a dispensable ritual in surgery
Dr Ujagar Singh Dhaliwal*
Pre-operative shaving of the operation area is in practice since the dawn of modern surgery in the last century. Although exact origin of this is not well documented, it has been due to :
– aesthetic reasons,
– to prevent hair fall in the wound,
– to prevent hair being entangled in sutures,
– incovenience to give incision,
– prevent infection of the wound,
– prevent the possibility of formation of sinus, etc, etc.
In early seventies, it was observed by Seropian et al that pre-operative hair shaving influences the infection rate of the wound, and trauma caused by razor is responsible for increased infection rate, because the minor abrasions caused by razor injury were acting as good medium for growth of bacteria at the operation site. Even non-visible razor injuries were found responsible for increased infection rate as compared to those areas which needed no shaving because of natural lack of hair especially in females.
Interestingly, it was further observed by Seropian et al that timings of shaving before surgery also had direct effect on wound infection rate, i.e., it was 20% if shaving was done more than 24 hours before surgery, 7.1% if it was done upto 24 hours and 3.1% when it was done immediately before surgery on the operation table after induction of anaesthesia (Powis et al, 1976).
To eliminate this trauma by shaving, other materials like clipping of hair and depilation of hair by hair removing cream were used which gave tremendously good results reducing the infection rate to 0.6% (Cruse and Ford, 1973; Court Brown, 1981).
But in spite of all this no surgeon has stopped shaving as a routine. It was way back in 1985, when I was personally advised by a saintly person, Sant Kahla Singh of Gurdwara Jyoti Swaroop, Jandiala Guru, not to shave his hair for a Hernia operation. Hesitantly, I did his operation through quite a good growth of hair and was surprised to see that his wound healed up absolutely without any problem.
However, I could not make up my mind to practice this in ordinary patients, although in many amritdhari Sikhs, I performed operations as such on their request, without shaving, with good results, which further encouraged me to perform surgery on amritdhari Sikhs without shaving and with no ill effects.
It was in early 1994 that I took up this problem as a research project under a controlled study on scientific principles on 50 male patients undergoing abdominal surgery. This has been completed on August 9, 1996. The patients were advised to take good bath before taking them to the operation table without shaving. The operation field was prepared by Betadine 5%. Incision was given through the growth of hair and wound was closed after surgery as usual and dressing and done.
Following observations have been made
– All the patients were males above 20 years of age with black hair.
– Almost all types of operations were done, like Hernia (12), Appendicectomy (9), Cholecystectomy (6), Laparotomy (7), Ureterolithotomy (4), Prostatectomy (6), Spleenectomy (1), partial Gasterectomy (1), highly Selective Vagotomy (1), Cystogastrostomy (1) and Varicocele (1)
– Only one patient got wound infection and all others had very good wound healing without any sinus or abcess formation.
The length and population of hair, site and length of incision, and duration of operation also had no specific effects.
There was some inconvenience in giving incisions in patients with long and thick growth of hair, but falling of hair in the wound, if any, did not produce any bad effects. Wound closure was also done without any problem. The only problem faced was the removal of sticking plaster on the dressing at the time of stitch removal or change of dressing of wound, which was quite painful.
After the excellent results of this study, I am now performing surgery with the hair intact and without any difficulty. Hundreds of operations have been performed under these conditions. This has many times rewarded me with very good remarks from the Sikh patients, especially amritdharis, and I will strongly recommend to all surgeons not to shave the hair before surgery, especially on Sikhs, to avoid their sentimental trauma which is true as per scientific principles.
– Seropian R; Reynolds B N : Wound infection after pre-operative depilatory versus razor preparation.
Am. J. Surg. 121-1971, 251-253
– Powis SJA; Waterworth; Arkell, C G : Pre-operative skin preparation : Clinical evaluation of depilatory cream.
Br. Med. J. 2 1166-1168, 1976
– Cruse, PJE; Ford R : A five year prospective study of 23,649 surgical wounds. Arch. Surg. 107. 1973-206-210
– Court-Brown, C M : Pre-operative skin depilation and its effects on post-operative wound infection.
J R Coll. Surg. Edin 26-238-241-1981