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Basrah journal of surgery ( An Open Access Journal ) indexed in DOAJ   scientific, open access journal licensed under a Creative Commons Attribution 4.0 International (CC-BY 4.0) journal is published biannually by University of Basrah, College of Medicine, Iraq since 1995. The edittor utilizes iThenticate to check  plagiarism and to ensure the originality manuscripts submitted to this journal. A double-blind peer reviewing system is also used to assure the quality of publication. Basrah Journal of Surgery publishes original articles, review papers and case reports in...
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Journal Information

Publisher: Basrah University

Email:  basjsurg95@yahoo.com

Editor-in-chief: Professor Dr. Thamer A. Hamdan, FRCS,FRCP,FACS,FICS

Editor-in-chief: Professor MSc. Salam N. Asfar, MSc

Print ISSN: 1683-3589

Online ISSN: 2409-501X

GLOBAL COMPARISON OF THE OUTCOME OF SURGICAL TECHNIQUES FOR SPONDYLODISCITIS

Jessica Burton; Thamer Hamdan; Bisola Ajayi; Mohsen Raza; Angelo Fragkakis

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 3-11
DOI: 10.33762/bsurg.2020.167423

Global comparison of The outcome of surgical techniques for spondylodiscitis
 
Jessica Burton@, Thamer Hamdan*, Bisola Ajayi#, Mohsen Raza$, Angelo Fragkakis&, Cristina Lupu^, Timothy Bishop%, Jason Bernard! & Darren Lui**.
 
@MB,ChB student. *Professor of Orthopaedic Surgery at Basrah University, Visiting Professor at London Imperial College and Research Fellow as Saint George’s Hospital London. #Orthopaedic and Spine Physician Associate. $Orthopaedic Registrar. &Spine Fellow. ^ Spine CNS. %Orthopaedic Spinal Surgeon. !Orthopaedic Spinal Surgeon. **Orthopaedic Spinal Surgeon. Department of Trauma and Orthopaedics, Saint George’s University Hospital, London, UK.
 
Abstract
 Spondylodiscitis is an infection of the intervertebral disc and neighbouring bone. It is treated conservatively or surgically using a range of techniques.
 The aim of this review is to determine whether the surgical techniques between different countries have an effect on clinical outcome: postoperative complications, relapse rate, treatment failure rate or mortality rate.
 Many articles were screened using Ovid and Pubmed databases for studies pertaining to the surgical treatment of spondylodiscitis. Paediatric studies, tubercular/brucellar/fungal/ postoperative infection and case reports were excluded from this review.
 The results shows that no differences in the outcome of surgery between countries was found, and reasons for this along with solutions for moving forward with comparing surgical techniques worldwide are noted.
Key words: Spondylodiscitis, Surgery, Outcome, Comparison, Literature review

FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Ahmed M Al-Abbasi; Sabah A Al-Uraibi; Saddam S Atshan

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 12-18
DOI: 10.33762/bsurg.2020.167508

Abstract
 Treatment of sinonasal diseases is either conservative or surgical. The recent advances in surgical management is the use of endoscopic sinus surgery (ESS) as it causes less morbidity, complication, pain and above all, less recurrence rates.
 This study aimed to evaluate the effectiveness of ESS for the treatment of nasal & paranasal sinus diseases and to address the postoperative complications.
 A prospective study was done at the Department of Otolaryngology in Basrah Teaching Hospital in the period from January 2016 to August 2019. One hundred twenty six patients with sinonasal diseases were involved in this study, more than this number of patients was operated upon but they either refused participation in this study or dropped from follow-up.
 The main indications of surgery were; chronic rhinosinusitis without nasal polyp (33%), chronic rhinosinusitis with nasal polyp (28.6%), Allergic fungal sinusitis & mycetoma (17.4%), and acute recurrent sinusitis (16%).
 Main presenting symptoms were; nasal obstruction (85.7%), nasal discharge (69%), headache and facial pain (66.6%) and hyposmia and or anosmia (57.9%).
 The majority of operated upon patients were primary cases (98 patients, 77.7%), while (28 patients, 22.2%) were revision cases. The commonest causes of revision were; retained or incompletely removed uncinate process in 28.5% of cases, followed by incomplete removal or persistence of anterior ethmoid cells in 21.4% cases.      
 In this series complications occurred in 15%, which were generally minor (9.5%), major complications occurred in 5.5% of operated upon patients. The commonest major complication is sever bleeding which was reported in 4.7% and anosmia which was reported in one patient. No CSF leak, retro orbital haemorrhage, or blindness was reported.
 Most of the patients in this series were improved (88.8%), complete symptom improvement occurred in (75 patients, 59.5%), partial improvement (37 patients, 29.3%), while (14 patients, 11%) were not improved.
 In conclusion, functional endoscopic sinus surgery is a safe surgery for sinonasal diseases, it carry good success rate with non-significant major complications.
Key words: Nasal Sinus, Functional Surgery, Endoscopy

