About Journal

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

WHAT EVERY SURGEON'S ETHICS SHOULD BE?

Thamer A Hamdan

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 1-2
DOI: 10.33762/bsurg.2020.165457

 





thics is defined as moral principles that govern a person's behavior, the conductivity of an activity, or the branch of knowledge that deals with honest attitude.
 Ethics is a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct.
 Ethics was found in Hammurabi code law (Babylon 1754 B.C.), then followed by    Hippocratic Oath, prayer of Moses maimonides, declaration of Helsinki, code of ethics of the American Medical Association, and all Holy Books which insist on ethical points.
 Ethics in general is governed by four principles which are; respect for autonomy, beneficence, non maleficence, and justice. To the above, I added; respect for the dignity of the patient.
 Ethics start from humanitarian handling of the patient in the first visit with a big smile and soft welcoming words, a lot of respect, careful listening and understanding followed by very gentle physical examination.

IN COVID-19 PANDEMIC, A LITTLE NEGLECT MAY BREED GREAT MISCHIEF

Ahmed M Al-Abbasi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 3-8
DOI: 10.33762/bsurg.2020.165458

  COVID-19, the disease caused by SARS-CoV-2, is a highly communicable disease. There is urgent need for highlighting the ongoing outbreak to be public health emergency especially in our locality. Based on current published evidence, this review systematically summarizes the causative agent, epidemiology, presentation, diagnosis, treatment, prevention and surgeon precautions against COVID-19. Hopefully, this review may put a small stone for public health building in this regard and may afford a reference for future studies in our district.

DOES ANTICOAGULANT THROMBOPROPHYLAXIS INCREASE BLEEDING COMPLICATIONS IN SPINAL SURGERY AND SPINAL CORD INJURY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Anh TV Nguyen; Sonia Tran BMed; Thamer A Hamdan; Robin Turner; Ahmed Ramadan Sadek; Darren Lui; Alexander S Montgomery

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 9-20
DOI: 10.33762/bsurg.2020.165459

This study is a systematic review and meta-analysis. The routine use of anticoagulants for the prevention of venothromboembolism in spinal patients is controversial and the risk benefit analysis is poorly described. The objective of this study is to collate the current evidence and quantify the risk of bleeding associated with anticoagulant thrombophylaxis in the spinal patient, both in the elective and trauma settings. 
Medline, Embase, Cochrane Trial Register databases and the grey literature were searched. Data were pooled via a meta-analysis from randomized trials and cohort studies comparing the rates of spinal epidural haematoma and wound haemorrhagic complications in spinal surgery patients receiving low molecular weight and low dose unfractionated heparin (LMWH/UFH) thromboprophylaxis and those not anticoagulated. The risk of bias within individual studies and across all the studies was assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, respectively.
 The meta-analysis included 10 studies of 96,042 patients with 1,007 relevant bleeding complications. A significant increase in the risk of extra-spinal wound haemorrhage was found in patients receiving peri-operative LMWH/UFH thromboprophylaxis compared to controls (OR 1.56, 95% CI 1.18-2.06, p=0.002, I2=8%). The same comparison revealed no significant increase in the risk of spinal epidural haemorrhage (OR 1.20, 95% CI 0.65-2.22, p=0.56, I2=0%). The quality of evidence for both outcomes was low. There was insufficient data to conclude about the risk of haemorrhagic complications in spinal trauma and in patients receiving non-heparin thromboprophylaxis agents.
In conclusion, the results of this study raise concern about a possible increased risk of extraspinal wound haemorrhage associated with LMWH/LDUFH thromboprophylaxis in spinal surgery.  Level of evidence: Therapeutic level III.
 

COMPARISON OF THE EFFECTIVENESS OF STEREOTACTIC RADIOSURGERY FOR SPINAL OLIGOMETASTATIC DISEASE WITH SURGICAL AND CONVENTIONAL EXTERNAL BEAM RADIOTHERAPY DETERMINED BY LOCAL CONTROL, OVERALL SURVIVAL, PAIN RESPONSE AND TOXICITIES: A SYSTEMATIC REVIEW.

