Abstract: Aims and Objectives:
To compare monopolar electrocautery versus ultrasonic dissection of gall bladder in laparoscopic cholecystectomy in terms of duration of surgery, intra-operative complications, post-operative drain used, post-operative pain and duration of hospital stay.
Set up: A tertiary care hospital-based study in the department of General Surgery, IGMC, Shimla.
Study Period: One-year w.e.f.1st July 2019 to 30th June 2020.
Setting: This study was done in the Department of General Surgery at Indira Gandhi Medical College and Hospital, Shimla w.e.f.1stJuly 2018 to 30thJune 2019 on 100 patients admitted for laparoscopic cholecystectomy, randomly divided into 2 groups; Group 1- dissection done with harmonic scalpel, Group 2- dissection done with electrocautery.
Study Design: Observational study
Parameters recorded: A) Intra-operative - operative time, intra-operative gall bladder perforation and blood loss, number of times lens cleaned during surgery, use of drain;
B) Post-operative - post-operative pain, length of hospital stay, post-operative complications.
Results: The patients in these two groups were similar as regards to age, sex, symptomatology, general & systemic examination and laboratory investigations. Data was analysed and the following observations were made: Gallstones were more common in females. Majority of the patients belonged to the middle age group (40-59 yrs). In the present study perforation of gall bladder occurred in 24% of cases in group 1 as compared to 38% of cases in group 2, lens was cleaned less frequently in group 1 as compared to group 2, drain was used in 24% of patients in group 1 whereas it was used in 40% of patients in group 2, The total duration of surgery was shorter in harmonic group. Mean intra-operative blood loss, pain score at 6 & 24 hours in Group 1 was less than in Group 2, Mean duration of hospital stay was 1.64 +- 0.66 days in group 1 and 2.88+- 1.09 days in group 2.
Conclusion: The harmonic scalpel use for dissection of gall bladder offers various advantages over conventional use of monopolar electrocautery in terms of safer dissection, lesser duration of surgery, decreased number of times lens cleaned intra-operatively, lesser post-operative pain and lesser duration of hospital stay. These factors result in lesser morbidity to patient and early recovery.