CAESAREAN SECTION: TIME TREND AND RISK FACTORS

Rasmiya Oraibi Lafta; Husam Ali Habeeb

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 27-31
DOI: 10.33762/bsurg.2020.167509

The increased incidence of caesarean section has got an important issue in the recent researches in obstetrics. The evaluation of the condition and factors that make a decision for an operation still a main challenge to both doctors and patients in evaluating benefits and risk factors both pre and post-operative to the mother and the baby. Continuous studies all over the world are still in run focusing on this problem. World Health Organization reported an incidence lower than 15% to be accepted. Almost all countries still recording higher rates, both in developed and developing countries.
  This study has aimed to spotlight the problem in the main teaching obstetrics and gynecology hospital in Basrah, calculating the rate and risk factors associated with caesarean section which, similar to other countries, the rate is growing up.
  A retrospective study was conducted to review the statistical data during the last ten years calculating the incidence rate of caesarean operations, reviewing the data of 700 first caesarean operations in year 2019 to assess the main causes for an operation.
  It was clear that the rate of caesarean section has increased during the period from 2010 to 2019 from 24.2% to 38.5% with a study increment in both the total number of birth and the operation rate. The main reasons for operation were; repeated caesarean after a previous one in nearly 50%, while for a first caesarean, the causes were; failure to progress in 35%, infertility in 20.4%, breech presentation in 14.4%, meconium in 8.2%, cephalopelvic disproportion in 7%, and elevated blood pressure in 4%.
 In conclusion, the decision for an operation is still a challenge to both doctors and patients, the included reasons for an operation are; patient background, fear of labor pain, advances in anesthesia, private sectors and family economic situations, all interacts with the obstetrical, gynecological and medical risk factors for an operation leading to an increasing rate of caesarean operations. Clear criteria are still in need with more expanded studies to reduce the rate, taking in account all the possible post-operative complications.
 Key words: Spondylodiscitis, Surgery, Caesarean, Causes, Timing, Risks, Literature review

Clinical results and functional outcome of humeral shaft fractures treated with MIPO technique

Ashish Jaiman; Rajat Ranjan; Rajesh Kumar Chopra

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 38-47
DOI: 10.33762/bsurg.2020.127563.1000

Introduction:
The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method.
The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique.
Material and Methods:
A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO).
Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow.
Results:
83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores.
Conclusion:
Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

NONUNION OF LONG BONES IN BASRAH; EVALUATION AND MANAGEMENT

Thamer A Hamdan; Mofeed Y Alwaaly

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 19-26
DOI: 10.33762/bsurg.2020.167510

