Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : Endoscopy


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.

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.

ENDOSCOPIC MEDIAL WALL MAXILLECTOMY FOR TREATMENT OF INVERTED PAPILLOMA

Rafid Yaseen Jabbar

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

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

FUNCTIONAL ENDOSCOPIC SINUS SURGERY

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

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

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

VIDEO CAPSULE ENDOSCOPY

Sarkis K Strak

Basrah Journal of Surgery, 2006, Volume 12, Issue 1, Pages 77-80
DOI: 10.33762/bsurg.2006.55342

VIDEO CAPSULE ENDOSCOPY
The first rigid endoscope that allowed inspection of the upper gastrointestinal tract under a general anaesthetic was introduced by Bruening in 1907. Forty years later, the first flexible fiber optic instrument allowed procedure to be done under light sedation. A major advance occurred in 1998 when capsule endoscopy was developed in Europe and introduced into clinical practice, which enabled complete visualization of the small intestine. The U.S Food and Drug administration (FDA) approved its use in August 2001. Since then, more than 50000 capsules have been used in more than 50 countries.
Historically, the small intestine was considered technically difficult to examine because of its length, location, and tortuosity.
Esophago-gastro-duodeuoscopy allows for direct inspection of the duodenum, similarly, incubating the ileocecal valve at colonoscopy or so called terminal ileoscopy can access the very distal portion of the small intestine. Evaluating the more than 20 feet of small bowel that lie beyond the reaches of these instruments has been impeded by difficult technical challenges. Yet, examination of this segment is especially important in evaluating patients with various disorders including gastrointestinal bleeding from an obscure source.
Previously the small intestine could be partly assessed by a push enteroscope, which is longer (about 2 meters) than a standard gastroscope and therefore allows examination of up to 80-120 cm beyond the ligament of Treitz, while intraoperative enteroscopy required a general anasethetic and laparotomy where the enteroscope is manually fed though the small intestine and gradually pulled back to allow for close inspection of the mucosa.
Barium follow though and enteroclysis allow indirect examination of the small Bowel but have a low diagnosis rate1, relatively insensitive for flat diminutive, infiltrative or inflammatory lesions.
Given the limitation of these tests, there has been a surge in investigations on the practical diagnostic ability and clinical utility of capsule endoscopy that allows for direct visualization of the entire small intestine lining2,3.
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Bas J Surg, March, 12, 2006

ECG CHANGES DURING UPPER GASTROINTESTINAL TRACT ENDOSCOPY (A PROSPECTIVE STUDY)

Mutez Nahi Mansur; Issam Merdan; Ali Raheem; Mazin Hawaz Al Hawaz

Basrah Journal of Surgery, 2006, Volume 12, Issue 1, Pages 86-91
DOI: 10.33762/bsurg.2006.55339

This study aimed to evaluate the cardiac changes and complications that occurred in patients who underwent upper gastrointestinal tract endoscopy. The study was conducted from January 2002 to December 2002at Basrah General Hospital and Al-Sadir Teaching Hospital. One hundred and forty eight patients complaining of upper gastrointestinal tract disorders were included in this study. Detailed history, physical examination and ECG was taken before, during and half hour after endoscopic examination. Patients were divided into two groups according if they have previous cardiopulmonary diseases.
One hundred and forty eight patients included in the study, 91 males and 57 females. The age group between 20–40 years represent the commonest group underwent oesophago-gastroduodenoscopy (O.G.D) examination.
All ECG changes that developed in patients before endoscopic examination arise from those who had cardiopulmonary diseases. Forty-two (40.4%) and 21 (47.7%) patients from group I. and group II. respectively showed abnormal ECG changes while 18 (17.3%) and 13 (29.5%) patients from group I. and group II. respectively showed abnormal ECG findings half hour after endoscopic examination . Bradycardia represents the commonest ECG changes occurred during and half hour after examination. We concluded that OGD is a safe procedure but in elderly patients and those with cardiopulmonary disease ECG monitoring should be done during endoscopic examination
Bas J Surg, March, 12, 2006