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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Comparison of Scrotal Hitch Technique and Conventional Scrotal Dressing in Reducing the Postoperative Scrotal Oedema in Inguinoscrotal Surgeries: A Non Randomised Clinical Study
Correspondence Address :
Balaji Rajavarman,
18, Mariamman Koil Street, Tindivanam-604001, Tamil Nadu, India.
E-mail: rajavarman12@gmail.com
Introduction: Inguinoscrotal swellings, including hernias and hydroceles, are the most common complaints in the surgical outpatient department. Hernioplasty and eversion of the sac are the most common elective procedures for inguinoscrotal swellings. Scrotal oedema is one of the complications following the surgery, which increases the patient’s morbidity.
Aim: To evaluate the effectiveness of the scrotal hitch technique in preventing scrotal oedema and postoperative pain after inguinal and scrotal surgeries compared to conventional scrotal dressing.
Materials and Methods: This is a non randomised clinical study conducted in the Department of General Surgery at Melmaruvathur Adhiparasakhti Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India, from September 2021 to December 2023, among 60 patients undergoing inguinoscrotal surgeries. Group-A consists of 30 patients who were given scrotal hitch and 30 patients in Group-B were given conventional scrotal dressing. The outcomes were compared between both groups for scrotal oedema and postoperative pain. Descriptive statistics were presented as mean±Standard Deviation (SD) for continuous variables and frequencies and percentages for categorical variables. Fisher’s-exact test was used as a test of significance for categorical data. Student’s t-test and Mann-Whitney U test were used as tests of significance for continuous data.
Results: The mean age of patients in Group-A was 51.7±13.87 years and in Group-B was 53.03±14.22 years. In Group-A, two patients developed scrotal oedema with the scrotal hitch, while in Group-B with scrotal dressing, 11 patients developed scrotal oedema 72 hours postsurgery. In Group-A, the median Visual Analogue Scale (VAS) score at 6, 24, 48 and 72 hours was 6, 3, 1 and 0. In Group-B, the median VAS score was 7, 4, 1 and 0 at 6, 24, 48 and 72 hours.
Conclusion: Postoperative pain was found to be lower in the scrotal hitch group compared to patients with conventional scrotal dressing.
Hernioplasty, Hypnotic stitch, Scrotal bandaging, Scrotal hydrocele
Throughout the world, approximately 20 million inguinal hernia repairs are performed every year. Therefore, inguinal hernia repair is one of the most frequently performed surgeries worldwide (1). Similarly, in India, inguinoscrotal surgeries are common procedures performed by general surgeons. These surgeries include inguinal hernia repair and eversion of the sac for inguinal hernia and hydrocele, respectively (2). As complications are quite common with every surgical procedure, the complications of hernia repair Inuclide infection, recurrence, bleeding, nerve damage, scrotal swelling and pain (3),(4). One significant complication in inguinal surgeries that causes considerable morbidity to the patient is scrotal oedema, which is believed to be due to excessive handling of the cord structures (1). Eversion of the sac, also known as Jaboulay’s procedure, is most useful for recent-onset hydrocele, where the sac is opened, everted and the edges sutured behind the testis. Scrotal surgery, although generally considered to be technically easy and routine, has a considerable incidence of complications as this procedure is associated with an increased risk of haematoma (5). In scrotal surgeries, scrotal haematoma causes significant morbidity to the patients when haemostasis is not meticulously performed. Therefore, scrotal oedema is a common complication in both inguinal hernia repair and scrotal surgery. Scrotal support is used to prevent the stretching of the spermatic cord and the associated structures such as vessels and testes.
Scrotal support prevents oedema by providing antigravity support and compressing the layers of the scrotum to reduce the risk of haematoma and scrotal oedema (4). Over the years, various methods of scrotal dressings have been used to reduce scrotal oedema and haematoma. These methods include a surgical face mask with Elastoplast by Mandler, circumferential pressure dressing using the roll bandage technique and turban scrotal dressing by Manson and MacDonald, where a 2-inch-wide roll of gauze is wrapped around the scrotum in a turban style. Other methods include simple scrotal compression dressing and tight V undergarment (6),(7). In the present study, the authors aimed to compare the effectiveness of scrotal hitching against conventional scrotal dressing in preventing scrotal oedema.
A non randomised clinical study was conducted in the Department of General Surgery at Melmaruvathur Adhiparasakhti Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India, from September 2021 to December 2023. Approval was obtained from the Institutional Ethical Committee (Serial Number: MAPIMS/IEC/52/2021) and registered with the Clinical Trial Registry, India (CTRI/2022/02/040472). Written informed consent was obtained from all study participants.
Sample size calculation: The sample size was calculated using open epi software for two proportions. The proportion of scrotal oedema in subjects in Group-A (scrotal hitch) was 6.7% and the clinically significant difference between the two proportions was 10% (8). In this study, a sample size of 45 was required at a 95% confidence interval and a power of 80%. To account for potential loss to follow-up or a dropout rate of 20%, the final sample size was 60, with 30 patients in each group in a 1:1 ratio.
Inclusion and Exclusion criteria: A total of 60 male patients aged over 18 years who presented with inguinal, inguinoscrotal and scrotal swellings were included in the study. Patients with recurrent inguinoscrotal swellings and those unfit for surgery were excluded. Patients who were unwilling to participate in the study were also excluded.