NONUNION OF LONG BONES IN BASRAH; EVALUATION AND MANAGEMENT Thamer A Hamdan* & Mofeed Y Alwaaly@*FRCS, FRCP, FICS, FACS, American Board (Orthopedic Surgery), Professor of Orthopedic Surgery. @MB,ChB, FIBMS, Specialist Orthopedic Surgeon, Basrah Teaching Hospital, Basrah, IRAQ.Abstract Nonunion of long bone fracture holds a big challenge for both the patient and the orthopedic surgeon. This study aimed to explore the possible causes and to evaluate the effectiveness of the treatment of nonunion in our region. Eighty-four patients with established nonunion of long bones were enrolled. All patients with primary fracture underwent; conservative, immediate or delayed operative treatment. Evaluation of nonunion was done by; careful general & local clinical examination, general & specific laboratory investigation, and radiological assessment with special emphasis to classify as atrophic or non-atrophic types. According to treatment modalities of nonunion, the patients were divided into three groups: Conservative (for those who refuse surgery or unfit for anesthesia), early, and delayed operative treatments. From the total 84 patients, 68 patients (81%) were males while 16 patients (19%) were females. Their age range was 13-77 years with a mean of 36.5 years. Five patients (6%) had co-morbidities including; diabetes, bronchial asthma, renal failure, hypertension. Cigarette smoking was not significant (p-value: 0.827). Tibia was the commonest bone involved in nonunion representing 46% (39 patients), followed by femur 36% (30 patients) and humerus 18% (15 patients). Forty-Five patients (54%) developed hypertrophic nonunion while 39 patients (46%) have atrophic nonunion. Non-union in this study was in seventeen cases (20.2%) due to single cause, while in fifty-five patients, (65.5%) due to two causes and the other twelve patients (14.3%) were due to combinations of three causes. Internal fixation with bone graft was performed for thirty patients (36%), external fixation with bone graft was applied to eighteen patients (21%), external fixation alone was done for 14 patients (17%), internal fixation alone was applied to 7 patient (8%), bone graft alone was done for 3 patients (4%), external and mini internal fixation with bone graft was done for 2 patients (2%). The mean time of follow up after definitive treatment for nonunion was 12.4 weeks. The majority of our patients (36 patients, 43%) were followed for 12-24weeks. The commonest bone that showed complete union in this study was femur (48%), tibia (30%), and humerus (22%). In conclusion, the chief causes that stand behind nonunion of the long bones which we revealed by our successive clinical, radiological, labrotary and active operative judgments in this study were; infection, insecure fixation, comminution, and soft tissue interposition. Internal fixation with autogenous bone graft proved to be the vital step to dissolve the obstacle of nonunion.Keywords: nonunion, bones, long, evaluation, treatment


 

THE EFFECT OF VARICOCELECTOMY IN IMPROVING PREMATURE EJACULATION IN PATIENTS WITH BOTH PREMATURE EJACULATION AND VARICOCELE

Adnan Odhafa Almayyahi; Firas Shakir Attar; Abdullah Yousif Altimari; Amro Usama

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 32-37
DOI: 10.33762/bsurg.2020.167511

 Premature ejaculation (PE) is the most common sexual dysfunction in men with a prevalence rate reaching up to 75%. Varicocele is defined as elongated, dilated, and tortuous veins of the testicular pampiniform plexus. The link between PE and varicocele was demonstrated in many studies. This study aimed to evaluate the effect of varicocelectomy in improving PE in men with both PE and varicocele.
 This prospective study was conducted on sixty patients (age range 19-40 years) who had clinical varicocele and premature ejaculation. The study period was from January 2018 to January 2020 and was performed in Basrah Teaching Hospital. Forty patients met the inclusion criteria of this study. All patients had varicocelectomy and were followed up for the improvement of their PE.
 The study showed that majority of patients with concomitant PE and varicocele (26 patients, 65%) had improvement of PE after varicocelectomy with an ability to delay ejaculation.
 The development of PE in patients with varicocele may be related to the occurrence of prostatitis due to the backflow of blood from the varicocele to the prostatic venous plexus. The study concluded that improvement of PE in patient with concomitant varicocele could be achieved by performing varicocelectomy.
Key words: Varicocele, premature, ejaculation, improvement, varicocelectomy.

THE OUTCOME OF LONGITUDINAL DORSAL ISLAND FLAP FOR REPAIR OF HYPOSPADIAS IN CIRCUMCISED PATIENTS AND THOSE WITH FAILED PREVIOUS REPAIR

Majed Asgar Mohammad; Firas Shakir Attar; Khaldon Sadek Alkhateep

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 48-54
DOI: 10.33762/bsurg.2020.167512

 Patients with penoscrotal, proximal shaft and mid shaft hypospadias who were previously circumcised or patients with insufficient urethral plate such as those with severe chordee that cannot be corrected just by simple degloving, or failure of previous hypospadias repair, such patients represent a challenge for subsequent repair and appropriate procedure choice.
 The aim of this study is to assess the outcome of longitudinal dorsal island flap (LDIF) by both onlay and tubularized repair for patients with hypospadias who were previously circumcised or had poorly developed urethral plate.
 This prospective study was done on 36 patients who had penoscrotal, proximal and mid shaft hypospadias and were previously circumcised or had poorly developed urethral plate. Twenty four of them were operated upon by using onlay LDIF and 12 patients by using tubularized LDIF. Patients were followed-up for 12 months to look for any complication for these 2 types of surgeries and for assessing the functional outcome of the repair.
 The success rate for onlay LIDF was 75% and for tubularized LIDF was 58.33%. Overall complications occurred in 11 (30.55%) children.
 In conclusion, LDIF can be used successfully for repair of hypospadias in circumcised children or those with failed previous repair.
Keywords: Hypospadias, LDIF, failed repair, tabularized incised plate urethroplasty

