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Use of Ligasure Sealing Versus Conventional Suture - Ligation in Total Thyroidectomy
Wael AlJuraibi
,
Mohamed Rifaat Ahmed
,
Aly Saber
Issue: Volume 4, Issue 3-1, June 2016
Pages: 34-38
Received: 8 April 2016
Accepted: 10 April 2016
Published: 4 June 2016
DOI:
10.11648/j.js.s.2016040301.17
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Abstract: Introduction: Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system (Ligasure) has been applied in various specialties of surgery. The objective of this randomized study was to compare the outcome of ligasure versus conventional clamping and tie in total thyroidectomy for benign thyroid diseases. Patients and Methods: A total of 200 patients diagnosed to have bilateral BMNG were subjected to primary total thyroidectomy and divided into two main groups Ligasure (L) and Suture-Ligation (SL). For detection of laryngeal nerves status, vocal cords were checked immediately postoperatively by laryngoscope and at the day 10 of postoperative period to assess the status of both laryngeal nerves. The function of the parathyroids was checked by detecting the serum calcium concentration and parathyroid hormone level. The following parameters were measured to compare the effect of ligasure versus conventional suture-ligation technique in decreasing the operative blood loss, operative time, securing laryngeal nerves and parathyroids, postoperative drainage and postoperative wound infection. Results: There was no statistical difference between the two groups regarding age, sex and body mass index and also there was no operative mortality. As regard the operative time, in ligasure group it was 115.54 ±15.35 minutes while in suture-ligation group was 127.1 ±7.95 minutes and intraoperative blood loss in group A was 62.06 ± 7.34 and in group B was 75.84± 9.21. Temporary RLN injury was detected in 3 patients (3%) in group A and in 5 patients in group B (5%). No permanent hypoparathyroidism was seen in group A patients but in one patient (1%) of group B, transient hypoparathyroidism occurred in 2 patients (2%) of both groups. The amount of fluid drained in group A was 54.16 ±9.21 and 66.28 ±8.99 in group B. Conclusion: The use of the Ligasure sealing system in total thyroidectomy is proved safe and effective in reducing the operative time, intraoperative blood loss together with reduction in postoperative fluid drainage. Owing to the ability to reduce energy spread profile, use of Ligasure sealing system is accompanied with better outcome regarding the function of laryngeal nerves and parathyroids.
Abstract: Introduction: Effective vessel haemostasis can be achieved by suture knot tying technique or newer techniques of vessel haemostasis like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system...
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Nasopharyngeal Branchial Cyst, a Rare Presentation
Issue: Volume 4, Issue 3-1, June 2016
Pages: 25-28
Received: 14 March 2016
Accepted: 16 March 2016
Published: 18 April 2016
DOI:
10.11648/j.js.s.2016040301.15
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Abstract: Introduction: Branchial cleft cysts are congenital developmental defects of which second branchial anomalies are the most common type. Most of these anomalies present as a lateral neck mass along anterior border of sternocliedomastoid muscle. Careful examination and proper intervention is needed in some of these cases to avoid unwanted complications or even emergencies. Case presentation: A 5 years old boy was brought by his parents with history of dysphagia and snoring for about one month. There was no other associated history of sore throat or shortness of breath or oral bleeding. During fiberoptic examination we found a pedunculated left nasopharyngeal mass. CT imaging showed a left nasopharyngeal hypodense lesion with no vascular or bony invasion. Excision of the cyst was done via combined transoral/transnasal endoscopic approach. Follow up after eight months showed no evidence of recurrence. Conclusion: Second branchial cleft cysts presenting in the nasopharynx are considered rare presentations of the disease and other differential diagnosis should be always brought in mind. Fiberoptic examination of such cases is mandatory to rule out laryngeal involvement and to predict the extension of the cyst for surgical intervention. Surgical excision through combined transoral/transnasal endoscopic including the tract ligation is the treatment of choice to prevent recurrence and to minimize the occurrence of possible secondary infection of the cyst.
Abstract: Introduction: Branchial cleft cysts are congenital developmental defects of which second branchial anomalies are the most common type. Most of these anomalies present as a lateral neck mass along anterior border of sternocliedomastoid muscle. Careful examination and proper intervention is needed in some of these cases to avoid unwanted complication...
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Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis
Abdallah M Taha
,
Mohamed Yousef A.
,
Asmaa Gaber R.
