Mean Blood Loss In Group Research Articles

A Prospective Study to Evaluate the Efficacy of Trenexamic Acid in Addition to Oxytocin for Prevention of Post Partum Hemorrhage

Background: One of the most prevalent causes of maternal mortality worldwide is postpartum hemorrhage which can be prevented by early prompt action. Active control of the third stage of labor is one such intervention that is strongly recommended.Methods: Prospective, randomized, comparative study conducted in Department of Obgyn in MY Hospital, Indore, with comparative groups of 500 each. One group received oxytocin alone and other group received oxytocin and trenexamic acid both.Results: The mean age in group I was 23.73 ± 3.53 years and in group II it was 23.83 ± 3.34 years, showing a comparable mean age between the two groups. The incidence of anemia was 9.6%, PPH was 6.0% and hemorrhagic shock was 0.6% in group I and in group II it was 8.0, 5.4 and 0.8%, respectively. The incidence of anemia and postpartum hemorrhage was higher in group I in comparison to group II. The mean blood loss in group I was 257.04 ± 139.17 mL, while in group II it was 242.60 ± 120.89 mL, showing a significantly lower blood loss in group II in comparison to the group I shows that trenexamic acid shows decrease and blood loss and anemia and occurance of PPH.Conclusions: Analysis concluded that tranexamic acid tended to minimize blood loss and the need for blood transfusions during childbirth during caesarean sections and vaginal deliveries and appeared safe and efficient for prevention and control of bleeding during pregnancy.

Comparative study of propofol and dexmedetomidine Infusion for hypotensive anesthesia in FESS surgeries: A randomized prospective double-blind controlled study

Background: Intra operative bleeding is most common factor that diminishes visibility resulting in an increased incidence of complications in patients undergoing functional endoscopic sinus surgery (FESS). Methods to reduce intra-operative bleeding include Trendelenburg position, maintenance of normothermia, and controlled hypotension by various anesthetic techniques. Many studies have shown that propofol and dexmedetomidine infusion reduces the amount of bleeding in different surgeries. Aims and Objectives: The aim of the study was to compare the effects of dexmedetomidine and propofol infusion over hemodynamic, quantity of blood loss, and quality of surgical field in patients undergoing FESS and to compare the side effects of dexmedetomidine and propofol infusion in cases undergoing FESS. Materials and Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. The duration of study was 2 years. 60 patients of ASA Grades I and II with age between 20 and 60 years, including both males and females posted for FESS were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into two groups (on the basis of whether they received propofol or dexmedetomidine infusion) of 30 patients each. Hemodynamic parameters (Heart rate and mean arterial pressure [MAP]) quantity of blood loss, quality of surgical field, and side effects were recorded and compared in both the groups. For statistical purposes, P<0.05 was taken as statistically significant. Results: Antrochoanal polyp and chronic sinusitis were the most common indication of FESS in studied cases. Intraoperatively, heart rate was lower in both the groups as compared to baseline. However, the heart rate was lower in the Group D at all times as compared to Group P and the difference was statistically significant from 20 min onward after induction. The mean arterial blood pressure in both the groups was comparable till up to 15 min post induction with no statistical difference. Thereafter, the mean arterial blood pressure was lower in Group D than in Group P throughout the procedure, the difference being statistically significant (P<0.05). The isoflurane requirement in Group D was significantly lower starting from 5 min of induction to throughout the procedure as compared to Group P (P< 0.05). Mean blood loss in Group D was 115.0±16.78 ml and in Group P was 140.47±29.42 ml, the difference in blood loss was statistically significant (P<0.0001). Conclusion: Dexmedetomidine is comparatively better than propofol in controlling heart rate and MAP, reducing the blood loss, and isoflurane requirement in patients undergoing FESS.