ENDOSCOPIC MEDIAL WALL MAXILLECTOMY FOR TREATMENT OF INVERTED PAPILLOMA

Rafid Yaseen Jabbar

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 55-59
DOI: 10.33762/bsurg.2020.167513

Sinonasal tumors are not uncommon lesions, they are either benign or malignant, benign tumors are relatively common while the malignant are considered rare. The inverted papilloma of the paranasal sinuses is the commonest benign tumor and has a potential to become malignant.
 This is a report of three cases of inverted papilloma of the paranasal sinuses which were approached surgically by endoscopic sinus surgery with very good results.
 These cases were diagnosed by CT-scan of paranasal sinuses followed by biopsy taken via endoscopic guidance.
Keywords: Endoscopy, maxillectomy, inverted papilloma

CLINICAL EXPERIENCE IN THE MANAGEMENT OF PEDIATRIC WILMS TUMOR

Haithem Hussein Ali Almoamin; Ansam Mahmood Saleh; Athar Abdulsamad Majeed; Hussam Mahmood Saleh

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 60-66
DOI: 10.33762/bsurg.2020.167514

Wilms tumor is the commonest renal tumor in children. This study aimed to evaluate the characteristics, diagnosis, treatment, and outcome of Wilms tumor in pediatric age group and to analyze factors affecting the outcome.
 This retrospective study included 61 children younger than 15 years with Wilms tumor who were managed at Basrah Children Specialty Hospital during the period between 2011 and 2016. Patients` characteristics, mode of diagnosis, treatment modalities, complications, relapse, and outcome were all reviewed.
 The results showed that Wilms tumor was the commonest tumor affecting the kidneys (85%). The median age of onset was 30 months, and mostly in children aged 2-4 years. The most common presenting feature was abdominal mass (44.3%). Twenty three patients were diagnosed as stage 1 (37.7%).  Favorable histology Wilms tumor was encountered in only 65.6%. Tumor relapse was seen in 12 patients (19.7%), eight of them died (66.7%).  The overall 2-year survival was 70.5% (43 cases).
 In conclusion, Wilms tumor is the most common renal tumor with high rate of unfavorable histology (anaplasia) in our society. Stage I tumor is the predominant stage but unfortunately carries a relatively high mortality. Advanced stages still represent a significant proportion which may reflect poor awareness and delayed diagnosis which thereafter worsens the outcome. Advanced stages, presence of anaplasia, and tumor relapse are the major factors affecting survival of children with Wilms tumor.
Keywords: Renal tumors, Wilms, Staging, Histology, Outcome

EFFICACY OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN PATIENTS WITH PREMATURE EJACULATION

Muhammed Salama Muhammed; Adnan Adafa AL-Adham; Mohammed Fawzi Hamza

Basrah Journal of Surgery, 2020, Volume 26, Issue 2, Pages 67-70
DOI: 10.33762/bsurg.2020.167515

Premature ejaculation (PE) is the most common sexual dysfunction compliant in about 35 to 45% of men younger than 40 years.
  In this study, the efficacy of two drugs (Fluoxetine and Citalopram) which are selective serotonin reuptake inhibitors (SSRI) used for treatment of patients suffering from PE is evaluated. The effectiveness of both drugs in PE patients was studied with different protocol to find out the most effective drugs with least side effect.
  A total of 93 patients were referred to the Urology Clinic in Basrah Teaching Hospital for the treatment of PE. Patients were randomly divided into two groups; Patients in group 1 (N=49) received 40mg (2 capsules of 20mg) fluoxetine daily for 4 weeks, and patients in group 2 (N=44) received 40mg citalopram daily for 4 weeks.
The mean intravaginal ejaculation latency time (IVELT) before treatment in patient of group 1 was 65.81±27.63 seconds, while after treatment it raised to 311.47± 43.29 seconds. In group 2, the mean IVELT before treatment was 61.42±32.65 seconds, while after treatment it raised to 293.15± 51.72 seconds.
In conclusion, both drugs (Fluoxetine and Citalopram) improved ejaculation duration significantly.
Key words: Fluoxetine, Citalopram, premature, ejaculation, timing.

TO TREAT OR TO SATISFY THE PATIENT; WHICH ONE IS THE BEST?

