himesh chauhan - Academia.edu (original) (raw)
Uploads
Papers by himesh chauhan
International Surgery Journal, 2016
Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute ch... more Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute cholecystitis because of the fear of increased morbidity and high rates (60%) of conversion to open surgery. Nowadays, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The purpose of this study is to find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: A total of 100 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay by chi square test and paired t-tests using SPSS software. 45 patients underwent laparoscopic cholecystectomy within 48 h to seven days of onset of symptoms (group 1) and 55 patients underwent surgery after 6 weeks of onset of symptoms (group 2). Results: While the duration of surgery was comparable in both groups (56.5±15 vs. 45.5±15 min), there were no significant difference in conversions or major biliary or other organ injury in any of the two groups. Postoperative stay was also comparable between the two groups (4±1.5 vs 3±1.5, days) but total hospital stay was significantly reduced in group1 compared to group 2 (5±1.5 vs 8.5±1.5 days) and so as total cost is also reduced. Conclusions: Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis. Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.
International Surgery Journal, 2016
The use of cutting electrocautery instead of scalpel for skin incision is gradually gaining wide ... more The use of cutting electrocautery instead of scalpel for skin incision is gradually gaining wide acceptance due to the observation that no change in wound complication rates or postoperative pain are reported with the use of cutting electrocautery. However, these studies include operations without the use of prosthetic materials during other general surgical procedures. The aim of this study was to evaluate the outcome of electrocautery skin ABSTRACT Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it's safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.
International Surgery Journal, 2016
Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute ch... more Background: Initially, laparoscopic cholecystectomy was contraindicated in patients with acute cholecystitis because of the fear of increased morbidity and high rates (60%) of conversion to open surgery. Nowadays, acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy but when to perform surgery still remains controversial. The purpose of this study is to find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. Methods: A total of 100 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay by chi square test and paired t-tests using SPSS software. 45 patients underwent laparoscopic cholecystectomy within 48 h to seven days of onset of symptoms (group 1) and 55 patients underwent surgery after 6 weeks of onset of symptoms (group 2). Results: While the duration of surgery was comparable in both groups (56.5±15 vs. 45.5±15 min), there were no significant difference in conversions or major biliary or other organ injury in any of the two groups. Postoperative stay was also comparable between the two groups (4±1.5 vs 3±1.5, days) but total hospital stay was significantly reduced in group1 compared to group 2 (5±1.5 vs 8.5±1.5 days) and so as total cost is also reduced. Conclusions: Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis. Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.
International Surgery Journal, 2016
The use of cutting electrocautery instead of scalpel for skin incision is gradually gaining wide ... more The use of cutting electrocautery instead of scalpel for skin incision is gradually gaining wide acceptance due to the observation that no change in wound complication rates or postoperative pain are reported with the use of cutting electrocautery. However, these studies include operations without the use of prosthetic materials during other general surgical procedures. The aim of this study was to evaluate the outcome of electrocautery skin ABSTRACT Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it's safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.