Basrah Journal of Surgery

This is an overview of the various factors related to the substernal (retrosternal) goitre. The
presentation and discussion include the terminology of the condition, its definition, type, the
mechanism and way the goitre descends in the thorax, its incidence, clinical features,
investigations, and possible challenges in anaesthesia and surgical exposures.

Anal fissure is a common and painful disorder. Its relation to hypertonic anal
sphincter is controversial. The most common surgical treatment of chronic anal
fissure is lateral internal sphincterotomy either open or closed methods,
associated with a risk of pain, bleeding, recurrence and incontinence.
The study was designed to compare the results of open and closed technique
of lateral internal sphincterotomy and to find postoperative complications.
This prospective clinical trial conducted in the Department of surgery in Basrah
General Hospital between January 2006 and October 2008, one-hundred
patients were randomly assigned to open or closed internal sphincterotomy.
Standardized questionnaires assessing patients were administered
preoperatively and at 1st, 2nd weeks and 1-6 month postoperatively.
Out of the 100 patients included in the study, 50 patients underwent open
lateral internal sphincterotomy and the other 50 were subjected to closed lateral
internal sphincterotomy. There was no significant difference in postoperative
acute complications. However, incontinence in terms of soiling and passage of
flatus was 14% in open method and 10% in closed method. There was no
difference in terms of recurrence rate being 4% both in open and closed
methods.
In conclusion, there was no significant difference between open and closed
methods of lateral internal sphincterotomy in regard recurrence rate, healing
rate, hospital stay and other complications, but in view of these findings, closed
method of treatment is recommended if the surgeon is experienced.

This study aimed to learn the incidence of Helicobacter pylori infection in
patients with various gastroduodenal endoscopic lesions and the frequency of
virulence H.pylori associated genes CagA and VacA in these patients.
One hundred seventy six patients (96 males and 80 females) attending
endoscopy units for various dyspeptic symptoms were studied.
Antral biopsies were obtained to detect H.pylori by rapid urease test, culturing
and histopathologic examination. Twenty five patients with positive H.pylori
isolates who were found to be mannose resistant, were tested for cytotoxic
associated (CagA) and vacuolating cytotoxin A (VacA) genes.
Among studied patients, positive H.pylori detected by rapid urease test,
culturing and histopathologic examination (from 50 patients only) were 113
(63%), 127 (71%) and 25 (50%) respectively.
Out of 25 patients with positive H.pylori isolates who were found to be
mannose resistant, positive genes of either CagA or VacA were detected in 18
(72%) patients with positive isolates, while positivity of both genes were
detected in 13(52%) patients with positive isolates. Five (45.4%) and 5 (45.4%)
out of patients with duodenal ulcers and gastritis respectively were positive for
both (CagA) and (VacA) genes.
In conclusion, the highest detection rate of H.pylori infection was by bacterial
culture. A correlation between CagA and VacA genes and endoscopic lesions of
duodenal ulcers and gastritis was found.

Acute appendicitis is the most common abdominal emergency. In 150 patients with acute
appendicitis treated by appendectomy in AL-Sader Teaching Hospital in Basrah, a prospective
study was made to study the delay prior to admission to the hospital and subsequent delay
before induction of anesthesia.
In 67 (44.66 %) patients, the appendix was perforated or gangrenous and in 83 (55.34%)
patients it was acutely inflamed. The median duration of abdominal pain to the induction of
anesthesia was 18 hours ranged 3-69 hours for the acutely inflamed group and 35 hours ranged
8-70 hours for the perforated /gangrenous group.
The median preadmission delay was 12 hours and 25 hours for acutely inflamed group and
gangrenous /perforated group respectively, while the median post admission delay to the
theatre was 2 hours ranged 1-15 hours and1hour ranged 1-13 hours for acutely inflamed and
perforated / gangrenous groups respectively.
Patients arriving at hospital during the hours 08:00 to 14:00 from Sunday to Thursday waited
longer than those seen out of routine working hours before going to the theatre.
In conclusion, Increasing age and preadmission delay were both associated with an increasing
risk of perforated / gangrenous appendix. Cases of acute appendicitis should be given the same
priority as cases of peritonitis if morbidity is to be minimized.