Thamer A Hamdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2017.141312

L
uckily, there is increasing interest in patient satisfaction in the present days. Many writers started differentiating between the two issues; treatment or satisfaction. Patient satisfaction is a top priority and it should be the target. Perfect treatment is not always satisfactory to the patient. Some surgeons, sadly, spoil their ideal treatment by misconduct. They are good enough to offer treatment, but not good enough in performing the art of communication, which is really vital. They do not know how to respect the dignity, the honor and rights of the patient. The first meeting is the key for success in achieving life-long friendship or, on the other hand “putting salt on the wound”

SILENT OSTEOPOROSIS IN ASSOCIATION WITH OTHER ORTHOPEDIC DISEASES

Thamer A Hamdan; Mubder A Mohammed Saeed; Saad J Abdulsalam

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 3-8
DOI: 10.33762/bsurg.2017.141313

Thamer A Hamdan*, Mubder A Mohammed Saeed# & Saad J Abdulsalam@
*FRCS, FRCP, FACS, FICS, Professor Of Orthopedic Surgery, Chancellor of Basrah University. #FICMS, Assistant Professor Of Orthopaedic Surgery, Basrah General Hospital, @FACMS, Orthopedic Surgeon, Al-Karkh General Hospital, Baghdad.

Abstract
Osteoporosis is the most common metabolic bone disease. It is a major global health problem that increases dramatically as people getting older than before because of good health services.
The aim of the study is to assess how far osteoporosis is associated with orthopedic diseases and to increase the awareness in the mind of orthopedic surgeons for osteoporosis in patients who are not suspected apparently to have this disease.
A sample of 522 patients referred to Dual-energy X-ray absorptiometry (DXA) clinic by orthopedic surgeons or rheumatologists was taken during a seven months period, in two centers, Basrah, 259 patients and Mosul, 263 patients. All the patients had back pain, joint pain, bone pain, fracture or other musculoskeletal complains. The only method used to assess osteoporosis in our patients was the DXA scan.
Of the total 522 patients, the results of DXA scan was normal in 136 patients (26%), osteopenia in 178 patients (34%), and osteoporosis in 208 patients (40%). Back pain was the main cause of referral 184 (35%), followed by joint pain 138 (26.5%), bone pain 74 (14%), fracture 28 (5.5%), and others 98 (19%).
In conclusion, osteoporosis may be a silent disease, even in patients with complains like joint pain, bone pain, or radicular symptoms.

COMPARATIVE STUDY BETWEEN STAPLER AND HAND SEWING IN GASTROINTESTINAL ANASTOMOSIS

Mustafa Adnan Maatooq; ssam Merdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 21-25
DOI: 10.33762/bsurg.2017.141316

COMPARATIVE STUDY BETWEEN STAPLER AND HAND SEWING IN GASTROINTESTINAL ANASTOMOSIS

Mustafa Adnan Maatooq* & Issam Merdan@
*MB,ChB, Board candidate, Al-Sadir Teaching Hospital, Basrah. @MB,ChB, FICMS, CABS, Professor of Surgery, Department of Surgery, College of Medicine, University of Basrah, IRAQ.

Abstract
Gastrointestinal anastomosis is an important part of gastrointestinal operations and can be achieved by hand sewn anastomosis or by the newly developed staplers.
The study aims to compare between the two surgical methods of anastomosis in a prospective , randomized design, regarding: operation time, post operative hospital stay and the incidence of post operative anastomotic leak in both groups. The study was carried out in Department of Surgery at Alsader Teaching Hospital in Basrah, Iraq from October 2015 to December 2016, it included 40 patients of both gender and with a different age, they divided into 2 groups (hand sewn and stapler groups), each group included 20 patients, comparing the following parameters: time of anastomosis, duration of surgery, post operative leak and hospital stay.
There were no significant differences in the age, gender distribution, the indication for resection, post operative anastomotic leak (p=1) and hospital stay (P Value 0.15 ) in both group but there was significant differences in duration of anastomosis (P Value0 .00001) and operation time (P Value 0.00001). Our study concluded the superiority of stapler on hand sewing in gastrointestinal anastomosis in term of reducing operative time.

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY

Mohammed Salim Mohammed; Jasim D Saud; Mansour Amin Mohammed; Mazin H Al-Hawaz

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 15-20
DOI: 10.33762/bsurg.2017.141315

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY

Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@
*MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ.

Abstract
Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome.
This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay.
This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases).
The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups.
In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.

