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...
Read More ...

Journal Information

Publisher: College of Medicine, University of Basrah

Email:  basra.journalsurgery@uobasrah.edu.iq

Editor-in-chief: Professor Dr. Murtadha Almusafer

Managing Editor: Lecturer Dr. Ali Muhammed Radi

Print ISSN: 1683-3589

Online ISSN: 2409-501X

NONDISCOGENIC SCIATICA SYNDROME, A REPORT ON 41 PATIENTS.

Thamer Hamdan; Daren F. Lui; Raed Jasim Chasib

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 3-11
DOI: 10.33762/bsurg.2021.168420

41 patients with clinical features of discogenic sciatica during the last 25 years, proved later on by investigations and imaging to be a nondiscogenic in origin, The aim of the study is to inform spinal surgeons of possible differential diseases that mimic discogenic sciatica. All patients present clinically with a sciatica. They were recorded and treated accordingly and sent for investigations. Patients proved to have discogenic sciatica were excluded. Others further investigated and followed until finding a cause for the symptoms and recorded as nondiscogenic sciatica syndrome. 22 individual aetiologies were found to cause nondiscogenic including infectious, traumatic, oncogenic, degenerative, metabolic and ischemic causes. In conclusion a proper history and thorough physical examination, in addition to imaging and investigations were very useful in detecting the exact etiology of sciatica. The pain pattern and the related clinical features were the guide for the diagnosis. High index of suspicion is vital to achieve the definite diagnosis to avoid missing the diagnosis of nondiscogenic sciatica. One should maintain a high index of suspicion in patients with intractable sciatica. Keywords: [Nondiscogenic Sciatica syndrome, pseudosciatica, spine surgery, radicular pain.]

A CLINICAL EXPERIENCE IN ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL HYPOPHYSECTOMY IN SKULL BASE CENTER OF BASRAH

Mustafa Atiyah; Ahmed M Al-Abbasi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 12-16
DOI: 10.33762/bsurg.2021.168427

Endoscopic Endo-nasal Trans-Sphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for removal of sellar and parasellar tumors. This prospective study was carried out on 50 patients in Basrah skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019. The technique involved a unilateral, endoscopic, endonasal approach to the sella turcica via an anterior sphenoidotomy which is performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon The most common presenting symptom for pituitary tumor was; headache which present in 80% (40 patients) of the patients, followed by visual disturbance in 56% (28 patients). Infertility and hemiparesis are the least symptoms 2% for each (one patient). The MRI study of brain and sellar region showed that forty six patients (92%) was diagnosed as pituitary adenomas and one patient (2%) have Rathke’s cyst and another one have meningioma. Tumor location and extension which was assessed by MRI revealed that 70% (35 patients) had tumor located in sella with extension to suprasellar region, where only 2% (one patient) had sellar with supra- and parasellar extension. Eighty percent (40 patients) were virgin cases (not operated before), while only 20% (10 patients) were revised cases (operated before either open or transsphenoidal). We achieved complete resection of the tumor in 82% cases (41 patients). The most common method used for reconstruction of the surgical defect was underlay multilayers which was used in 62% (31 patients), while in 10%, posterior based middle turbinate flaps were used in reconstruction. We noticed that 3 patients (6%) developed significant epistaxis, CSF rhinorrhea in 3 patients (6%), and unfortunately 3 patients (6%) died postoperatively. In conclusion, this study shows that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective and safe procedure to remove pituitary tumors. Key words: Hypophysectomy, Endonasal, Endoscopy, Transsphenoidal.

OUTCOME OF TRANSORAL ENDOSCOPIC THYROIDECTOMY VESTIBULAR APPROACH (TOETVA) IN COMPARISON WITH OPEN THYROIDECTOMY FOR BENIGN THYROID NODULES

Sadq Kadem; Sabah Abdulsahb Mohamd; Zainab Taher Ibrahim

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 17-24
DOI: 10.33762/bsurg.2021.168428

Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient’s satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee.Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients’ preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients’ satisfaction in comparison to open thyroidectomy.In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients’ satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.Key words: Thyroidectomy; Endoscopic thyroidectomy; Transoral thyroidectomy; Benign, Nodule

COMPARISON OF SURGICAL OUTCOME OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY WITH OR WITHOUT FLAP

Wissam Egab Aziz; Ahmed M Al-Abbasi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 25-29
DOI: 10.33762/bsurg.2021.168431