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 < 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

Comparative Efficacy of Syntometrine Versus Oxytocin in Active Management of Third Stage of Labour

Objective: The study's objective is to examine the effectiveness of syntometrine and oxytocin in actively managing the third stage of labour in order to lower the risk of PPH and other undesirable third stage outcomes. Study Design: Randomized/Prospective study Place and Duration: Gynae & Obs department of Combined Military Hospital Peshawar for the duration from 1st June 2021 to 30th November 2021. Methods: This study comprised of 140 females of third stage labour. Age of the females was 18-40 years. After getting informed written consent detailed demographics of enrolled cases were recorded. Patients were equally divided in two groups. Group I had 70 patients and received syntometrine (5 IU Synthetic Oxytocin and 0.5 mg ergometrine maleate) and in group II oxytocin was given to 70 females. Outcomes among both groups were recorded in terms of blood loss and postpartum hemorrhage. SPSS 23.0 was used to analyze all data. Results: The mean age of the patients was 28.3±6.18 years and had mean BMI 27.6±11.25 kg/m2. Mean gestational age was 36.11±5.19 weeks. Frequency of primigravida was 80 (57.1%). Frequency of emergency delivery was found in 85 (60.7%) cases while 55 (39.3%) females admitted to OPD. 72 (51.4%) females were from rural areas and 67 (47.8%) cases were educated. We found that mean blood loss in group II was higher 165.1±8.66 ml as compared to group I 118.7±9.39 ml with p value <0.005. There was no any PPH found in group I while in group II PPH found in 3 (4.3%) cases. Frequency of hypertension was higher in group I. We found higher number of adverse outcomes among females of syntometrine group as compared to oxytocin group. Conclusion: In this study we concluded that use of syntometrine in third stage of labour was effective and useful in terms of reduction in blood loss and PPH as compared to oxytocin while frequency of adverse events and hypertension was higher in syntometrine group as compared to oxytocin. Keywords: Pregnant Females, Third Stage Labour, Syntometrine, Oxytocin, Blood Loss

Hepatic Artery Anomalies and Its Impact in Patients Undergoing Pancreaticoduodenectmy. A Comparative Study from Kashmir Valley

Background: Pancreaticoduodenectomy provides the only opportunity to cure resectable and borderline pancreatic ductal adenocarcinoma. This is linked to a high rate of morbidity and mortality, especially when combined with hepatic artery anomalies. The goal of this study was to analyse the spectrum and impact of hepatic artery anomalies on intraoperative and postoperative variables, and oncologic outcomes in patients undergoing pancreaticoduodenectomy. Materials and Methods: All patients with resectable periampullary or pancreatic head tumours who underwent pancreaticoduodenectmy (PD) were included. Patients were divided into two groups using computer-generated random numbers; Group A included patients who had pancreaticoduodenectmy (PD) with normal hepatic artery anatomy and Group B included patients with aberrant hepatic artery anatomy. The data was collected and analysed using SPSS 22. Results: Among the 238 patients who met the inclusion criteria, 177(74.36%) participants were included in Group A (Normal hepatic artery anatomy) and 61 (25.36%) in Group B (Aberrant hepatic artery anatomy). The mean age of patients in Group A was 51.3 ± 8.63 years while it was 50.6 ± 8.09 years in Group B. The difference in gender, BMI, pre-operative haemoglobin, bilirubin and albumin between two groups was statistically insignificant (P value >0.05). The difference in mean operative time of Group A 230.9(168–390) minutes and Group B 319.6(200–620) minutes was statistically significant (p-value <0.001). The mean blood loss in Group A (511.5 120.18 ml) was significantly lower than in Group B (623.6 127.06 ml) (P ≤ 0.001). There were no significant differences between the two groups in terms of post-operative pancreatic fistula, delayed gastric emptying, wound infection, atelectasis, hospital stay, peri-operative mortality, positive resection margins, and mean lymph node yield. Conclusion: Patients with hepatic artery anomalies who undergo pancreaticoduodenectomy have significantly more operative blood loss. This could be due to the procedure’s complexity and lengthy operative time. There were no differences between the two groups in terms of postoperative morbidity, oncological outcome, or mortality.