ENDOSCOPIC BIOPSIES , CELIAC DISEASE, SEROLOGICAL TEST

Zahraa A Hashim; Sarkis K Strak; Wassan M Jazi; Sura A AL-Namil

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 34-39
DOI: 10.33762/bsurg.2017.141318

THE VALUE OF ENDOSCOPIC BIOPSIES FROM FIRST AND SECOND PARTS OF DUODENUM IN THE DIAGNOSIS OF CELIAC DISEASE IN CORRELATION WITH A SEROLOGICAL TEST
Zahraa A Hashim*, Sura A AL-Namil@, Wassan M Jazi# & Sarkis K Strak$
*MB,ChB, Postgraduate board student. @MB,ChB, FIBMS, Consultant pathologist. #MB,ChB, FIBMS, Consultant pathologist, Al-Sadir Teaching Hospital. $MRCP, FRCPLond., FRCPI., Professor of Medicine, University of Basrah, IRAQ.

Abstract
Celiac disease is a chronic immune-mediated enteropathy of the small intestine caused by environmental exposure to gluten in genetically susceptible individuals. This study was conducted to evaluate and correlate the serological with histopathological findings of duodenal biopsies for the diagnosis of celiac disease.
Sixty-eight patients, 40 (59%) females whose ages ranged from 13-75 year (mean age 36.4 years), and 28 (41%) males whose ages ranged from 13-65 year (mean age 37.8 years), with symptoms of chronic diarrhea, weight loss, bloating and unexplained iron deficiency anemia, were tested for anti-tissue transglutaminase IgA tTG, and correlated with histopathological findings of duodenal biopsies obtained from 1st and 2nd parts according to modified Marsh's classification. Histopathological findings from the 1st and 2nd duodenal parts were also compared with each other.
The results of the 68 patients who were enrolled in the study showed that: 24(35.3%) patients tested positive for anti-tissue transglutaminase (titer >18U/ml), 37(55.8%) patients had positive histopathological changes (stage I–III). Twenty-three (33.8%) patients who had both positive anti tTG and histopathological changes were classified as a celiac disease. The sensitivity of 1st and 2nd parts of duodenal biopsies in detecting celiac disease were 83.7% and 100% respectively.
In conclusion; the histopathological changes from the 1st and 2nd parts of duodenum in detecting celiac disease were equally representative especially in stage IIIa, b, and c.

TO TREAT OR TO SATISFY THE PATIENT; WHICH ONE IS THE BEST?

Thamer A Hamdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2017.141312

L
uckily, there is increasing interest in patient satisfaction in the present days. Many writers started differentiating between the two issues; treatment or satisfaction. Patient satisfaction is a top priority and it should be the target. Perfect treatment is not always satisfactory to the patient. Some surgeons, sadly, spoil their ideal treatment by misconduct. They are good enough to offer treatment, but not good enough in performing the art of communication, which is really vital. They do not know how to respect the dignity, the honor and rights of the patient. The first meeting is the key for success in achieving life-long friendship or, on the other hand “putting salt on the wound”

TRANSDUODENAL SPHINCTEROPLASTY VERSUS CHOLEDOCHODUODENOSTOMY IN MANAGEMENT OF LOWER COMMON BILE DUCT STONES

Ali H Al-Azzawi

Basrah Journal of Surgery, 2012, Volume 18, Issue 1, Pages 33-39
DOI: 10.33762/bsurg.2012.54970

Common bile duct stones have been noted in 10-15% of patients with gall stones, these stones are either primary (formed in the common bile duct) or secondary (formed in the gallbladder and migrate down to the common bile duct). Their management includes ERCP (Endoscopic Retrograde Choledochopancreatography), biliary drainage procedure and choledochal exploration.
In this interventional study, we compare between transduodenal sphincteroplasty and choledochoduodenostomy regarding morbidity (anastamotic and duodenal leak, cholangitis, and pancreatitis) and mortality related to each surgical option.
A review of 68 patients with lower common bile duct stones presents with different clinical presentations in an interventional study carried in Basrah General Hospital and Al–Moussawi Private Hospital, 22 patients underwent transduodenal sphincteroplasty and, 46 patients underwent choledochoduodenostomy. Both groups received general anesthesia and comparable in age and sex. Statistical analysis done by SPSS (Statistical Package for Social Sciences) version 18.
Age and sex are comparable in both groups, the incidence of postoperative cholangitis is 9.09% in the transduodenal sphincteroplasty group and 32.6%in choledochoduodenostomy group which is statistically significant (P value 0.01). The incidence of duodenal and anastamotic leak is 13.6% and 10.9% in transduodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.707). The incidence of postoperative pancreatitis is 0% and 8.7% in transduodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.296). The mortality is 0% after transduodenal sphincteroplasty and 6.5% after choledochoduodenostomy.
In conclusion, transduodenal sphincteroplasty is better than choledochoduodenostomy in the management of lower common bile duct stones, less postoperative cholangitis, pancreatitis, and lower mortality rate.