The goals of this study were to evaluate the results of endoscopic endonasal dacryocystorhinostomy (DCR) and to compare the surgical success rates of the different procedures (with or without mucosal flap) in patients with nasolacrimal duct obstruction. This prospective study investigated the results of 39 patients, they were 36 females (92.3%) and 3 males (7.7%). Endoscopic endonasal DCR was performed at the Basrah Teaching Hospital, Department of Otolaryngology in the period between July 2018 to July 2019. The patients were divided into two groups; with or without flap. During surgery, the mucosal flap was preserved in 13 patients (group B) and removed in 26 patients (group A). For all patients, silicone stents were put at the end of surgery. The silicone tube was removed within 6 months after surgery. After six months follow-up, the results were; patent ostium reported in 17 patients (81%) in group A and in 10 patients (90.9%) in group B. There was no statistically significant difference between the groups (P-Value 0.461). The overall incidence of crustation and adhesion is more in group A than in group B but it was also statistically not significant.In conclusion, endoscopic endonasal DCR carries no significant difference of success ratewhether it is with or without mucosal flap.Key words: Endoscopy, Dacryocyctorhinostomy, flap, Surgery.

RISK FACTORS FOR THE DEVELOPMENT OF BRAIN METASTASES IN PATIENTS WITH METASTATIC BREAST CANCER

Hayder Hashim Abdulsamad; Mazin H Al-Hawwaz

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 30-35
DOI: 10.33762/bsurg.2021.168434

Metastatic breast cancer is the second most common cancer associated with brain metastases;it has become a major life-limiting problem in those patients with metastatic breast cancer.This study aimed to detect early brain metastasis and intent to manage so to decrease disability and mortality in patients with breast cancer.This is a retrospective study analysing patients with metastatic breast cancer during the period from February 2018 to August 2019 at Basrah Oncology Centre which is the main tertiary referral hospital serving the southern part of Iraq. During the study duration (around 18 months), we found that risk factors for developing brain metastasis are tumour size, nodal involvement, tumour grade, hormone receptor (if negative), human epidermal growth factor2 (If positive) and radiotherapy (if not given as adjuvant) .In conclusion, the tumour size, grade, nodal involvement, whether the hormone receptors positive or negative, and if the patient received radiotherapy or not, all are predictive factors tobe considered, so patients should have appropriate imaging technique.Key words: Brain metastasis, breast cancer, risk factors.

CLINICO-RADIOLOGICAL EVALUATION OF LEGG-CALVE-PERTHES DISEASE MANAGED BY PROXIMAL FEMORAL VARUS DEROTATION OSTEOTOMY: A RETROSPECTIVE STUDY

AMITOSH MISHRA; AJAI SINGH; SIBANANDA RATHA; SYED AFAQUE; ANIL PANDA

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 59-65
DOI: 10.33762/bsurg.2021.129221.1002

Introduction:
Legg-Calve-Perthes disease is a juvenile idiopathic aseptic, non-inflammatory, osteonecrosis of immature hip in which the blood supply of femoral epiphysis is not sufficient and the bone dies provisionally followed by a subchondral fracture, fragmentation, revascularization and remodeling. It is associated with both substantial hip pain and dysfunction during the disease process as well as later in adulthood. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity. In the current study, authors evaluated the outcome of proximal femoral varus derotation osteotomy in children with Legg-Calve-Perthes disease.
Material & Methods:
All the children (up to 16 years) presenting with Perthes disease, of both sex and willing to get enrolled in the study and were managed by proximal femoral varus derotation osteotomy were included in the study. Evaluation were done in terms of clinical symptoms and signs, Harris hip score and radiologically with X-rays.
Results:
The study results indicated improvement in pain, limp, abduction, internal rotation and Harris Hip Score which was statistically significant in the study subjects.
Conclusion:
According to this study, proximal femoral varus derotation osteotomy is an acceptable method for management of patients with Legg-Calve-Perthes disease in all age group of patients. This surgery led to decrease in pain, limping, and increase in range of motion.

