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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: 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

THE OUTCOME OF DOUBLE DARTOS VERSUS SINGLE LAYER FLAP IN SNODGRASS URETHROPLASTY FOR DISTAL HYPOSPADIAS REPAIR IN BASRA TRAINING CENTER OF UROLOGY

Murtadha Almusafer; Safaa Gatea Mezban; Murtada Faisal

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 2-8
DOI: 10.33762/bsurg.2021.170236

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon (rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is considered the most popular one, and there are multiple variations in this procedure to get high success rate and decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal flaps in TIP urethroplasty. This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of double flaps in preventing possible complications in particular, urethral fistula. A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020. A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap & (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally 3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF) was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups in the occurrence of UF (P = 0.001). According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and meatal stenosis are higher in group II than group I but they were statistically insignificant. Keywords: Hypospadias, Urethroplasty, Tubularized Incised Plate (TIP), urethral fistula, dartos flaps.

laser vs optical urethrotomy for urethral stricture

Ali Haseeb; Mahmood shakir abdulkarim karbalaie

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 9-19
DOI: 10.33762/bsurg.2021.131829.1013

A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that
constricts the urethral lumen. As the constriction increases, obstruction occurs and
leads to symptoms which may be related to the obstruction or secondary to it(1).
(Figure 1).
The term stricture usually used for constrictions of the anterior urethra. Otherwise in
the posterior urethra the terms stenosis or contracture are applied(2).
The site and the age of the patient may give a hint about the cause of the stricture. For
example, Meatal strictures may be caused by lichen sclerosis (the most common
identifiable cause of anterior urethral stricture in young adults), and instrumentation or
poor hygiene at any age(2)
A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction increases, obstruction occurs and leads to symptoms which may be related to the obstruction or secondary to it(1).
(Figure 1).

The term stricture usually used for constrictions of the anterior urethra. Otherwise in the posterior urethra the terms stenosis or contracture are applied(2).
The site and the age of the patient may give a hint about the cause of the stricture. For example, Meatal strictures may be caused by lichen sclerosis (the most common identifiable cause of anterior urethral stricture in young adults), and instrumentation or poor hygiene at any age(2).

A comparative study between traditional and ejaculation preserving Transurethral resection of prostate

Issam Al-Azzawi; Ihab Mahmood Hussein

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 20-25
DOI: 10.33762/bsurg.2021.131298.1011

This is to evaluate the efficacy & safety of a modified ejaculation preservation Transurethral Resection of Prostate ( epTURP ) , in comparison with the traditional technique - Transurethral Resection of Prostate ( TURP ) . A prospective controlled clinical interventional study whereby 40 Iraqi male patients scheduled for TURP were randomly assigned into 2 groups; group 1 treated with epTURP, and group 2 treated with TURP. Pre & post-operative evaluation of the patients included history taking, filling the international prostate symptom score ( IPSS ), the international index for erectile function ( IIEF – 15); questions 9,10,13 & 14, measurement of ejaculate volume, Uroflowmetry (Q-max) & measurement of Post Voiding Residual urine (PVR). Follow up schedule was at 6 weeks & 3 months post-operatively. The Mean age of patients was 59 year, mean prostate volume was 46 ml. Post-operatively 19/22 patients in the epTURP group & 3/18 patients in the TURP group had preserved their antegrade ejaculation, which led to a significant difference between the 2 groups in mean ejaculate volume & IIEF .There was a comparable improvement in post-operative values of IPSS, Q-max & PVR in both groups. Complications were minimal & manageable in both groups. In Conclusion The epTURP was in our experience a safe & effective technique in preserving antegrade ejaculation & improving urinary outflow in patients with prostate volume approaches 50 ml . Keywords: Transurethral resection of prostate, ejaculation preservation, uroflowmetry, post voiding residue, ejaculate volume

EVALUATION OF THE CLINICAL OUTCOME OF SIX VERSUS FOUR STRANDS AUTOLOGOUS HAMSTRING GRAFT FOR ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Midhat M. Mahdi; Ahmed K. Lafta

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 26-36
DOI: 10.33762/bsurg.2021.170238

Anterior cruciate ligament (ACL) injury is a common injury among sport men. Currently the arthroscopic reconstruction is the gold standard treatment in majority of cases. There are different ways to do the surgery, different approaches and different grafts. Each has its advantages and draw backs. The autologous four strands hamstring graft is a widely used graft. A new method of using six strands graft is now used to strengthen the graft. This study is to compare the clinical outcomes of the patients underwent a six strand autologous hamstring graft ACL reconstruction and those done with four strands graft. It`s retrospective and prospective comparative study carried out in Basrah Teaching Hospital. Started at January 2015. Twenty one patients with six strands graft included prospectively and 35 patients with four strands included retrospectively from previous study. All patients were subjected to the same procedure by the same surgeon. The patients are assessed preoperatively by stability tests and Tegner Lysholm score,then followed up after 6 months and after one year by the same tests and Tegner Lysholm score. Twenty one male patients with six strands graft have age ranging from 20 to 35 years (mean 26.1±3.9). A thirty five patients with four strands were included, their age were (24.6±2) years. In the six strands group (71.6%) were sport men versus (82.8%) in the four strands group. The six strands graft size ranged 8-11 mm with mean (9.9±0.8)mm, while the four strands graft size ranged 7-9.5 mm with mean (8.5mm). After one year the results was instability (9.5%) of the six strands group versus (25.8%) in the four strands group. The mean post- operative Tegner Lysholm score in six strands group was (92.9±6) with excellent in (85%) while it was excellent in (22.8%) of the four strands group, although the mean Lysholm score not mentioned in the previous study. In conclusions, the six strands autologous hamstring graft is an alternative method for ACL reconstruction particularly when the four strands graft cannot provide sufficient size. Keywords: Anterior Cruciate Ligament (ACL) injury, hamstring graft, ACL reconstruction.

