Print ISSN: 1683-3589

Online ISSN: 2409-501X

Volume 14, Issue 1

Volume 14, Issue 1, Spring 2008, Page 1-88


2- UTILISATION OF LAPAROSCOPIC SURGICAL TECHNOLOGY AND EXPERIENCE TO PERFORM NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES), A NEW ERA IN MINIMALLY INVASIVE SURGERY`

Majeed H Alwan

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 3-7
DOI: 10.33762/bsurg.2008.55512

The field of minimally invasive surgery has seen tremendous development and refinement
since the first laparoscopic cholecystectomy was performed in 1987. Laparoscopic surgery has
several advantages over traditional surgery. The next logical step in the evolution of minimally
invasive surgery may be to eliminate all abdominal incisions. The terms being used in the
literature include �incisionless�, �endoluminal�, �transluminal�, and �Natural Orifice Transluminal
Endoscopic Surgery� (NOTES). This article aims to summarize the background and current
status of NOTES.

3-ENDOSOCOPIC THYRIOD SURGERY

Ghassan A A Nasir

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 8-13
DOI: 10.33762/bsurg.2008.55513

Thyroid resection is one of the most
common operations performed
throughout the world. This procedure is
classically realized through a transverse
cervical incision and associated with a
very low morbidity and mortality rate.
However, the visible scar on the
anterior surface of the neck is disliked
by many patients, especially by young
women in whom this

4PATTERN OF DEGENERATIVE SPINAL CANAL STENOSIS IN SOUTH OF IRAQ. A REVIEW OF 1699 CASES

Thamer A Hamdan

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 14-18
DOI: 10.33762/bsurg.2008.55514

Background context: Both systemic hypertension and degenerative spinal canal stenosis are
common diseases in the population, however, the cross relationship had not been reported.
Purpose: To determine the incidence of systemic hypertension among patients with
degenerative spinal canal stenosis and to describe the pattern of this degenerative spinal canal
stenosis in south of iraq.
Study design: Retrospective and prospective review.
Patient sample: A total of 1699 persons (644 females and 1055 males) whom their blood
pressure measured. A 326 patients had degenerative spinal canal stenosis and 1373 not had
spinal stenosis {599 patients had prolapsed intervertebral disc prolapse operated on(control
no.1 group) and 774 persons were normal (control no.2 group)}.
Outcome measure: Postoperative blood pressure monitoring.
Methods: Systemic blood pressure measurement were reviewed for all of the 1699 persons
with postoperative follow up of their blood pressure, also the level of pathology was recorded.
Results: Systemic hypertension was present in 46% of patients with degenerative spinal canal
stenosis, 18.1% of patients with intervertebral disc prolapse (control no.1) and in 17.4% of
normal persons(control no.2). Postoperativly, hypertension resolved spontaneously or easily
controlled with less number and lower doses of antihypertensive drugs.
Conclusion: Systemic hypertension highly prevalent among patients with spinal stenosis and
disappear or becomes lower after operative treatment.

5- BEST METHOD TO MINIMIZE POST APPENDECTOMY WOUND INFECTION

The late Haider T Al-Baaj; Issam Merdan; Nezar A Al-Mahfooz

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 19-22
DOI: 10.33762/bsurg.2008.55515

Despite numerous methods of wound care post appendectomy, no definite technique documented
to be the best. Wound irrigation under pressure with syringe is regarded recently as an
acceptable physical and biological way to prevent post appendectomy wound infection. This
study compares the best of several method of wound infection prevention on 418 patients subjected
to appendectomy and divided in different groups, including the use of systemic antibiotic,
local antibiotic, povidone iodine, and saline pressure irrigation. We concluded that: syringe
pressure irrigation to the wound significantly decrease post operative infection, and is
best in
comparison to other methods.

6-MISSILE HAND INJURIES IN BASRAH CITY

Amin M Hasan; Ali A Al-Iedan; Falih W Hashim; Avadis A Muradian

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 23-28
DOI: 10.33762/bsurg.2008.55516

Missile hand injuries (MHI) have increased in our locality, in this prospective study 130 patients
(140 hands) with MHI were included, they were 86% male, and 42% were between 21 to 30
years of age. Forty nine percent were injured by bullet and 26% by explosions of different
objects. Combined tissue injuries were presented in 62% of the patients with associated
fractures in 63%. In 70% of the hands initial surgical wound debridment was performed, 24% of
the fractures were stabilized by K- wire and with the simple skeletal external fixations in 18%.
Serial different types of secondary and definitive surgical treatment were performed in 62% of
the patients. After the follow up period, most of the patients had multiple complains and only
14% had a satisfactory functional hand.
The initial, definitive management, the severity and mechanism of the injury that lead to
multiple tissue damage had a great affect on final functional recovery.