CLINICO-MICROBIOLOGY OF CHOLESTEATOMA OBTAINED DURING MASTOID SURGERY IN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Marwah Abd Ali; Isam M Al-Shareda

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 36-40
DOI: 10.33762/bsurg.2021.168435

Abstract Chronic Otitis Media (COM) is a long standing inflammation of the middle ear and mastoid, it is a common health problem. The evidence of microbiology in COM in different studies showed variable frequencies, but little studies showed the role of fungal colonization. This study aimed to identify the microbiology of cholesteatomatous COM concentrating on clarification of fungal colonization. A prospective study was done in otolaryngology department of Basrah Teaching Hospital from June 2018 till July 2019. This study was carried on a randomly collected data of 25 patients diagnosed as COM by a specific designed questionnaire including history and examination. The specimen was collected during mastoid surgery which included any cholesteatoma in the middle ear and mastoid and sent for bacteriological and mycological examination. Statistical study was done by using SPSS v.23 Bacteria were isolated in 84% of the cases in which Pseudomonas aeruginosa was the commonest one (33.3%). Fungi were isolated in 28% cases, in which the Aspergillosis was the commonest (19.3%). There is no recognizable pattern of significant association between the fungi and the reported complications or the stage of the disease. In conclusion, there is significant percentage of fungal colonization in COM with cholesteatoma so it may has a role in inflammatory response of perimatrix, but there is no clear mechanism of this interaction, so may need larger sample and longer duration of study with postoperative follow-up and trail of combined antibiotic-antimycotic treatment. Key words: clinical,microbiology, cholesteatoma, mastoid surgery, otitis media.

COBLATION TONSILLECTOMY, IS IT SUPERIOR TO COLD STEEL METHOD?

Haider Hashim; Ahmed M Al-Abbasi; Sabah Al-Urabi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 41-44
DOI: 10.33762/bsurg.2021.168436

AbstractCoblation tonsillectomy is a new technique that was started in 1975, it involves passing a radiofrequency bipolar electrical current through a medium of normal saline, resulting in a plasma field of highly ionized particles which in turn break down intercellular bonds and thus melt tissue at around 40º to 70ºC (in comparison with electrocautery which cuts tissues at 400ºC)The aim of this study is to evaluate the benefit of coblation tonsillectomy over conventional (cold steel) tonsillectomy, comparing tonsillectomy duration, blood loss during the surgery, and the postoperative pain. This prospective randomised single-blinded clinical trial was done on 90 patients. Patients were divided into 2 equal groups; Group A: Underwent coblation tonsillectomy, and Group B who underwent cold steel tonsillectomy. The study was performed in Al-Musawy Private Hospital, Basrah Teaching Hospital, and Al-shifaa hospital, Basrah, Iraq. All surgeries were done by the three authors in the period between February 2018 to August 2020. The intraoperative bleeding, duration of surgery, and postoperative pain were evaluated and compared for both groups. The age range of the studied patients was 4–32 years, 52 were males and 38 were females. The average duration of tonsillectomy procedure was 31.8 minutes in coblation tonsillectomy (Group A), while the average duration in the cold steel tonsillectomy (Group B) was 25.8 minutes. The average operative blood loss in cold steel tonsillectomy was 31.5 ml while that incoblation was 3.2 ml. Average postoperative pain in coblation group was (20.7± 6.15), while in cold steel group was (27.5±7.27).In conclusion, coblation tonsillectomy is effective and beneficial in decreasing the volume of intraoperative blood loss but not for postoperative pain in comparison with conventional method, in addition that it take more time to be completed.Key words: coblation, cold steel, tonsillectomy.

THE EFFECT OF EARLY VERSUS LATE TRACHEOSTOMY ON DURATION OF MECHANICAL VENTILATION AND INTENSIVE CARE UNIT STAY IN TRAUMATIC BRAIN INJURY PATIENTS

Doaa Mudhafar Abdul-Samad; Abdul-Razzaq H Alrubaye; Duraid A Altameemi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 45-50
DOI: 10.33762/bsurg.2021.168437

AbstractTracheostomy is a surgical procedure that frequently performed for patients in the intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in the ICU.This study aimed to compare the effect of early versus late tracheostomy on duration of mechanical ventilation and ICU length of stay in traumatic brain injury patients and to determine the appropriate timing to perform tracheostomy for those patients.A Prospective comparative study was performed for head trauma patients with Glasgow coma scale (GCS) less than eight who needed endotracheal intubation with or without mechanical ventilation in the ICU of Al-Sadr Teaching Hospital in Basrah from February 2019 up to December 2019.In this study, there were 94% males and 6% females, 52% were in the age group between 20-40 years, median duration on endotracheal tube in early tracheostomy (ET) group was 5 days while in late tracheostomy (LT) group was 11 days. Total duration on MV was significantly shorter in ET group (9.63±1.87 versus 17.81±6.66 days in LT group; p<0.05). Post tracheostomy MV duration was shorter in ET (6.23±1.48 versus 10.69±4.34 days p<0.05). The ICU length of stay also was significantly shorter in early group (12.70±1.80 versus 22.37±7.19 days; p<0.05).In conclusion; early tracheostomy in traumatic brain injury before 7 days from endotracheal intubation significantly shortens the duration of mechanical ventilation and ICU length of stay.Key words: early, late, tracheostomy, mechanical ventilation, ICU stay, brain injury