Study Procedure
A total of 30 eligible study participants were assigned to Group-A, who underwent the scrotal hitch technique and 30 eligible participants were assigned to Group-B, who underwent conventional scrotal dressing. The allocation was based on the investigators’ or surgeons’ preference. There were no losses to follow-up. In Group-A, patients underwent scrotal hitch, where the scrotum was pulled up over a gauze roll onto the abdomen lateral to the penis and sutured to the lower abdomen and upper thigh with 2-3 monofilament sutures. In Group-B, patients underwent conventional scrotal support with gauze dressing, provided in the form of a bandage immediately postsurgery and the use of tight undergarments the following day.
Patients were followed-up at 6, 24, 48 and 72 hours for various parameters, such as complications (cord oedema, seroma, or haematoma) and postoperative pain. Postoperative pain was measured by the VAS (9). The scrotal hitch was removed on the 3rd postoperative day. The incidence of scrotal oedema and postoperative pain were compared between the scrotal hitch Group and conventional scrotal support group.
Statistical Analysis
The data were analysed using Statistical Package for the Social Sciences (SPSS) version 22.0 software. Categorical data were expressed as frequencies and proportions, while continuous data were presented using means and standard deviations and medians for discrete variables. The Fisher’s-exact test was used as a test of significance for categorical data. Student’s t-test and Mann-Whitney U test were used as tests of significance for continuous data. A p-value of <0.05 was considered statistically significant at a 95% confidence interval.
The mean age was 51.7±13.87 years in the scrotal hitch group and 53.03±14.22 years in the conventional scrotal dressing group, with no statistically significant difference between the two groups (Student’s t-test, p=0.715). The majority of the study participants (71.5%) underwent hernioplasty. In Group-A, most participants had a right inguinal hernia, while in Group-B, the majority had bilateral inguinal hernia (Table/Fig 1).
At 24 hours, two patients in Group-A and eight patients in Group-B developed scrotal oedema. By 72 hours postoperatively, 2 patients (6.7%) in Group-A and 11 patients (36.7%) in Group-B had developed scrotal oedema. These differences were statistically significant (p-value <0.05) (Table/Fig 2).
The VAS scores between the two groups were not statistically significant at six hours (p=0.078), 24 hours (p=0.404) and 48 hours (p=0.674), but were statistically significant at 72 hours (p=0.035) (Table/Fig 3).
In the present study, we performed a scrotal hitch technique where a simple suture was done by lifting the skin from the bottom of the scrotum and stitching it to the skin near the pubic symphysis and pubic tubercle using a non absorbable suture material. Elevating the scrotum in this way prevents excessive fluid collection. There were no complaints or side effects among the patients due to this procedure. In a study conducted by Griffin JH and Canning JR, 46 cases were treated with scrotal hitching and no patients developed scrotal oedema. Scrotal hitching is not only used after inguinoscrotal surgeries but also in other urological procedures (10). In the present study, the incidence of postoperative scrotal oedema and pain was significantly lower in patients who underwent scrotal hitching.
A recent pilot study conducted by Raja R et al., showed that scrotal hitching, as a novel technique, reduced the incidence of postoperative scrotal oedema and pain compared to conventional scrotal support in inguinal hernia repair (8). The mean age of the participants in their study was 45.63±21.745 years in Group-A and 41.43±24.579 years in Group-B. In the scrotal hitch group, 6.7% of patients developed scrotal oedema, while 20% of those who underwent coconut bandage as scrotal support developed scrotal oedema, significantly higher than the scrotal hitch group. The median VAS scores at 6, 12, 48 and 72 hours in the scrotal hitch group were 3, 2, 1 and 1, respectively and 4, 4, 2 and 2 in the scrotal support group, showing significantly lower pain scores which support the findings of the present study.
Another study by Sadre DA et al., showed that 7.6% and 12.3% developed scrotal oedema in the scrotal hitch and scrotal support groups on postoperative day 1, respectively. By the end of 72 hours, 1.5% and 6.5% developed scrotal oedema in the scrotal hitch and scrotal support groups, respectively. The increase in scrotal oedema could be explained by increased movement in the scrotal position with scrotal support, whereas in the technique where the scrotum is hitched close to the lower abdomen skin, scrotum movement is restricted, thereby reducing oedema (11). In 4.6% of the scrotal hitch patients in the Sadre DA et al., study, stitch failure and infection at the hitch site were seen. In the same study, the median VAS score in the scrotal hitch group was four at six hours, two at 24 hours and one each at 48 and 72 hours. In the scrotal support group, the median VAS score was nine at six hours, five at 24 hours and three and two at 48 and 72 hours, respectively. The study showed that the pain score in the scrotal hitch group significantly improved (11).
In a study conducted by Kosternoy A and Bayumi EK 5% and 10% developed scrotal oedema in the scrotal hitch and scrotal support groups, respectively, which was statistically significant (12). The total pain score was higher in scrotal support patients than in scrotal hitch patients; however, it was not significant, which supports the findings of the present study.
Limitation(s)
The study was a single-centre study and only limited variables were analysed; therefore, the findings cannot be generalised to the entire population. Further randomised studies can be planned with determinant variables and long-term follow-up to quantify the outcomes following the scrotal hitch procedure.
The scrotal hitch has been found to result in less postoperative scrotal oedema and pain compared to conventional scrotal support. This effective technique could be adopted by surgeons in common inguinoscrotal surgeries to prevent these complications.
DOI: 10.7860/JCDR/2024/74817.20283
Date of Submission: Aug 08, 2024
Date of Peer Review: Sep 13, 2024
Date of Acceptance: Oct 03, 2024
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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ETYMOLOGY: Author Origin
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