Issue: Volume 4, Issue 3-1, June 2016
Pages: 29-33
Received: 16 March 2016
Accepted: 17 March 2016
Published: 18 April 2016
DOI:
10.11648/j.js.s.2016040301.16
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Abstract: Introduction: Acute cholecystitis is a relatively common complication of gallstones It can lead to significant morbidity and mortality from potentially life-threatening complications such as empyema, gallbladder gangrene and gallbladder perforation It presents as a surgical emergency and usually requires hospitalization for management Laparoscopic cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of controversy Aim: To compare the outcome of early versus delayed laparoscopic cholecystectomy in cases of non-complicated acute cholecystitis, as its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate Design: Prospective interventional comparative study Methods: 120 Patients admitted to Qena and Aswan universities’ hospitals with acute cholecystitis over two years period (2013-2015) were included in this study An early laparoscopic cholecystectomy (ELC), within 7 days from onset of symptoms, for 50 patients, and delayed Laparoscopic cholecystectomy (DLC) after 6 weeks of conservative treatment for 70 patients was performed Demographic details, operative findings, conversion to open surgery, operative time, complications, timing of endoscopic retrograde cholangiopancreatography (ERCP) and hospital stay for all those patients were recorded Statistical analysis was performed by SPSS version 18 Results: There was insignificant difference in the conversion rates (2 in ELC group versus 2 DLC group, p value: 0.555), post-operative hospital stay (2 days vs 1.5days, p value: 0.375) However, operative time was significantly more in the ELC group (85 minutes versus 70 minutes, p value: 0.023) Postoperative ERCP was required in 2 patients in ELC group and one patient in DLC group Pre-operative ERCP was required in 2 patients in delayed group 40% of patients (48) had previous admissions with similar symptoms Conclusion: ELC for uncomplicated acute cholecystitis is technically demanding surgery, but it is safe and do not have increased complication rate than DLC It decreases re-admission rate and overall hospital stay.
Abstract: Introduction: Acute cholecystitis is a relatively common complication of gallstones It can lead to significant morbidity and mortality from potentially life-threatening complications such as empyema, gallbladder gangrene and gallbladder perforation It presents as a surgical emergency and usually requires hospitalization for management Laparoscopic ...
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Evaluation of an Infection Control Measures Protocol Application by Nurses on Patients' Safety at Burn Units
Amany Ibrahim Ezz Eldeen
,
Magda Abd-Elaziz
,
Amr Mohamed Moghazy
,
Eman Saleh Shahin
,
Amal Bakr Abo El-Ata
Issue: Volume 4, Issue 3-1, June 2016
Pages: 1-9
Received: 28 January 2016
Accepted: 29 January 2016
Published: 23 March 2016
DOI:
10.11648/j.js.s.2016040301.11
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Abstract: Introduction: Healthcare-Associated Infection (HAI) has become a major component of the national and international movement to enhance patient safety. Infection is the most common cause of death among burn patients following the burn injury itself. Nurses are at the center of patient care and are the healthcare professionals most likely to intercept errors and prevent harm to patients. The aim of this study was to improve nurses' performance in Burn Units regarding infection control measures with subsequent enhancement of the patients' safety. Subjects and methods: The data were collected using three tools: a self-administered questionnaire, an observation checklist, and a bacteriological culture results form. The results of this study indicated that the percentage of nurses having satisfactory knowledge increased from a pre-intervention level of 17.6%, to a post intervention level of 67.6%. This improvement was statistically significant (p<0.001); as well the percentage of nurses having adequate practice rose from a pre-intervention level of 0.0%, to a post intervention level of 85.3%, with statistically significant difference (p<0.001). There were no any statistically significant correlations between nurses’ knowledge and practice scores before and after the intervention. Moreover, the number of nurses with negative hands' culture results increased from 3(8.8%) to 7(20.6%), but the difference was not statistically significant. The intervention program was identified as the main positive predictor of the change in nurses’ knowledge and practice scores. In conclusion, nurses' knowledge of infection control in burn units and their related practice are very deficient; the educational intervention is successful in improving them. The intervention is also successful in decreasing the Bacillus spp. in nurses’ culture samples. The study recommended different strategies to decrease rates of infection as well as improve patient safety.
Abstract: Introduction: Healthcare-Associated Infection (HAI) has become a major component of the national and international movement to enhance patient safety. Infection is the most common cause of death among burn patients following the burn injury itself. Nurses are at the center of patient care and are the healthcare professionals most likely to intercep...
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Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy
Aly Saber
,
Emad K. Bayumi
Issue: Volume 4, Issue 3-1, June 2016
Pages: 10-13
Received: 28 January 2016
Accepted: 29 January 2016
Published: 23 March 2016
DOI:
10.11648/j.js.s.2016040301.12
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Abstract: Introduction: Perianal abscess is one of the most common general surgical emergencies encountered in clinical practice and the initial treatment is simple incision and drainage, other surgical procedures as fistulotomy may be required as a definitive measure for treating fistula because about 40% of patients present with a fistula after simple incision and drainage of their perianal abscesses. The aim of this study was to detect the outcome of simple drainage versus drainage and fistulotomy for perianal abscess as regard to abscess recurrence, fistula formation and time off from work. Patients and Methods: A total number of 200 patients of both sexes; 100 for each group, their ages ranged between 21- 65 years were enrolled to this parallel prospective randomized clinical trial where patients were divided randomly into two main groups; A and B. Group A patients [N =100] were subjected to simple incision & drainage and those of group B [N = 100] were subjected to drainage & fistulectomy for acute perianal abscess. End Points: The primary end points were abscess recurrence, fistula formation and incontinence. The secondary end points were time off from work, wound discharge, wound healing and patients’ satisfaction. Results: Patient’s satisfaction of the treatment maneuver in relation to abscess recurrence and fistula occurrence was 80 % and 95% of group A and B respectively. Conclusion: The present study showed that treatment of perianal abscess through the combined maneuver of incision – drainage with fistulotomy at the same time significantly reduced the likelihood of persistent abscess, recurrence and need for repeat surgery. Patient’s satisfaction after treatment with this combined method showed a significant value than incision – drainage only as regard disease recurrence, time of wound discharge and the incidence of fistula formation.