Priyanshu Saha; Thamer A Hamdan; Bisola Ajayi; Cristina Lupu; Timothy Bishop; Jason Bernard; Darren Lui

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 21-31
DOI: 10.33762/bsurg.2020.165461

The aim of this study is to determine whether there is a benefit of using stereotactic radiosurgery (SRS) versus surgery or conventional external beam radiotherapy (cEBRT) for spinal oligometastatic disease in terms of tumor control, pain control, toxicity and morbidity.
 This systematic review was conducted by searching electronic databases such as Pubmed, Medline (Ovid) and Oxford Academic using an adapted version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) checklist. Retrospective and prospective studies were identified and investigated for methods of treatment such as SRS, surgery and radiotherapy of spinal oligometastatic disease. Local Control rates, Overall Survival (OS) rates, Pain Response (PR) and toxicities were extracted to be investigated and compared. A study eligibility criterion was made to ensure that results were valid, statistically significant and relevant to the investigation.
 One hundred and five articles were relevant to oligometastatic disease with the mention of spinal metastases however 89 of these articles were excluded based on irrelevance to investigation, title, abstract and duplication. Sixteen full text articles were thoroughly screened including 9 of them in the review. For 601 patients the average one year local control rate was 89%, average one year overall survival rate was 88%, evidence of pain relief was present, and some patients suffered low grade toxicities.
 In conclusion, stereotactic radiosurgery is an excellent modality of treatment of spinal oligometastatic disease as local control rates, overall survival rates, pain response and toxicities indicate improved outcomes in comparison to studies that investigated the same factors with the treatment of surgery or cEBRT. However, there is a lack of data here to make statistically valid claims and require more studies & data to be analyzed and compared.
 

THE BENEFICIAL EFFECTS OF TONSILLAR FOSSA CLOSURE AFTER TONSILLECTOMY; A PROSPECTIVE STUDY

Muhanned M Al-Ali; Ahmed M Al-Abbasi; Haider Sabri Hashim; Haider K Saeed; Ali M Altaie

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 32-37
DOI: 10.33762/bsurg.2020.165463

The objective of this study is to evaluate the effect of tonsillar fossa closure after tonsillectomy on the amount of intra-operative blood loss, post-operative pain and bleeding.
 Sixty patients enrolled in this single blind case control study held at Basrah Teaching Hospital in the period from July 2017 to November 2018.  Patients age was between 7 to 50 years, of them 28 (46.7%) females and 32 (53.3%) males. One of tonsillar fossae was selected for closure and the other was left open as a control side, the duration of dissection, the amount of bleeding for each side, the level of post-operative pain on (0, 3, 7, 10-14) days was estimated utilizing Visual Analogue  Score (VAS) together with any evidence of post-operative bleeding.
 There was statistically significant reduction in the level of post-operative pain in the sutured side compared to the control for all the follow-up periods. No significant differences in the amount of intra-operative blood loss between both sides were found. None of the patients experienced post-operative primary or secondary hemorrhage.
 In conclusion, Closure of tonsillar fossa has beneficial effect in reducing the level of
post-operative pain after tonsillectomy with no effect on post-operative bleeding. No difference was noted regarding the amount of intra-operative bleeding.

THE EFFICACY AND SAFETY OF CERVICAL SPINE IMMOBILIZATION IN ELDERLY PATIENTS WITH CERVICAL SPINE FRACTURES: A SYSTEMATIC REVIEW

S. Epton; R. Preece; D. Hay; M. kaminaris; D. Lui; A. Trompeter

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 38-45
DOI: 10.33762/bsurg.2020.165466

As both life expectancy and average population age continue to rise, so too does the incidence of cervical spine (c-spine) injuries. C-spine fractures are associated with high morbidity and mortality, but the question is how best to treat them?
This review is to compare the safety and efficacy of c-spine immobilisation in a rigid collar with other treatment modalities in elderly population. Available literature was reviewed to determine how treatment efficacy is assessed, with particular focus on whether osseous union or fibrous non-bony union should be considered as a successful outcome.
  This study was designed in accordance with PRISMA guidelines. Pubmed/Medline databases were selected for analysis.
  When considering patients over the age of 65, it is unclear whether management with a collar is safer than operative management or immobilisation with HALO vest. However, amongst studies that further subdivide elderly patients according to age there is more of a consensus; it appears that in those under the age of 75, operative management is safer, whereas in those over the age of 85, immobilisation in a collar is associated with lower mortality rates. Between the ages of 75-85 there is less clarity. Osseous union occurs more commonly in patients managed operatively, but fibrous non-bony union was not associated with any adverse outcomes in these studies.
  Conclusion: At present, there are no randomised controlled trials that have tried to delineate whether management in a collar is safer or more effective than other treatments such as HALO vest or operative fixation. However, evidence from various cohort studies does suggest that “elderly” patients with c-spine fractures should not be considered as one homogenous cohort, but should instead be subdivided according to age. Interestingly, these studies suggest that fibrous non-bony union may be an adequate treatment outcome in older. Further research into this complex field is required.
Keywords: Trauma, elderly care, spinal fractures, treatment outcome, survival rate