OUTCOME OF ANTEROMEDIAL PLATING VERSES ANTEROLATERAL TECHNIQUE FOR FRACTURE OF MIDDLE 1/3RD OF THE HUMERUS

Background: Humerus shaft fracture accounts for 3-5% of all fractures commonly encountered by orthopedic surgeons. The application of plate for fracture of middle 1/3rd of Humerus is a gold standard in the presence of lot of intramedullary and extramedullary devices for these fractures.
 Objectives: To compare the outcome of anterolateral plating with the anteromedial plating for fracture of middle 1/3rd of the Humerus.
 Subjects and Methods: 
 Study Design: Randomized control trial
 Study Setting: Department of orthopedic surgery services hospital Lahore
 Study Duration: Jan 2018 to Jan 2019
 Data collection and Analysis:
 Total number 60 patients with fracture of middle 1/3rd of shaft of the humerus were admitted through emergency department of this hospital. Subjects were randomly assigned into two equal groups. In Group A all fractures were fixed with DCP on the anterolateral surface of Humerus with anterolateral approach while in group B all 30 patients with fracture of shaft of Humerus were plated on the medial flat surface of Humerus by anterolateral technique. The radial nerve injury was also assessed in both of these groups post operatively. All these patients were followed for 6 months with weekly interval up to 03 weeks, then at 06 weeks, 03 months and thereafter at 06 months. At each follow up each patient was evaluated clinically and radiologically for fracture union range of motion at elbow and shoulder joint and post operative complications. Data was entered and analyzed in SPSS ver: 21.0. Mean and standard deviation was calculated for quantitative variables and frequency and percentages for qualitative variables. Independent t–test was applied for numerical outcome and chi-square test was used for proportions with p < .05 as statistical significant.
 Results: Mean age 42.2 + 5.98 years. 66.6% of the fractures were as a result of RTA Mean duration of surgery in Group A (Anterolateral surface) was 60.25 + 7.56 and in Group B (Anteromedial surface) was 52.34 + 10.29. (p < .001). Mean blood loss in group A was 110.17 + 12.36 and in Group B was 80.75 + 8.94 (p < .000). No radial nerve injury in group B while 3 (10.0%) patients had iatrogenic radial nerve palsy in group A (p =.076).
 Conclusion: Anteromedial plating on the flat medial surface of Humerus is an excellent technique for fixation of fractures of middle 1/3rd of the Humerus as compared to anterolateral plating. It avoids the injury to the radial nerve.

Compare Bipolar Diathermy and Suture Ligation for Hemostasis in Tonsilectomy in Terms of the Amount of Blood Loss

Objective: The purpose of our study is to compare the outcomes in terms of blood loss, post-operative hemorrhage and operative time between bipolar diathermy and suture ligation for hemostasis in tonsillectomy. Study Design: Randomized Control trial Place and Duration: The study was conducted at ENT department of Peshawar Medical College Peshawar and Chaudhary Muhammad Akram Teaching and Research Hospital Lahore during the period from February 2020 to July 2020. Methods: There were ninety four patients of both genders with ages 5-40 years were presented. Included patients had chronic tonsillitis. After obtaining informed permission, the recruited patients' demographic data, including their age and gender, was recoded. Patients were equally categorized in two groups. Group I had 47 patients and received bipolar diathermy and group II received suture ligation among 47 cases. Outcomes among both groups were calculated and compared in terms of operative time, blood loss and post-operative complications. SPSS 25.0 version was used to analyze complete data. Results: Majority of the patients were males 55 (58.5%) and the rest were females 39 (41.5%) in study. In patients of bipolar diathermy mean age were 14.11±4.55 years while in group II mean age was 13.32±6.49 years. Number of left side tonsils in group I was among 25 (53.2%) patients and in group II left tonsils found in 30 (63.8%) cases. Mean operative time in group I was lower 11.9±8.88 minutes as compared to group II 15.4±4.35 minutes with p value <0.03. Mean blood loss in group II was significantly higher 40.15±7.71 mL as compared to group I 25.4±6.42 mL with p value <0.04. There was no any case found of post-operative hemorrhage in both groups. Frequency of ligatures among group I was 2 (4.3%) significantly lower than group II in 45 (95.7%) cases. Conclusion: We concluded in this study that the use of bipolar diathermy for hemostasis in tonsillectomy was beneficial and efficient in terms of less operative time with less blood loss as compared to suture ligation technique. Except this both technique are beneficial in term of post-operative hemorrhage which was not observed in both groups. Keywords: Bipolar Diathermy, Hemostasis Tonsillectomy, Suture Ligation, Hemorrhage, Blood Loss