BREAST CANCER AMONG WOMEN IN BASRAH, IRAQ: A DESCRIPTIVE STUDY IN BIRAD 1 & 2 SCREENED CASES

Mazin H Al-Hawwaz; Hayder Hashim Abdulsamad; Rajaa Ahmed Mahmoud

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 51-58
DOI: 10.33762/bsurg.2021.168438

Breast cancer is the most commonly diagnosed cancer among women around the age of menopause. With an advice from WHO, screening programs are encouraged globally for detection of the breast cancer in early stage using mammography imaging technique that is used to understand the breast health and early detection of breast lumps.The study aimed to determine the socio-demographic characteristics of breast cancer screened cases among women aged above 35 years in Basrah with studying the time trend of registered breast cancer cases in Basrah from 2014 to 2020. In addition, it also aimed to detect malignant cases among Breast Imaging Reporting and Data System (BIRADS) 1 & 2 breast cancer screened cases. This is a database descriptive study using mammography medical records of women attended to Basrah Cancer screening Center in Basrah Teaching Hospital. A total of 448 female patients who had histopathological result indicating breast cancer and were classified according to mammogram (BI-RADS) grading methodology in the period 2014-2020. The study found that above 55 years of age multipara women were the highest group affected by breast cancer. Most importantly, malignancy was detected in 20% of breast cancer cases that were categorized as BIRAD 1 & 2.In conclusion, women with BIRAD 1 & 2 should be included in active follow-up examinations to detect any little risk that the lesions are malignant.Key words: Breast Cancer, Basrah, BIRAD, mammography screen

STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY

Ali G Mohammed Redha; Adil A Jaber; Aqeel M Nassir

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 66-70
DOI: 10.33762/bsurg.2021.168440

Inguinal hernia repair can be achieved by many techniques but skin closure still limited to only two methods; sutures and staples. In spite of that both have the same role in healing by approximation of skin edges; they differ in terms of cost, pain, cosmoses, wound complications,and time of wound closure.Two groups, each contain 50 patients were studied regarding inguinal hernia repair by using subcuticular suturing or staples for skin closure. The time of closure, cost, infection rate, pain at removal and scar acceptance were assessed and compared in the two groups.The mean time was shorter in staples group (8.77 min. Vs 2.35 min.) with a p-value <0.05.Stapler cost was significantly higher than sutures (12 USD VS 2 USD) and p<0.05. Infection rate was more with sutures than staples (8% VS 4%) however it was with no significant difference (p>0.05). Pain difference was significant at time of removal assessed by visual analog scale score which is mild with staples and moderate with sutures (p<0.05). No much difference in scare acceptance between the two groups with more than 90% good scar in both(p>0.05).In conclusion, staples are good alternatives to subcuticular sutures in closure of skin incision in inguinal hernia repair. They are associated with good cosmetic results, less pain at removal, less wound infection and shorter time of wound closure but there is a need to reduce their cost.Key words: Staples, Sutures, Skin closure, Wound complications

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.

8- TONSILLECTOMY FOR THE TREATMENT OF HALITOSISY!

Zahra Kadum Saeed; Ahmed M Al-Abbasi

Basrah Journal of Surgery, 2008, Volume 14, Issue 1, Pages 37-41
DOI: 10.33762/bsurg.2008.55518

This study aimed to investigate the tonsils as an origin of halitosis and to assess the efficacy of
tonsillectomy for the treatment of oral bad breath caused by chronic tonsillitis. After excluding
dental, periodontal, sinonasal, oral, pulmonary, and gastroenterological diseases as the origin of
halitosis, fourty-four patients with halitosis caused by chronic tonsillitis which proved by positive
Finkelstein's tonsil smelling test (pressing the tonsils and smelling the squeezed discharge),
were included in the study. All patients were treated by tonsillectomy. Subjective and objective
postoperative assessment was based on self-and-family report and clinical assessment.
Patients were reviewed after 4 and 8 weeks postoperatively. Complete improvement of halitosis
occurred in 31 patients (70.4%) after 4 weeks, this value increased to 35 patients (79.5%) in the
second review after 8 weeks. It is concluded that tonsillectomy is significantly effective
procedure for the treatment of halitosis caused by chronic tonsillitis.

Directory of Open Access Journal (DOAJ)

Date added to DOAJ: 18 May 2020 Record Last Updated: 18 May 2020

Keyword Cloud