MESENTERIC CYST-OVARIAN IMPLANT SYNDROME; ‎CASE REPORT ‎

Ali Y. Alwajah; Rafif A. Al-Saady

Basrah Journal of Surgery, 2004, Volume 10, Issue 2, Pages 109-112
DOI: 10.33762/bsurg.2004.57549

Mesenteric cyst ovarian implant syndrome have been rarely reported in the literature, we report the first ‎case that occur in young female following trauma and it is the first case in which the ovarian tissue get ‎implanted higher up in the jejunal mesentry out side the pelvis.‎

PENETRATION OF CEFOTAXIME INTO INTERVERTEBRAL DISCS REMOVED FROM PATIENTS UNDERGOING DISCECTOMY

Thamer A Hamdan; Mohammed S hashim; Nazar S Haddad; Abdullah M Jawad

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 3-9
DOI: 10.33762/bsurg.2031.162890

The intervertebral disc is an avascular tissue, and penetration of antibiotics occurs by passive
diffusion. Cefotaxime penetration has not been well studied. The aim is to investigate the
penetration of cefotaxime into the intervertebral disc removed from patients undergoing
discectomy.
Twenty-six patients undergoing discectomy were recruited for this study. They were given one
gram of cefotaxime intravenously as a prophylactic antibiotic. Cefotaxime was extracted from
nucleus pulposus and serum and analyzed using an HPLC method with cefuroxime axetil as
internal standard.
Cefotaxime penetrated into all the 26 samples of nucleus pulposus resulting in a mean
concentration of 0.66±0.13 µg/gm. The mean serum concentration at time of disc removal was
13.61±3.54 µg/ml. The concentration in 16 samples were below the minimum inhibitory
concentration against Staph. aureus with an average of 0.27±0.03 µg/g. There is a statistically
significant correlation between time after intravenous cefotaxime administration and its
concentration in the nucleus pulposus. The greater increase is in the third hour after
administration. Factors like age, body weight, gender, number of associated diseases and
surgical history did not seem to affect nucleus pulposus cefotaxime concentration.
In conclusion, cefotaxime can penetrate into the nucleus pulposus but its concentration is
relatively low. This concentration has a strong positive correlation with time after cefotaxime
intravenous administration. Cefotaxime, therefore, needs to be given at least two hours before
disc removal, with re-dosing immediately before operation to maintain high serum concentration.

LAPAROSCOPIC ENTRY: A REVIEW OF TECHNIQUES, TECHNOLOGIES, AND COMPLICATIONS

Issam Merdan

Basrah Journal of Surgery, 2013, Volume 19, Issue 1, Pages 10-23
DOI: 10.33762/bsurg.2013.73613

L
aparoscopy (Gr: Laparo-abdomen, scopein-to examine) is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdomi¬nal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen’s contents with an illuminated telescope. With the advent of videocameras and other ancillary instruments, laparoscopy rapidly advanced from a being a diagnostic procedure to one used in fallopian tubal occlusion for sterilization and eventually in the performance of numerous sur¬gical procedures in all surgical disciplines for a variety of indications.

6-FACTORS AFFECTING MORBIDITY AND MORTALITY IN PERFORATED DUODENAL ULCER

Adnan Yassin Abdul-Wahab; kassim Trayem Hayef

Basrah Journal of Surgery, 2011, Volume 17, Issue 1, Pages 0-0
DOI: 10.33762/bsurg.2011.55109