EFFICACY OF RECTAL MISOPROSTOL VS INTRAVENOUS OXYTOCIN IN PREVENTING POSTPARTUM HEMORRHAGE FOLLOWING ELECTIVE CAESAREAN SECTION

Objective: To compare the efficacy of rectal misoprostol with intravenous oxytocin in prevention of postpartum hemorrhage (PPH) in elective cesarean section (CS) operation. Methodology: This randomized controlled trial was conducted in the Department of Obstetrics & Gynecology Department, Lady Reading Hospital, Peshawar. A total of 334 women undergoing elective CS were recruited in the study through consecutive sampling and randomly allocated to misoprostol group (group A) and IV oxytocin group (Group B). Follow up was done to determine the mean blood loss in both groups to determine the efficacy in terms of presence or absence of postpartum hemorrhage. Results: The mean age in group A was 31.2±6.8 years compared to 30±6.2 years in group B. The mean blood loss in group A was 776±285.7 ml, while in group B it was 817±1318 ml. Efficacy of rectal misoprostol was 83.8% as compared to 74.9% for I/V Oxytocin with a significant p-value of 0.043. Conclusion: Rectal misoprostol in women prepared for elective cesarean section show better efficacy in terms of PPH prevention as compared to IV oxytocin.

Comparison of Bipolar Diathermy and Suture Ligation for Haemostasis in Tonsillectomy

Objective: To compare bipolar diathermy and suture ligation for haemostasis in tonsillectomy in terms of the amount of blood loss, number of ligatures applied, average time taken and incidence of postoperative haemorrhage. Study Design: Randomized controlled trial Place and Duration of Study: Multicenter study conducted in ENT Surgery Departments/Units of Public and Private Sector Hospitals of Lahore from 1st July 2017 to 31st July 2018. Methodology: Sixty six patients were enrolled. Informed consent and demographic information was takenfrom all the patients. Patient himself was the control and the trial. One tonsil was treated with ligation technique (Group A) and other with bipolar diathermy technique (Group B). Both the tonsil side and the technique were randomized. The outcome in both groups was noted. Results: The mean age was 12.39±7.41 years and male to female ratio was 0.8:1. The mean haemostasis time in group A was 14.32±2.81 minutes whereas in group B patients it was 10.62±1.76 minutes. The mean blood loss in group A patients was 42.82±13.360 ml whereas in group B patients was 28.015±8.619 ml. The incidence of post-operative haemorrhage was zero for both bipolar diathermy and suture ligation, which shows the safety of both procedures. Conclusion: Bipolar diathermy is safe, effective, easier and faster technique for haemostasis in tonsillectomy than ligation technique Keywords: Tonsillectomy, Bipolar Diathermy, Ligation Technique

Comparison of Misoprostol With Tranexamic Acid in Preventing Post-Partum Hemorrhage

Aim: To compare the amount of average blood loss in transamine and misoprostol groups in patients undergoing spontaneous vaginal delivery in third stage of labour. Method: We conducted the randomized controlled trial from July 26th 2016 to 25th of January 2017. Results: In my study the mean age of the patients undergoing normal vaginal delivery was 28.47 years, parity wise, 31%, 33%, 24% and 11% of participants were para 1, para 2, para 3 and para 4 respectively. Mean blood loss in group A was 224.08 +/- 20.81mls and in group B 331 +/- 398 mls. Conclusion: This study has demonstrated that the blood loss in transamine group (group A) is less than the mean blood loss in misoprostol group (group B). Keywords: Transamine, misoprostol, normal vaginal delivery

A Prospective, Single-Blinded, Bicentric Study, and Literature Review to Assess the Need of C2-Ganglion Preservation - SAVIOUR's Criteria.

