Comparison of Pedicle Coagulation Hemorrhoidectomy With LigaSure Versus Conventional Milligan Morgan Hemorrhoidectomy in Reducing Post-operative Pain: A Randomized Controlled Trial.

Background Hemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan-Morgan open hemorrhoidectomy with pedicle ligation with LigaSure (Medtronic, Dublin, Ireland) in terms of postoperative pain on day 1 and day 7. It is important to assess the technique that is associated with lower postoperative pain because both of these techniques are still practiced in the developing world. Methods It was a randomized controlled trial conducted in the Department of Surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aged from 15 to 60 years who presented with symptomatic third and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Pain was assessed using the Visual Analogue scale (VAS). Data was entered and analyzed using SPSS v. 23.0 (IBM Corp., Armonk, USA). Chi-square tests were applied. P-value <0.05 was taken as statistically significant. Results Out of 100 patients, 68 (68%) were males while 32 (32%) were females. The mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64 (p<0.0001). Postoperative pain at day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group (p<0.0001). Conclusion LigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. Pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative pain helps in greater patient satisfaction and lesser requirement of analgesia among patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.

Synthesis and characterization of copper oxide nanoparticles: its influence on corn (Z. mays) and wheat (Triticum aestivum) plants by inoculation of Bacillus subtilis.

Nanotechnology is now playing an emerging role in green synthesis in agriculture as nanoparticles (NPs) are used for various applications in plant growth and development. Copper is a plant micronutrient; the amount of copper oxide nanoparticles (CuONPs) in the soil determines whether it has positive or adverse effects. CuONPs can be used to grow corn and wheat plants by combining Bacillus subtilis. In this research, CuONPs were synthesized by precipitation method using different precursors such as sodium hydroxide (0.1 M) and copper nitrate (Cu(NO3)2) having 0.1 M concentration with a post-annealing method. The NPs were characterized through X-ray diffraction (XRD), scanning electron microscope (SEM), and ultraviolet (UV) visible spectroscopy. Bacillus subtilis is used as a potential growth promoter for microbial inoculation due to its prototrophic nature. The JAR experiment was conducted, and the growth parameter of corn (Z. mays) and wheat (Triticum aestivum) was recorded after 5 days. The lab assay evaluated the germination in JARs with and without microbial inoculation under CuONP stress at different concentrations (25 and 50 mg). The present study aimed to synthesize CuONPs and systematically investigate the particle size effects of copper (II) oxide (CuONPs) (< 50 nm) on Triticum aestivum and Z. mays. In our results, the XRD pattern of CuONPs at 500 °C calcination temperature with monoclinic phase is observed, with XRD peak intensity slightly increasing. The XRD patterns showed that the prepared CuONPs were extremely natural, crystal-like, and nano-shaped. We used Scherrer's formula to calculate the average size of the particle, indicated as 23 nm. The X-ray diffraction spectrum of synthesized materials and SEM analysis show that the particles of CuONPs were spherical in nature. The results revealed that the synthesized CuONPs combined with Bacillus subtilis used in a field study provided an excellent result, where growth parameters of Z. Mays and Triticum aestivum such as root length, shoot length, and plant biomass was improved as compared to the control group.

Comparison of Ultrasonic Dissection and Suture Ligation for Mesoappendix in Laparoscopic Appendectomy.

Objective To compare the use of ultrasonic dissector and suture ligation for mesoappendix in laparoscopic appendectomy in terms of mean operative time and per-operative bleed. Methodology This was a randomized controlled trial conducted at Surgical Unit II, Holy Family Hospital over a period of six months. All patients with the diagnosis of acute appendicitis who presented in the emergency department of Holy Family Hospital on the call days of Surgical Unit II undergoing laparoscopic appendectomy were included in the study. After taking informed consent about the respective procedure, patients were allocated to two groups using computer-generated random numbers. Group A was operated using harmonic scalpel and in Group B suture ligation was done. Total time required to ligate the mesoappendix or to cauterize it using the harmonic scalpel was measured in minutes. Data was entered and analyzed in SPSS version 21.0 (IBM Corp., Armonk, NY). Results A total of 110 patients were enrolled in the study according to the inclusion criteria of the study. Patients were randomly divided into two equal groups. Patients in Group A were operated using harmonic scalpel whereas patients in Group B were operated by suture ligation for dealing the mesoappendix in laparoscopic appendectomy. Mean operative time to ligate the mesoappendix for Group A patients was 1.56 (SD = 0.68) minutes while that of Group B was 21.07 (SD = 2.84) minutes. There was no per-operative bleeding in case of Group A while its incidence was 24% of patients in Group B. Results were statistically significant. Conclusion The conclusion of the study is that the use of harmonic scalpel was better than suture ligation for ligating the mesoappendix in laparoscopic appendectomy in terms of mean operative time and per operative bleed, hence it's preferable over the later in laparoscopic appendectomy.

Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis.

Introduction Laparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes. This study compares laparoscopic appendectomy and open appendectomy in cases of a perforated appendix by assessing surgical site infection, mean operating time, and length of hospital stay. Materials and methods This study was a prospective randomized study conducted at the Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan, from January 2016 to January 2017, by randomly allotting the laparoscopic or the open appendectomy technique to 130 patients by the lottery method. Patients having a perforated appendix were included after they provided informed consent. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, US). Results The frequency of wound site infection was significantly higher in open appendectomy (27.69%) than in the laparoscopic approach (10.77%; p=0.01). Mean hospital stay was slightly longer in the laparoscopic approach (4.38 ± 1.09 days) than in open appendectomy (4.18 ± 0.77 days; p=0.23). Mean operating time for laparoscopic appendectomy and open appendectomy was 46.98 ± 2.99 minutes and 53.02 ± 2.88 minutes, respectively (p<0.000). Conclusion Laparoscopic appendectomy was associated with fewer surgical site infections and shorter mean operating time than an open appendectomy.