Patterns of Non-union of Femoral Shaft Fracture in Basra Teaching Hospital. A Retrospective review.

Mofeed Yaseen Alwaaly

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 37-42
DOI: 10.33762/bsurg.2021.131908.1012

Abstract:
Background and objectives: Long bone fractures are witnessed almost every day in the orthopedic practice. Femoral shaft fractures (FSF) generally are due to high energy trauma in working age group. non-union of FSF is not infrequently encountered challenge. This study reviews cases of FSF that ends up with non-union in Basra Teaching Hospital to explore some factors related to non-union.
Patients and methods: A retrospective case series were conducted in Basra Teaching Hospital from January 2012 - June 2014 including 124 patient with FSF. Thirty three patients were identified during the study period (18 months), demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate of the patients are described.
Results: Among 33 patients with nonunion FSF, 23 were males and 10 females, aged from 15 to 60 years (mean = 35). High energy trauma is the chief source of FSF in this analysis .
After 9 - 12 months from initial trauma, patients ends up with non-union, 9 atrophic, 13hypertrophic and 11 infected non-union. Thirty patients underwent revision surgery, with addition of bone graft , three patients no revision surgery, within the study period ( 18 months ), 25achieved successful union or showing signs of progressive union , 3 had united fractures with chronic osteomyelitis , 5 non-united fractures .

Conclusion: nonunion of FSF a great challenge to the orthopedic surgeon and the patient life and development, to overcome this problem both the surgeon and the patient should cooperate to avoid this tragedy story.

Quality of Life in Women with Breast Cancer attending Basrah Oncology Centre

Elaf Muhammad Saleh AL-Tawri; Narjes A.H Ajeel

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 43-49
DOI: 10.33762/bsurg.2021.130806.1009

Abstract
Background
Quality of life issues are increasingly being recognized as critical in the spectrum of cancer treatment that the prolongation of survival cannot be the only therapeutic objective. In some cases, patients and physicians may have to choose between the prospects of longer survival or better quality of life during the remaining time.
Patients and methods: This is a cross sectional study carried out to measure health-related quality of life in 275 women with breast cancer attending Al-Basrah oncology center during six months period, data were collected through direct interview using the standard European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-C30) and its complementary questionnaire specific for breast cancer (QLQ -BR -23).
Results: The study showed that the mean score for global QoLwas52.39 ±17.1 indicating that the patients had average scale score. The most important predictors of global QoL were physical, role, cognitive and sexual functions in addition to future perspective and arm symptoms.
Conclusion
The most important determinants predicting global QOL were role, physical, cognitive and sexual functions in addition to future perspective and arm symptoms.

Prospective randomized study comparing safety and efficacy of standard versus tubeless percutaneous nephrolithotomy

ERSHAD HUSSAIN GALETI; Vedamurthy Reddy Pogula; Abhiram KUCHERLAPATI

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 50-59
DOI: 10.33762/bsurg.2021.132363.1016

Objective:To prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.
Patients and methods:220 patients undergoing PCNL were randomized to two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with nephrostomy tube placement postoperatively with 110 patients in each group.Inclusion criteria were stone size more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter Results:There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the complications, stone clearance, need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively.
Conclusion:Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower), in patients with bilateral disease and effective procedure if done in a selected group of patients.

the benefit of tympanometry for certain ear diseases

Hussam Haider Salman; Adnan khudier yaqoop; Rafid Y. Jabbar Almaidi

Basrah Journal of Surgery, 2021, Volume 27, Issue 2, Pages 60-64
DOI: 10.33762/bsurg.2021.130727.1007


 Tympanometry is an objective test measure the mobility (compliance) of the tympanic membrane as a function of applied air pressure in external canal, It is particularly useful in assessing the secretory otitis media during childhood. This is a prospective study performed at ENT department of the Basrah Teaching Hospital for the period from November / 2013 to February / 2014. The study is to assess the advantage of tympanometry as a diagnostic tool and to audit the uses of tympanometry in the ear diseases in ENT department of Basrah Teaching Hospital. The statistical calculations were carried out using chi-square test. The p value >0.05 was considered statistically insignificant. Fifty patients aged (4—84years) who were referred by otolaryngologist to our audiological unit for audiological assessment were included in the study. Out of these 50 patients (55 ears had otitis media with effusion, 12 ears had Eustachian tube dysfunction, 4 ears had barotraumas, 7 ears had acute otitis media, 4 ears had chronic suppurative otitis media, 2 ears had otosclerosis and 15 ears were normal on clinical examination). The clinical diagnoses was compared with tympanometric findings and the coincidence between two, was as follow; 80% in otitis media with effusion, 75% in barotraumas , 100% in acute otitis media. In conclusion; tympanometry is an important tool in the diagnosis of some of the ear diseases. It is not necessary to performed in every case as the clinical examination could clarify the diagnosis in most cases . Keywords: benefit , tympanometry

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.

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.

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.

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.

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