ObjectiveJoint manipulation for craniovertebral junction instability is often hindered by the C2-ganglion (C2G). Our study aims to compare the surgical outcome among patients with or without C2G preservation and discuss the technical nuances. MethodsWe did a prospective, bicentric study and included all the operated patients with craniovertebral junction anomaly. The outcome was assessed by the Pain Numeric Rating Scale, Patient Satisfactions Score, and Stony Brook Scar Evaluation Scale. The fusion was assessed using Lenke fusion grade. ResultsOne hundred seventy-one patients (88 in group A and 83 in group B) were included. The most common symptom was spastic quadriparesis (n = 165, 96.5%) with median Nurick grade 3.3. Thirteen patients had suboccipital numbness and 12 patients had paraesthesia. Mean blood loss in group A was 490 ± 96.2 mL and group B was 525 ± 45.7 mL; median operative time was 217.9 and 162.2 minutes in the groups A and B, respectively (p < 0.05). At the follow-up (median, 46.8 months), Lenke fusion grade A was achieved in 92.4% and grade B in 7.6%. A trend suggesting better functional outcomes (numbness, parestheisa, scar outcome, and postoperative ulcer formation) in group A was seen with all 6 patients, who underwent O-C2 fixation, developed pressure sore. ConclusionOur results support ganglion preservation, especially in the subset of patients where occipital plating is required. Although the study fails to show any statistical significance, we suggest that one should always start with an ‘intent’ of preservation as the functional outcome is better.

Anesthesia Management and Fluid Therapy in Right and Left Lobe Living Donor Hepatectomy

ObjectiveRight lobe living donor hepatectomy poses a greater risk for the donor in relation to blood loss. The aims of this study were to compare anesthetic and intraoperative fluid management in right and left lateral segment living donor hepatectomy. Patients and MethodsThe anesthesia records of living donor hepatectomy patients were retrospectively reviewed. Donor age and weight, anesthesia time, central venous pressure, blood loss, blood product transfusion, intravenous fluids used, doses of furosemide, and urine output were compared and analyzed between groups using the Mann Whitney U test. ResultsForty-six patients underwent living donor left lateral segment hepatectomy (Group I); while 31 patients underwent right lobe hepatectomy (Group II). The mean blood loss in Group II was significantly higher compared to Group I (118 ± 81 mL vs 68 ± 64 mL), but clinically such amount of blood loss was not high enough to affect the hemodynamics. The fluid management was therefore not meaningfully different between the two groups. No blood transfusions or colloid infusions were required for either group. Urine output, hemoglobin changes, blood urea nitrogen, and serum creatinine pre- and postoperatively were not significantly different between groups. ConclusionsAs long as blood loss is minimal, we found no difference in the anesthetic management and fluid replacements between right and left lateral segment living donor hepatectomy.

TOTAL KNEE ARTHROPLASTY?;

The treatment of choice for osteoarthritic knee is Total knee arthroplasty (TKA)and the most important problem in it is the blood loss. Objectives: To compare the postoperativemean blood loss with Tranexamic acid versus control after Total Knee Arthroplasty.Study Design: Randomized controlled trial. Setting: Ghurki Trust Teaching Hospital Lahore.Period: 01 year. Methodology: 100 patients were included and divided in 2 groups, selectedby non-probability purposive sampling, fulfilling inclusion and exclusion criteria. Group T(Tranexamic) received 15mg/kg IV Tranexamic acid 10 minutes before inflating tourniquet andthe same dose intravenously 3 hours post-operatively. Group C (control) received placebo(normal saline) intravenously. Blood loss collected in a container was measured with syringe/jarafter 24 hours of surgery. Results: In group C there were 23(46%) males and 27(54%) femaleswith male to female ratio 1:1.7 with mean age of 64yrs ± 6.3 yrs. In group T there were 28(56%)males and 22 (44%) females with male to female ratio 1.2:1 with mean age of 65yrs ± 7.4 yrs.After 24 hours Mean blood loss in Group C were 694 ±151 ml with 74 % patient in range of600-900ml while Mean blood loss in Group T were 388 ml ±105 ml with 76 % patient in rangeof 300-600ml. Mean decrease in blood loss with the use of tranexamic acid { mean blood lossin T group – mean blood loss in T group } were 306 ml which were statistically significant(p&lt;0.05) using t Test. Conclusion: Tranexamic acid is a potent anti-fibrinolytic agent and its use intotal knee arthroplasty results in decrease in post-operative blood loss thereby decreasing theneed of blood transfusion.

