml in group A while in group B, it was 1.70 ±0.81 ml. Also 80 % patients were satisfied withhorizontal scar while 76 % patients in vertical group. Conclusion: Vertical incision for epigastricport insertion is better than horizontal incision in terms of blood loss, bleeding control whencompared in laparoscopic cholecystectomy.

The effectiveness of double incision technique in uterus preserving surgery for placenta percreta

BackgroundPlacenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; however, recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). In this study, we aimed to evaluate the effectiveness and results of the double incision technique.MethodsTwenty-two patients with a diagnosis of placenta percreta who underwent conservative surgery were included. Segmental resection was performed via single incision in ten patients and double incision in twelve patients.ResultsThere was no difference between the patients who underwent segmental resection via single and double incision in terms of age, gravida, number of previous caesarean deliveries, gestational age at delivery, or rate of elective surgeries. The operation time, transfusion requirement, intensive care unit admission, total hospitalization and success of conservative surgery were comparable between the groups.ConclusionsBased on the outcomes of our study, double uterine incision allows for the safe extraction of the foetus during uterus-preserving surgery in patients with placenta percreta without worsening the results compared to single uterine incision.Trial registrationNCT02702024, Date of registration: February 26, 2016, retrospectively registered.

Titanium tetrafluoride complexation with phosphorylated ketone Ph2P(O)(CH2)2C(O)Me in CH2Cl2

The products resulting from the reaction of TiF4 with Ph2P(O)(CH2)2C(O)Me (L') in CH2Cl2 have been studied by 19F{1H} and 31P{1H} NMR spectroscopy. At a twofold excess of L', solution contains cis-TiF4(L')2 (>90%), trans-TiF4(L')2, and fac-[TiF3L3']+, where L' is coordinated via the P=O group, as well as the dimer [(Ti2F7L'2)2]+, where L' is coordinated through the P=O and C=O groups. An equimolar solution contains dimeric and polynuclear complexes containing moieties with three terminal cis fluorine ions, while the other coordination sites are occupied by the P=O groups and F– bridges. At a twofold excess of TiF4, ligand L' coordinates via the P=O and C=O groups and behaves as a bridge along with F– ions. Thermodynamic stability of the structures of the TiF4L'2 isomers and the structure of [(µ-F)(µ-L')2(TiF3)2]+ has been calculated.

Benefits of xiphoidectomy in total gastrectomy: Technical note.

The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue. The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002-December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications. Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21-80) years. The time required for xiphoidectomy was 7-15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection. Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7-15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone.

English

AIMS: Comparative study of manual SICS technique by superior straight incision and oblique (9-12 O’clock) straight incision in terms of surgical duration, surgeon and patient’s comfort, intraoperative and postoperative complications and visual outcome up to 6 weeks. MATERIALS AND METHODS: 200 eyes of cataract were randomly subjected to cataract surgery by manual SICS technique using superior and oblique incision approach in 100 eyes each. Further grouping was done as Group A: RSS-Right superior straight incision, Group B: RSUT-Right superior upper temporal: Group C: LSS-Left superior straight, Group D: LSUN-Left superior upper nasal: 50 case each. Surgeon comfort was accessed in 5 steps namely tunnel making, capsulorrhexis, nucleus delivery, cortical wash and IOL implantation in both groups and graded as comfortable, convenient and difficult. Patient comfort was accessed as pain felt at 1st postoperative day, taken as P1, P2 and P3 according to increasing pain intensity. Surgical duration in both approaches was studied and compared. Visual outcome and complications were accessed at 2, 4 and 6 weeks. STATISTICAL ANALYSIS: Commercial SPSS 17 was used for statistical analysis. Chi square test and independent t test was used for calculating p value. RESULTS: Visual outcome was comparable in both the groups at 2, 4 and 6 weeks (p>0.05).Mean SIA in superior incision was +0.88D and +0.63D in oblique group (p value=0.00).Mean surgical duration in oblique group was 455.88+14.559 seconds and 541.63+31.699 seconds in superior group. Surgeon was comfortable in all 5 steps in both approaches except tunnel making, being difficult in oblique incision. Patient comfort at 1st postoperative day was insignificant between two groups. Postoperative hyphaema was found in 6 % in superior as compared to 14% in oblique incision group. CONCLUSION: Oblique (9-12 O’clock) incision was associated with less surgically induced astigmatism and surgical duration as compared to Superior incisional approach. Difference in visual outcome, Intra and postoperative complications, surgeon and patient comfort was insignificant between two groups.