7- FACTORS INFLUENCING POST-OPERATIVE COMPLICATIONS AFTER PROSTHETIC "MESH" REPAIR OF INCISIONAL HERNIA (A prospective study).

Ali K Hasson; Jasim D Masoud; Mazin H Al-Hawaz

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 29-36
DOI: 10.33762/bsurg.2008.55517

Incisional hernia is frequently met by the general surgeon, its frequently complicate (3.8-11.5%)
of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgical
problem with recurrence being a common. Numerous methods of repair have been described
simple opposition in one layer or complex opposition and the use of prosthetic mesh.
The aim of this study is to report our experience with use of mesh repair and risk factors that
influence post operative complications.
A prospective study done in Basrah General Hospital, Department of Surgery between January
2003 to December 2006.One hundred and ten patients with prosthetic repair of incisional hernia
were included in this study. History was taken and thorough examination was done, all patients
were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations,
primary or recurrent hernia and examined for their body mass index, size and duration of the
hernial defect were recorded. A proforma was completed for each patient, noting prophylactic
antibiotics had been given or not, type of the sac and whether opened or inverted, type and size
of mesh had been used, intraoperative and postoperative complications and postoperative
hospital stay.
Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years for
women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight
and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic
and (24)patients(21.8%)were corticosteroid used. The original operations were bowel related
and gynecological in the majority of patients. Previous incisions were long midline in(38).
Twenty patients had one past operation, (13)had two,(5) had three and one patient had four
past repair, the remaining were new Incisional hernia patients. The main hernia size was (12.3)
cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had
additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small
bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20)
patients. In the majority of patients (78), standard polypropylene mesh had been used and
vicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperative
complications were seroma formation (17.3%), wound haematoma (10%), wound infection
(9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to be
removed. Five recurrent incisional hernias occurred. Most patients developed complications
were obese, diabetic and corticosteroid used. No death in our series.
It is concluded that tension free incisional hernia repair using prosthetic mesh is a safe and
easy procedure with no major morbidity or recurrence. The patient-doctor should advice weight
loss to help reduce risks of surgery and improve the surgical results. Control of diabetes,
corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile
condition, precise and meticulous technique with the use of closed suction drains is important.

8- TONSILLECTOMY FOR THE TREATMENT OF HALITOSISY!

Zahra Kadum Saeed; Ahmed M Al-Abbasi

Basrah Journal of Surgery, 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.

9- PREVALENCE OF INTERNAL ABDOMINAL ORGANS� INJURIES IN PATIENTS OPERATED UPON AFTER BLUNT ABDOMINAL TRAUMA.

Kamal Ahmad Saeed

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 42-47
DOI: 10.33762/bsurg.2008.55519

Blunt abdominal trauma may result in multiple severe injuries which make the abdomen difficult
to assess and easy to overlook. Unrecognized intra-abdominal injury is a significant cause of
preventable death in blunt trauma. This study aimed to find the frequency and features of
lapratomy findings for different internal abdominal organs� injuries in patients subjected to blunt
abdominal injury. A total of 450 patients subjected to blunt abdominal trauma were admitted to
the emergency surgical department of Sulaimania Surgical Teaching Hospital following, 140 of
them were decided to undergo exploratory laparotomy depending on their clinical and imaging
findings that suggesting a visceral injury. Thirty one percent of the patients who subjected to
blunt abdominal trauma need exploratory laparotomy, 80.7% of them were male, and 67.9%
were young. The predominant causative factor of blunt abdominal trauma was the motor vehicle
accidents. Spleen and liver were the frequent injured solid organs. Almost all of the patients had
positive laparotomy results. Traumatic head and neck injuries were the most common
associated non abdominal injuries. Morality rate was only 5% while complication rate was only
7%. It is concluded that males at young active productive age are the main persons suffer from
blunt abdominal trauma. This has an important economic impact on the productivity of the
community. Spleen injury being the most commonly intra abdominal solid injured organ followed
by liver, other visceral structures are uncommonly involved.j1