HYPOCALCEMIA FOLLOWING THYROIDECTOMY; A PROSPECTIVE STUDY IN BASRAH, IRAQ

Rabee Hammed Qasim; Haider Kadhem Saeed; Ahmed M Al-Abbasi; Mohammed Mosa Mohammed

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 46-50
DOI: 10.33762/bsurg.2020.165483

This study aimed to find out the frequency of hypocalcemia in different thyroid procedures and the risk factors for its development.
 One hundred thirty six patients underwent different thyroid surgeries for different thyroid diseases in the Surgical and Otolaryngology Departments of Basrah Teaching Hospital for three years from July 2016 to July 2019.
 Patients mean age was 34.8±7.5 years (range: 18-65 years). Male to Female ratio was 2:5. Of the total 136 patients, 35 patients underwent isthmusectomy and lobectomy, no case of hypocalcemia was reported (0%). Out of 71 patients who underwent sub-total thyroidectomy, three of them developed hypocalcemia (4.2 %). Out of 30 patients who underwent near-total or total thyroidectomy, nine of them developed hypocalcemia (30%). Whether the inferior thyroid artery was ligated or not, there was no significant difference in the development of hypocalcemia. Of the total 136 patients, 129 patients had benign pathology, 9 of them developed hypocalcemia (6.9 %); 7 patients had malignant pathology; 3 of them developed hypocalcemia (42.8%).
 In conclusion, the frequency of hypocalcemia is correlated with the extent of thyroid resection; and it is more in malignant lesions but in most of the patients it was transient.

ULTRASOUND ASSESSMENT OF RIGHT INTERNAL JUGULAR VEIN DIMENSIONS FOLLOWING PASSIVE LEGS ELEVATION VERSUS HEPATIC COMPRESSION

Jasim M Salman; Mohammed Jamal Jasim; Salam N Asfar

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 51-60
DOI: 10.33762/bsurg.2020.165484

Central venous catheterization has an essential role in the management of patients who are critically ill, and patients who have special operative interventions. In general, the bigger the vein cross sectional area and diameter the easier the catheterization will be. There are different maneuvers to increase internal jugular vein caliber. These include; passive legs elevation, hepatic or abdominal compression, Trendelenburg position, Valsalva maneuver, and positive end-expiratory pressure.
The objective of the study is to evaluate the effect of passive legs elevation and hepatic compression on the diameter and the cross-sectional area of the right internal jugular vein.
 This prospective study included 80 adult patients ASA class I and II. Patients who had any contraindication to the passive legs elevation or hepatic compression, or those with disruption of the local neck anatomy; were excluded from the study. Patients were evaluated for their right internal jugular vein cross-sectional area and diameter by the use of linear high frequency two-dimensional ultrasound. Each patient has three stages of measurement; supine, Passive legs elevation at (30o-45o) for one minute, and hepatic compression.
  Of the 80 patients, 70% were males, the age range was (19–55 years) with a mean of (37.75±12.16) years, and the majority were overweight. The maximum diameter was achieved during hepatic compression with a stepwise statistically significant increase of about (0.44±0.27 cm) from the baseline in supine position, when compared to only (0.26±0.21 cm) during passive legs elevation. The cross-sectional area is significantly and maximally increased from the baseline of (0.93 ± 0.59 cm2), during hepatic compression. The increase in the diameter and the cross sectional area was more significant in males irrespective to age and weight.
 In conclusion, Hepatic compression is significantly superior to the passive legs elevation in achieving more right internal jugular vein diameter and cross-sectional area.

THE ACCURACY OF ABDOMINAL ULTRASONOGRAPHY IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Ali Hameed Kadhem; Shaymaa Yaqoop Khalid; Wisam Hamza Al-Sewadi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 61-64
DOI: 10.33762/bsurg.2020.165486

Acute appendicitis is the most common causes of abdominal emergencies that necessitate surgical intervention. This study aimed to evaluate the accuracy of abdominal ultrasonography in the diagnosis of acute appendicitis.
 This prospective study was performed in Alsadr Teaching Hospital from November 2015 to January 2017 involving 131 patients.
 The results showed that 84.7% of the patients who presented with positive features of acute appendicitis were confirmed by ultrasonographic study, while 15.2% of the patients showed negative ultrasound examination confirmation.
 In conclusion, ultrasound study is effective in the assessment of patients presented with clinical features of acute appendicitis.
 