Abstract: Introduction: Perianal abscess is one of the most common general surgical emergencies encountered in clinical practice and the initial treatment is simple incision and drainage, other surgical procedures as fistulotomy may be required as a definitive measure for treating fistula because about 40% of patients present with a fistula after simple inci...
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Response of Post-Mastectomy Lymphedema to Extracorporeal Shockwave Therapy
Mahmoud El-Shazly
,
Wafaa Hussien Borhan
,
Wael Naeem Thabet
,
Ashraaf Hassan
Issue: Volume 4, Issue 3-1, June 2016
Pages: 14-20
Received: 31 January 2016
Accepted: 31 January 2016
Published: 23 March 2016
DOI:
10.11648/j.js.s.2016040301.13
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Abstract: Introduction: Post-mastectomy lymphedema is a chronic, debilitating disorder that is frequently misdiagnosed, treated too late or not treated at all, Lymphedema (LE) is an abnormal accumulation of protein-rich fluid in the interstitium leading to limb swelling, chronic inflammation and reactive fibrosis of the affected tissues resulting from damage to lymphatic circulation following surgery, chemotherapy and/or radiation therapy. The aim was to investigate the effect of shockwave therapy on the post-mastectomy lymphedema. Subjects and methods: Sixty female patients underwent modified radical mastectomy surgery or lumpectomy, chemotherapy and radiotherapy associated with unilateral lymphedema (stage 2, 3), into two equal groups; their ages ranged from 30-50 years. The study group received shockwave therapy 2 times/week for 6 weeks plus traditional physical therapy program (manual lymphatic drainage, circulatory exercises with elevation, shoulder ROM exercises and pneumatic compression therapy) 3times /week /6weeks. Control group received traditional physical therapy program (manual lymphatic drainage, circulatory exercises with elevation, shoulder ROM exercises and pneumatic compression therapy) 3times /week /6weeks. Evaluation procedures were carried out to measure the upper limb volume measurement, ROM of shoulder flexion, abduction and external rotation. Results: Post treatment results showed that there was a significant improvement difference in shoulder ROM and upper limb volume in both groups in favor of the study group. Percentage of improvement of shoulder abduction, flexion, and external rotation in the study group was 38.92%, 26.61%, 36.24% respectively, while it was 20.86%, 14.93%, 16.17%in the control group. Percentage of improvement of upper limb volume in the study group was 24.21%, while it was 15.5% in the control group. Conclusion: extracorporeal shockwave therapy was considered to be an effective modality for treatment of the post-mastectomy lymphedema.
Abstract: Introduction: Post-mastectomy lymphedema is a chronic, debilitating disorder that is frequently misdiagnosed, treated too late or not treated at all, Lymphedema (LE) is an abnormal accumulation of protein-rich fluid in the interstitium leading to limb swelling, chronic inflammation and reactive fibrosis of the affected tissues resulting from damage...
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Response of Forced Expiratory Volume/Forced Vital Capacity Ratio to Acapella Device and Breathing Exercises After Upper Abdominal Surgeries
Nesma M. Allam
,
Mohammed M. Khalaf
,
Wael N. Thabet
,
Zizi M. Ibrahim
Issue: Volume 4, Issue 3-1, June 2016
Pages: 21-24
Received: 14 February 2016
Accepted: 15 February 2016
Published: 23 March 2016
DOI:
10.11648/j.js.s.2016040301.14
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Abstract: Background: A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The aim was to compare the effect of Acapella device and breathing exercises with traditional chest physiotherapy program on forced expiratory volume/ forced vital capacity ratio after upper abdominal surgeries. Subjects and methods: Thirty patients underwent upper abdominal surgery were assigned randomly into two equal groups; their ages ranged from 20-50 years. The study group received breathing exercises, Acapella device and traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). Control group received traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). All groups received three sessions per week for four successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure forced expiratory volume/ forced vital capacity ratio (FEV1/ FVC ratio) using electronic spirometer. Results: Post treatment results showed that there was a significant difference in FEV1/ FVC ratio in both groups in favor of the study group. Percentage of improvement of FEV1/ FVC ratio in the study group was 10.17%, while it was 2.96% in the control group. Conclusion: Acapella device and breathing exercises were more effective in improvement of FEV1/FVC % than traditional chest physical therapy after upper abdominal surgeries.
Abstract: Background: A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The aim was to compare the effect of Acapella device an...
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