10- DOUBLE J INDWELLING URETERIC STENTS: INDICATIONS AND COMPLICATIONS

Majid A Mohammed; Murtadha M S Majeed; Abdulla Y Al-Timary

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 48-52
DOI: 10.33762/bsurg.2008.55520

Ureteric stents have been used since many years in urologic practice. Many complications
encountered during its use. This study carried out in the Department of urology at Basrah
General Hospital from 2003 to 2007. During this period 213 patients required D-J stents
insertion were fallowed up. Complications encountered include loin pain in 21.6%, irritative
symptoms in 30.5%, febrile UTI in 10.8%, bacteriuria in 27.7%, upward migration in 3.3%,
slipping in 4.2%. We conclude that indwelling ureteric stents carried a significant risk of
complications and accurate timing of removal or changing is mandatory.

11- ONLAY MESH IN THE MANAGEMNT OF LARGE OR COMPLEX INCISIONAL HERNIA

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 53-56
DOI: 10.33762/bsurg.2008.55521

The aim of this study is to evaluate the use of onlay mesh in the management of large or
complex incisional hernia. A prospective study of 80 patients with incisional hernia
operated on at al-Sadr Teaching Hospital treated with onlay mesh between Jan 2001 to
Jan 2006. Thorough history and physical examination was done, data sheet was
designed include numerous factors that effect operative and healing process. Of 80
patients, 61.2% female &38.8 % male with median age 40.1 years for female & 53
years for male. Patients were with different associated medical problems. Main incision
was lower midline incision 26.2% &main post operative complications was seroma
7.5% & wound infection 7.5% while recurrence of hernia observed in 2.5%.This study
showed that, the big incisional hernias can be efficiently treated by the onlay
positioning of polypropylene mesh.

12- CANCELED SCHEDULED ELECTIVE SURGERY IN OUR PUBLIC HOSPITALS, WHY?

Jasim M Salman; Salam N Asfar

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 57-61
DOI: 10.33762/bsurg.2008.55522

Cancellation of operations increases
theatre costs and decreases
efficiency as well as causing emotional
trauma to the patients and there families.
Elective surgery cancellation is a
significant multifactor problem with
far-reaching consequences1. Obviously,
all cancellations can not be avoided.
Patients may have a change in their
medical condition on the day of surgery
which can not be expected or there is
unpredictable condition in the hospital.
Most problems, however, can be
prevented with a little initiative as we
noticed that in private hospitals all these
reasons may be of negligible
significance.
Postponing

13- HEPATIC TUBERCULOSIS: A REPORT OF TWO CASES

Mohammed H Saeed; Hashim S Khayat

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 62-65
DOI: 10.33762/bsurg.2008.55523

During the second half of the 20th century, as a result of improved nutrition, reduced crowding,
public health measures, and effective chemotherapy, a dramatic decrease in the incidence of
tuberculosis was seen in the world. But in recent years, increased incidence of tuberculosis has
been attributed to several causes, including AIDS epidemic, intravenous drug abuse and
increase in the number of immunocompromised. Hepatic tuberculosis is the most common
manifestation of upper abdominal parenchymatous organ tuberculosis and its incidence has
been increasing. Lack of familiarity with this condition was apparently responsible for the
diagnosis of hepatic tuberculosis being made at autopsy or surgery in the past. Since
tuberculosis remains a potentially curable disease, an awareness of its protean manifestations
is essential.

15- ABDOMINOPLASTY COMBINED WITH GYNECOLOGICAL PROCEDURES, SAFE OR SORRY ?? CASE REPORT AND REVIEW OF LITERATURES.

Amer S. Daood; Issam Mardan

Basrah Journal of Surgery, Volume 14, Issue 1, Pages 69-72
DOI: 10.33762/bsurg.2008.55525

Since abdominoplasty has been
shown to have a positive impact on
patient's self-image and quality of life,
and a large hanging panniculus can
cause problems such as intertrigo,
chronic infection, and immobility, it is
no surprise that the annual number of
these procedures performed has
continued to increase.
A 45 year female patient with history
of recurrent lower abdominal pain and
irregular menses and she was diagnosed
to have a big right ovarian cyst
amenable for surgery, also she had
previous history of two abdominal
surgeries for the same complaint. She is
a heavy smoker and she was obese with
BMI> 35.
A decision for ovarian cystectomy and
abdominoplasty was taken, the patient
was subjected to surgery by
Gynecologist alone in Almuthana
Hospital.
The patient