ASSESSMENT OF PAIN AND BLEEDING IN THE FIRST POSTOPERATIVE DAY FOLLOWING COBLATION TONSILLECTOMY

Rafid Yaseen Jabbar Almaidi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 65-68
DOI: 10.33762/bsurg.2020.165490

There are different techniques for tonsillectomy other than traditional such as; cold steel technique, bipolar diathermy, and nowadays the new plasma technology which is known as coblation (controlled ablation) tonsillectomy.
This study aimed to assess the first 24 hours postoperative pain and bleeding after coblation tonsillectomy.
Fifty patients aged between 4-10 years who underwent coblation tonsillectomy were included in this prospective descriptive study, the main indications for tonsillectomy were; recurrent tonsillitis and obstructive sleep apnoea.
The results showed that no bleeding at all within the first 24 hours with significant reduction in feeling of pain after.
In conclusion, coblation tonsillectomy is a promising technique to perform tonsillectomy.
 

CONGENITAL INTESTINAL MALROTATION IN ADULT PATIENTS

Firas Jabir; Issam Merdan; Wissam Saoud; Hamed Laftah

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 74-80
DOI: 10.33762/bsurg.2020.165493

 Congenital intestinal malrotation is an impaired embryological development of the gut causing incomplete rotation and attachment of the intestines to the abdominal wall.
 Three cases with congenital intestinal malrotation in adult patients were reviewed regarding their presentation, diagnosis and management. Two cases presented as emergency and the other one was incidental. Signs and symptoms of intestinal obstruction were the dominant presentation. A contrast computer tomography and upper gastrointestinal series confirmed the diagnosis of these cases. Ladd’s procedure was done in two cases.
 In conclusion, Intestinal malrotation should be considered as a cause of intestinal obstruction in all age groups. A contrast computer tomography is the best way to reveal this malformation. Surgical treatment is the greatest choice to relieve symptoms.
 

ACUTE APPENDICITIS AND ASSOCIATED PATHOLOGIES IN FEMALES

Ali Hameed Kadhem; Aamena AbdulAmeer Muhsin; Wisam Hamza Al-Sewadi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 69-73
DOI: 10.33762/bsurg.2020.165491

In females with right lower quadrant acute abdominal pain, gynecological & obstetric pathologies are the main disorders that should be eliminated from the diagnosis of acute appendicitis. This study included pathologic findings in 120 appendectomies in Al-Sadr Teaching Hospital in which exploration was performed as emergency acute appendectomies in 52 cases, while other pathologic processes related to gynecological diseases are distanced from appendicitis intraoperatively.
 There is a high percentage of coexistence with ovarian cyst in all its types whether twisted, ruptured, hemorrhagic or corpus luteal cyst. Other conditions included: ectopic pregnancy, uterine fibroid, Pelvic Inflammatory Disease (PID), Tubo-Ovarian Abscess (TOA), benign cyst adenoma & endometriosis. Also rarely, meckel's diverticulum that was either incidental finding or discovered by imaging techniques.
 

NASOPHARYNGOSCOPY VERSUS PLAIN RADIOGRAPHY IN ADENOID SIZE ASSESSMENT

Safaa Khalaf Faleh; Husam Haider Salman; Haidar Mohammed Salih

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 81-88
DOI: 10.33762/bsurg.2020.165495

This is a prospective comparative study of adenoid size assessment by using radiography versus nasopharyngoscopy using examination of the adenoid under general anesthesia (GA) as a standard method. This study was conducted on 35 children presented with signs and symptoms of adenoid hypertrophy. All patients were examined by both lateral radiograph view of the postnasal space and nasopharyngoscopy, then both results were compared.
The results for small size adenoid can not be calculated because of small sample size. For medium sized adenoid, the sensitivity for radiography and nasopharyngoscopy are 36.36%, 54.54% respectively, the specificity was 47.36%, 84.21% respectively and the accuracy was 43.33%, 73.33% respectively. For large sized adenoid the sensitivity for radiography and nasopharyngoscopy was 38.89%, 83.33% respectively, the specificity was 100%, 66.66% respectively, and the accuracy was 63.33%, 76.66% respectively. 
In conclusion, nasopharyngoscopy is a simple, safe, repeatable, readily available at the ENT unit, with no radiation hazards, and with negligible trauma. Over all, nasopharyngoscopy has a higher sensitivity, specificity and accuracy than radiography.
 

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”

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.‎

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.

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.

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.

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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