BACKGROUND:Haemorrhoids are one of the most frequent anorectal disorders encountered in the primary care setting. Heamorrhoidectomy is the procedure of choice. Harmonic scalpel had been advocated for performing bloodless Haemorrhoidectomy, in place of electric cautery and ligatures. AIM: The aim of this study is to compare Harmonic scalpel Haemorrhoidectomy with conventional M. M. Haemorrhoidectomy using electric cautery in the management of grade III and grade IV haemorrhoids with reference to certain characteristics like postoperative pain, complications, hospital stay, cost of surgery. METHODS AND MATERIALS: This is a randomized single blind control study with 50 patients divided into two groups. 25 patients underwent M. M. Haemorrhoidectomy (M. M. Group), and rest underwent Harmonic scalpel Haemorrhoidectomy (H. S. Group). Results were compared in relation to certain characteristics like perioperative bleeding, postoperative pain and complications, hospital stay, cost of surgery. RESULTS: Age and gender wise distribution in both groups is comparable. Intraoperative bleeding was more frequent in the MM group than in HS group (32% versus 16% respectively). Intraoperative bleeding was more frequent in the MM group than in HS group (32% versus 16% respectively). Hospital stay was prolonged in the MM group than HS group, as 44% in MM group were discharged at three days, when compared to 76% in HS group. CONCLUSION: Harmonic scalpel haemorrhoidectomy had better outcome in characteristics like postoperative pain, post-operative complications, hospital stay, but its more expensive than conventional M. M. Haemorrhoidectomy. KEYWORDS: Harmonic scalpel, Haemorrhoidectomy, Milligan Morgan. INTRODUCTION:Haemorrhoids are one of the commonest anorectal disorders encountered in general surgical practice. They are the most common cause of bleeding per rectum and responsible for considerable patient suffering and disability. (1) Haemorrhoidectomy is the treatment of choice for grade III and grade IV Haemorrhoids. Post-operative course after haemorrhoidectomy will be protracted and painful. Different surgical techniques and use of recent advancements in instrumentations like Harmonic scalpel, Ligature and circular stapler (PPH) had been advocated for better outcome and to minimize perioperative bleeding and post-operative pain.Harmonic scalpel is an ultrasonically activated instrument, which vibrates at a rate of 55,000 HZ per second. It generates less temperature during tissue dissection and controls bleeding by coacptive coagulation at low temperatures ranging from 50 o C to 100 o C. Coagulation occurs by means of protein denaturation when the blade vibrating at 55000 HZ, couples with protein, denaturating it to form a coagulum that seals small coapted vessels. When the effect is prolonged, secondary heat is produced that seals larger vessels.By contrast, electro surgery and lasers coagulate by burning (Obliterative coagulation) at higher temperatures (150 o C to 400 o C). Blood and tissue are desiccated and oxidiz...

Background: Physicians working in casualty are often confronted with acute abdomen and get much more bothered as the diagnosis is not easy. This is due to the fact that the etiology of acute abdomen is always much diversified and the classical findings are masked making the diagnosis difficult. Objective was to study incidence of appendicitis and ovarian cyst among female patients presenting with acute abdomen.Methods: A hospital based follow up study was carried out among 64 cases presented with acute abdomen to the casualty from January 2018 to August 2018. All necessary investigations were done to confirm the etiology of acute abdomen. The cases belonged to surgery and gynecology departments where they were operated. The patients were followed from admission in the casualty to the final outcome. The data was analyzed using proportions.Results: During the study period a total of 15413 patients were admitted in the casualty out of them, 64 (0.42%) presented with acute abdomen. Of these 64 cases, majority i.e. 35 (54.7%) were due to acute appendicitis; 13 cases were due to renal colic and eight cases each were due to ectopic pregnancy and ovarian cyst. The most common age group affected was 21-30 years (62.5%) followed by less than 20 years age (21.9%). 25% of the 64 cases had delayed wound healing and no other complications were reported. No death was recorded.Conclusions: Authors achieved excellent results as there were no major complications and no death was recorded. Thus, meticulous diagnosis and prompt treatment can save patient life and at the same time rate of complications can be reduced.