PRIMARY POSTPARTUM HEMORRHAGE

Objectives: The aim of our study is to determine the effectiveness of uterinemassage with active management and compare it with active management alone, in primarypostpartum hemorrhage prevention. Study Design: Randomized control trial. Period: 8months from September 2014 to April 2015. Setting: Tertiary Care Hospital in Karachi, Pakistan.Method: The study population consists of n=118 patients, both emergency and elected cases,who came to the gynecology and obstetrics ward at our hospital. The patient population wasdivided into two groups, group I received active management of labor ( third stage ) while groupII received active management of labor (third stage) in addition to the uterine massage (for a 2hrduration), the outcome was measured by measuring the amount of blood loss and the need foruterotonic agents. A p value of less than 0.05 was considered significant. Results: The studypopulation consisted of n=118 patients, undergoing spontaneous labor, and divided into twogroups, the mean blood loss in group I (control group) was 211.4mls and in group II (massagegroup) was 167.8mls (p value= 0.015). In group I n=15 patients required additional uterotonicsupport, while in group II only n=3 patients required it (p value= 0.00058). Conclusion:According to the results of our study, uterine massage in addition to the active managementof labor reduces post-partum hemorrhage, and it also reduces the requirement for additionaluterotonic agents for the control of hemorrhage.

Effect of Topical versus Parentral Tranexamic Acid on Blood Loss in Spinal Deformity Surgery. A Prospective Randomized Controlled Trial

Introduction Massive hemorrhage and massive blood transfusion are not uncommon in spinal deformity surgery. There are many factors which may affect the perioperative blood loss. Multiple studies showed the beneficial effects of parentral tranexamic acid (TXA) in decreasing intraoperative blood loss but there is a lack of knowledge about the effect of topical use of tranexamic acid. The aim of this study is to evaluate the effect of using tranexamic acid topically versus parentrally on the amount of intra operative blood loss. Material and Methods Between 2011 and 2014, eighty three patients (49 females/34 males, mean age 17 ± 4 ys, body weight 49 ± 6 kg) underwent correction (in the form of multiple Ponte osteotomies, PSO, PVCR) and posterior spinal fusion for spinal deformity (57 AIS, 14 congenital scoliosis, 12 syndromic). These patients were randomized into one of three groups. In group 1 ( n = 31 patients), TXA was used topically. TXA was sprayed directly in the wound and sponges soaked with it were used. In group 2 ( n = 29 patients), intravenous TXA was used intra-operatively. In group 3 ( n = 23 patients), TXA acid was used neither topically nor systemically. Intraoperative blood loss and the number of blood units transfused were recorded for all patients. The three groups were comparable in the mean age, body weight, operative time, type of deformity, type of osteotomy, number of fused segments, number of screws used. Results The mean operative time was (240 minute ± 50). The mean blood loss in group 1 was 1353 ± 273 cc, 1271 ±279 cc in group 2, and 1430 ± 311 cc in group 3. The mean number of blood units transfused in group 1 was 2.65 ± 0.587, 2.3 ± 0.571 in group 2, and 3.4 ± 0.5 in group 3. There were no significant differences in intraoperative blood loss and number of units of transfused blood between the first and second groups while there was a significant difference between them and the control group. One patient developed DVT in the intravenous TXA group. Conclusion Topical TXA is as effective as intravenous TXA and may be used safely to decrease the need for blood transfusion and intraoperative blood loss.