Excision of Orbital Dermoid Cysts via Upper Eyelid Incision: A Review of 24 Cases

Background: Dermoid cysts are abnormally located masses arising from abnormal involution of superficial ectoderm during closure of sutures between bones. Dermoid cysts are the most common orbital masses in childhood. They should be surgically removed at ages 1 - 2 as they may enlarge and lead to deformation in orbital bony structures and erosion. Traditional treatment is removal of the mass via an incision over the mass. Incisions through, below or above the brow are used to remove these cysts. Endoscopic incision of these cysts is also performed. Methods: In this study, 24 patients aged between 2 and 18 years underwent dermoid cyst excision via upper eyelid incision. Results: Cyst rupture did not occur except two patients. Mean operative time was found as 20 minutes. Loss of vision or eyelid functions occurred in no patients. Cyst recurrence was observed in no patients. All patients or parents were satisfied with the scar. Discussion: There is not a significant difference between direct incision over the mass and upper eyelid incision in terms of cyst rupture and operative time. As upper eyelid skin is the region of the body that hides the scar best with its thin skin, these masses may be removed easily and with a good field of vision via upper eyelid incision. J Curr Surg. 2014;4(4):110-112 doi: http://dx.doi.org/10.14740/jcs240w

Comparison of Pyloromyotomy with Supraumbilical Incision and Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis Performed by a Single Surgeon

Purpose: Hypertrophic pyloric stenosis (HPS) is known to be one of the most common cause of surgery for infants and pyloromyotomy was considered to the standard treatment. There has been an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating HPS. The aim of this study is to evaluate safety and effectiveness of LP by comparing the clinical results of both surgical strategies performed by single surgeon. Methods: Between January 2000 and December 2013, 60 patients who underwent pyloromyotomy at Asan Medical Center performed by a surgeon were followed: open-supraumbilical incision (n=36) and LP (n=24). The parameters included sex, age and body weight at operation. Clinical outcomes included operation time, time to full feeding, postoperative hospital stay, and postoperative complications. Results: There were no significant differences in characteristics, postoperative hospital stay between the two groups. Time to full feeding was shorter in LP (OP 24.5 hours vs. LP 19.8 hours; p=0.063). In contrast, the mean operation time was longer in LP (OP 37.5 minutes vs. LP 43.5 minutes; p=0.072). Complications such as perforation of mucosal layer (OP 1 vs. LP 0) and wound problems (OP 2 vs. LP 0) were found to be not worse in laparoscopic group as compared with open group. Conclusion: There has no difference both laparoscopic and open-supraumbilical incision in terms of postoperative hospital stay, time to full feeds and frequency of complications.

LUMBOTOMY;

Background: Urolithasis is a common urological ailment since antiquity. Treatment of urolithasis has witnessed a revolutionarychange with the advent of minimally invasive endoscopic techniques. However in developing countries very few cases of the renal stonedisease are being treated using minimally invasive techniques and vast majority are still being managed with open surgery. Objectives: Theobjective of the study was to compare the two incisions used for renal and proximal ureter access, and find out which was better in our set up.Methods: We carried out a study at our center, comprising of 50 cases of solitary renal stones, to compare the traditional oblique lumbar (OL)incision with dorsal lumbotomy (DL). Patients included in the study were with a BMI of less than 30, all ages, having single large stone of renal /proximal ureter, extra renal pelvis, no previous surgery on the ipsi-lateral side. Results: The study revealed that the lumbotomy incision is betterthan the traditional lumbar oblique incision in terms of surgery time, post operative pain, early return to work and cosmetically accepted scar.Conclusions: After analyzing the data we came to the conclusion that the lumbotomy incision was superior to the oblique lumbar incision inselected cases and we recommend that it should be used specially in centers where facilities for endoscopic/minimally invasive managementare not available.

Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision

ObjectivesTo determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy.Summary background dataIncisional hernias after midline incision are commonly underestimated but probably complicate between 2 and 20% of all abdominal wall closures. The midline incision is the preferred incision for surgery of the upper abdomen despite evidence that alternatives, such as the lateral paramedian and transverse incision, exist and might reduce the rate of incisional hernia. A RCT was preformed in the pre-laparoscopic cholecystectomy era the data of which were never published.MethodsOne hundred and fifty female patients were randomly allocated to cholecystectomy through midline or transverse incision. Early complications, the duration to discharge and the in-hospital use of analgesics was noted. Patients returned to the surgical outpatient clinic for evaluation of the cosmetic results of the scar and to evaluate possible complications such as fistula, wound dehiscence and incisional hernia after a minimum of 12 months follow-up.ResultsTwo percent (1/60) of patients that had undergone the procedure through a transverse incision presented with an incisional hernia as opposed to 14% (9/63) of patients from the midline incision group (P = 0.017). Transverse incisions were found to be significantly shorter than midline incisions and associated with more pleasing appearance. More patients having undergone a midline incision, reported pain on day one, two and three postoperatively than patients from the transverse group. The use of analgesics did not differ between the two groups.ConclusionsIn light of our results a transverse incision should, if possible, be considered as the preferred incision in acute and elective surgery of the upper abdomen when laparoscopic surgery is not an option.