kassim Trayem Hayef* & Adnan Yassin Abdul-Wahab@
*MBChB, Al-Sader Teaching Hospital, Basrah. @MBChB, FRCS, Assist. Professor, Department of
Surgery, College of Medicine, University of Basrah, Basrah, Iraq.
Abstract
Duodenal ulcer is a particular type of peptic ulcer disease that afflicts the lining of the
duodenum. The indications for surgery in duodenal ulcers are; bleeding, perforation, obstruction
and intractability or non-healing. Today, most patients undergoing operation for duodenal ulcer
disease have simple over-sewing of bleeding ulcer or simple patch of perforated ulcer.
Simultaneous performance of vagotomy either truncal or highly selective is increasingly
uncommon because of reliance on postoperative proton-pump inhibitor to decrease acid
secretion and eradication therapy for helicobacter pylori infection. Despite of the widespread
use of gastric anti-secretary agents and eradication therapy, the incidence of perforated
duodenal ulcer has changed little.
This study aimed to assess the factors that lead to increase the rate of morbidity and mortality
in patients with perforated duodenal ulcer in different age groups and to know the effect of time
lapsed between onset of symptoms and surgery.
This is a prospective study that included 100 patients who underwent emergency laparotomy
for perforated duodenal ulcer during a period from May 2008 to January 2011. The operations
were done in Al-Sader Teaching Hospital and Al-Basrah General Hospital. The clinical finding,
general risk factors, co-morbid medical diseases, operative finding and post–operative
complications were all taken in consideration. Follow-up period ranged from 2 weeks to 18
months.
Of the hundred cases who included in this study, 96% were males and 4% were females with
mean age of 43.13 years (range from 10 to more than 70 years). The disease was more
common in rural areas (58%) than in urban areas (42%). Fifty five percent of patients gave
previous history of duodenal ulcer and 45% had no previous history of duodenal ulcer. The most
common risk factors are smoking (32%) and NSIADs (25%). In this study most of elderly
patients presented with medical diseases such as hypertension, diabetes mellitus, ischemic
heart disease and chronic obstructive pulmonary disease. Most patients admitted to hospital
between 19–24 hours (21%), (8%) admitted during 6 hours and (2%) admitted after 120 hours.
Regarding the complications occurs in this study, wound infections, chest infections and
paralytic ileus were the most common complications. Mortality rate was 2%.
In conclusion, the most common factor that leading to development of postoperative
complications is delayed in hospital admission, so to improve the results of treatment of
perforated duodenal ulcer, the diagnosis and treatment should not be delayed and the
associated medical illness should be treated.

HEMORRHOIDAL ARTERY LIGATION WITH RECTO-ANAL REPAIR VERSUS TRADITIONAL HEMORRHOID-ECTOMY, A COMPARATIVE STUDY

Basrah Journal of Surgery, 2018, Volume 24, Issue 2, Pages 61-66
DOI: 10.33762/bsurg.2018.160090

Hemorrhoids, are vascular structures present in the anal canal as cushions that facilitate stool control. When swollen or inflamed they are regarded as hemorrhoidal disease; sometimes they are asymptomatic specially in the internal type which are presented with painless rectal bleeding while external type may present with painful swelling.
Although the traditional open hemorrhoidectomy (Milligan Morgan) is standard and effective technique, it is associated with many complications; the most important is post-operative pain and delayed return to normal activities. Nowadays Doppler-guided hemorrhoidal artery ligation (DG-HAL) with recto-anal repair (RAR) is a minimally-invasive technique for hemorrhoids, it is developed recently to overcome these complications.
The purpose of this prospective study is to compare between the classical open hemorrhoidectomy and HAL-RAR procedure, by assessment of post-operative pain, postoperative complications and outcome of the procedures.
This prospective, study was done between September 2014 and September 2016. Ninety six patients complaining of hemorrhoids were studied at Al-Sadr Teaching Hospital, Basrah, Iraq. They were divided equally into two groups; group A and B, group A underwent surgery by DG HAL and RAR, and group B were subjected to traditional procedure. Patients were followed for one year by evaluation at 1 week, 1 month, 6 months, and 1 year.
In conclusion, DG-HAL with RAR is an effective technique compared with traditional hemorrhoidectomy regarding complications, postoperative pain, in hospital stay, and time of return to normal activities.

THE RELATIONSHIP BETWEEN CLINICAL EXPERIENCE AND QUALITY OF CARE AND ITS OUTCOME.

MAJEED H ALWAN

Basrah Journal of Surgery, 2008, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55531

Quality assurance and performance evaluations, have become central issues in medicine.
There are several studies which indicates that general patients care is suboptimal in many
different medical conditions and clinical settings1,2. Delivering high-quality care is important to all
clinicians, but this issue may be more relevant to certain subgroups, such as those with less
specialised training and those who deal with smaller number of patients3. There is also a
general believe that the longer clinicians are in practice the more experienced they will be, and
therefore it is assumed that this group of medical doctors are able to provide a high quality of
care. But there are some studies that found a consistently or partially negative association. The
aim of this report is to discuss this subject further and reach some conclusions.

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