Clipless harmonic scalpel assisted cholecystectomy versus conventional laproscopic cholecystectomy

Introduction: Laproscopic cholecystectomy is gold standard in the management of symptomatic gallstone disease. Ultrasonically activated scalpel has come up as alternative to traditional electrocautery for haemostatic dissection of tissues. Little research has been done to compare effectiveness of conventional laproscopic cholecystectomy and harmonic cholecystectomy. Aim and objective: To compare conventional laproscopic cholecystectomy versus clipless harmonic scalpel assisted cholecystectomy among the patients undergoing laproscopic cholecystectomy for symptomatic cholelithiasis at IGMC Shimla. Materials and method: Prospective study involved 400 patients operated for symptomatic cholelithiasis. Patients were divided into two groups of 200 patients each.Group A was control group who underwent conventional laproscopic cholecystectomy and Group B who underwent laproscopic cholecystectomy with harmonic scalpel. Results: In group A mean duration of surgery was 43 min and 20 seconds while in group B it was 30 min and 40 sec. In terms of intraoperative complications in group A gallbladder perforation was seen in 48 patients while in group B in 8 patients, while spillage of gall stones was seen in 48 patients in Group A it was seen in 8 patients in group B. Mean blood loss in group A was 19.72 cc while in group B it was 13.18 cc. Mean time interval of rescue with analgesic for post operative pain in group A was 7.64 while in group B was 8.72. Conclusion: Present study clearly establishes that harmonic laproscopic cholecystectomy is a safe alternative to conventional laproscopic cholecystectomy with short hospital stay, less postoperative pain, early recovery and comparable complication rate.

Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country

The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. The patients were divided into two groups of 10 patients each. Group I included those patients who underwent early excision and grafting within 5 days of burn injury. Group II included those patients who were treated conservatively and the residual raw area was grafted 3 weeks or more after sustaining the burn. The two groups were compared for the amount of blood loss, transfusion requirement, graft take, and the total hospital stay. Statistical significance was tested by the application of Mann-Whitney U test. The mean percentage area burn was 29.1 ± 5.6% in group I and 24.7 ± 4.9% in group II. Mean percentage area resurfaced by skin grafting in group I was 9.4 ± 2.3% and 8.1 ± 1.6% in group II. Graft take in group I was 90 ± 7.8%, whereas that in group II was 95 ± 6.7%. Mean blood loss in group I and group II was 346 ± 17.6 ml and 241 ± 14.7 ml respectively. (P = .001). Mean transfusion requirement in the perioperative period was 1.6 pints in group I and 1.1 pints in group II. The mean hospital stay in the patients who underwent early excision and grafting was 15.1 ± 4.1 days, whereas that in the patients who underwent delayed grafting was 36.2 ± 6.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.

Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan's hemorrhoidectomy.

Objective:To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy.Methods:This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A (Haemorrhoidectomy by Ligasure) and group B (Milligan Morgan Haemorrhoiectomy). Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day.Results:Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 – 60 years. Third degree Heamorrhoids were present in 37 (67.3%) of patients while remaining 18 (32.7%) had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6± 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34±25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method.Conclusion:The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups.

Outcome of minimally invasive surgery in the management of tuberculous spondylitis.

Introduction:With the advancement of instrumentation and minimally access techniques in the field of spine surgery, good surgical decompression and instrumentation can be done for tuberculous spondylitis with known advantage of MIS (minimally invasive surgery). The aim of this study was to assess the outcome of the minimally invasive techniques in the surgical treatment of patients with tuberculous spondylodiscitis.Materials and Methods:23 patients (Group A) with a mean age 38.2 years with single-level spondylodiscitis between T4-T11 treated with video-assisted thoracoscopic surgery (VATS) involving anterior debridement and fusion and 15 patients (Group B) with a mean age of 32.5 years who underwent minimally invasive posterior pedicle screw instrumentation and mini open posterolateral debridement and fusion were included in study. The study was conducted from Mar 2003 to Dec 2009 duration. The indication of surgery was progressive neurological deficit and/or instability. The patients were evaluated for blood loss, duration of surgery, VAS scores, improvement in kyphosis, and fusion status. Improvement in neurology was documented and functional outcome was judged by oswestry disability index (ODI).Results:The mean blood loss in Group A (VATS category) was 780 ml (330-1180 ml) and the operative time averaged was 228 min (102-330 min). The average preoperative kyphosis in Group A was 38° which was corrected to 30°. Twenty-two patients who underwent VATS had good fusion (Grade I and Grade II) with failure of fusion in one. Complications occurred in seven patients who underwent VATS. The mean blood loss was 625 ml (350-800 ml) with an average duration of surgery of 255 min (180-345 min) in the percutaneous posterior instrumentation group (Group B). The average preoperative segmental (kyphosis) Cobb's angle of three patients with thoracic TB in Group B was 41.25° (28-48°), improved to 14.5°(11°- 21°) in the immediate postoperative period (71.8% correction). The average preoperative segmental kyphosis in another 12 patients in Group B with lumbar tuberculosis of 20.25° improved to –12.08° of lordosis with 32.33° average correction of deformity. Good fusion (Grade I and Grade II) was achieved in 14 patients and Grade III fusion in 1 patient in Group B. One patient suffered with pseudoarthrosis/doubtful fusion with screw loosening in the percutaneous group.Conclusion:Good fusion rate with encouraging functional results can be obtained in caries spine with minimally invasive techniques with all the major advantages of a minimally invasive procedures including reduction in approach-related morbidity.

HYSTERECTOMY

Abdominal hysterectomy, the procedure by which almost 90% of hysterectomies are currently being done. Laparoscopicassisted vaginal hysterectomy has been introduced as an alternative to abdominal hysterectomy, and is thought to allow a more rapid return tonormal activity. Laparoscopic assisted vaginal hysterectomy has less postoperative morbidity and quicker recovery than abdominalhysterectomy. Objective: To compare the laparoscopic assisted vaginal hysterectomy with total abdominal hysterectomy in term of operativetime, per operative blood loss and post-operative wound infection. Study Design: Randomized trial. Setting: This study was carried out in thedepartment of obstetrics and gynaecology, Shaikh Zayed Hospital, Lahore. Period: Six months (15th September, 2008 to 15th March 2009).Patients and methods: Eighty patients fulfilling the inclusion criteria were selected for this study. Patients were equally divided in two groups;group A (laparoscopic assisted vaginal hysterectomy) and group B (total abdominal hysterectomy). Operative time (in minutes), blood loss (inml) as estimated and post-operative wound infection was assessed by presence or absence of wound discharge, redness and edema aroundthe incision on 3rd, 5th and 7th post-operative day. Results: The mean ages of women in group A was 49.13+4.26 and 45.68+4.54 years ingroup B. The maximum number of parity between 3-4 was 19 in group A and 20 in group B. Mean weights of cases in group A was 65.60+10.45kilograms and 70.77+15.59 kilograms in groups B. The per-operative time in group A was 105.13+6.55 minutes and 83.38+14.82 minutes ingroup B. The mean blood loss in group A was 178.0+43.51 ml and 228.25+72.49 ml in group B. The wound discharge was not found in group A,while in group B, 4 cases (10%) on 3rd post-operative day, 6 cases (15%) on 5th post-operative day and 11 cases 27.5% on 7th post-operative.Conclusions: Laparoscopic assisted vaginal hysterectomy has a quicker post-operative recovery but at the expense of a bit long duration ofsurgery. Laparoscopic vaginal assisted hysterectomy is a feasible option in a selected group of patients who would otherwise require anabdominal hysterectomy. The drug requirement to control pain and level of pain experienced by patients were also significantly less.