BASRAH JOURNAL OF SURGERY

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Authors: Thamer A Hamdan

Mistakes are common problems of our daily practice. Sadly, we face them in all aspects of life, and at all levels. Mistakes may lead to insignificant harm, but still they should be counted as mistakes. Nonetheless, they could lead to serious problems, causing death or even reach the level of a surgical crim

10-16

Authors: Munther Jalil Abdul-Abbas & Sarkis K Strak

Abstract The link between gallstones formation and diabetes mellitus remains controversial. The study aims to find the prevalence of gallstones in diabetic patients and its relation with status of control, and duration of diabetes mellitus. A case-control study was conducted in Al-Basrah General Hospital; Basrah city, southern Iraq from January 2015 to September 2015. The study enrolled 100 type 2 diabetic patients with no abdominal pain (60% females, 40% males) as a test group and 100 asymptomatic subjects with no diabetes mellitus (60% females, 40% males) as a control group. Both groups were comparable for gender, age, and body mass index and examined by ultrasound to find gallstones. Blood samples were taken for fasting blood glucose and body mass index was measured. Age, gender, family history of gallstones, and parity for females were recorded in both groups. The tested group was further divided into two subgroups with and without gallstones. The association between duration of diabetes mellitus and hemoglobin A1c level with gallstones was assessed. Gallstones were detected in (28%) of diabetic group and (12%) of controls, which was highly statistically significant (p value=0.005). The prevalence of gallstones was found to be significantly higher among those with more than 10 years of diabetes and poor glycemic control compared with those with less than 5 years and good glycemic control. The study suggested that diabetic patients are at higher risk for gallstones in comparison to non-diabetic patients. Gallstones are found to be higher in those patients with long duration of diabetes mellitus and poor glycemic control.

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Authors: Mahmood Shakir Abdulkarim

Mahmood Shakir Abdulkarim MB,ChB, FICMS, FRCS, Assist. Prof. of Urologic Surgery, Department of Surgery, College of Medicine, University of Basrah, IRAQ. Abstract This study was done to evaluate a newly introduced technology to my country to determine the safety of the procedure, to what extent can it reduce patient’s symptoms and what are the possible complications that are associated with it. In addition to balance the benefits of the procedure to the draw backs, risks and complications. The study enrolled forty-one patients with Benign prostatic hyperplasia, with high international prostate symptom score and low flow rate excluding other causes for that like stricture, stone or neurological causes. A high power 180 W diode 980 nm LASER was used to vaporize the prostate recording data regarding the procedure and all patients were checked one month later for symptom scoring, flow-rate and ultrasound examination. The mean size of the prostate gland 53.07 gm ±11.75 SD, the Mean operative time was 61.51 min. The mean I-PSS was 9.82±1.88 SD compared to the pre-operative mean of 20.24±2.62 SD which is statistically significant (t (41) =17.66, P≤0.001). The maximum flow-rate was 7.94 ml per second ± 2.41 SD before surgery and there was a significant rise of 14.15 ml per second ± 2.502 SD postoperatively (t (41) = -14.86, P≤0.001). The only significant complication patients had was voiding irritative symptoms. The results show clearly that 980 diode LASER is an effective procedure for the treatment of patients with benign prostatic hypertrophy, as well as being safe procedure that could be recommended as replacement for transurethral resection of the prostate with some reservations regarding the cost of the fiber.

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Authors: Issam Merdan, Sadq Ghleb Kadem & Yaqoop Ayoob Yaqoop

Issam Merdan*, Sadq Ghleb Kadem# & Yaqoop Ayoob Yaqoop@ *MB,ChB, FICMS, CABS, Professor of Surgery, Department of Surgery. College of Medicine, University of Basrah, Consultant Surgeon, Al-Sadir Teaching Hospital, #MB,ChB, FICMS, General Surgeon, Department of Surgery, Al Shiffa General Hospital, @MB,ChB, FICMS, CABS, General Surgeon, Department of Surgery, Al Shiffa General Hospital, Basrah, IRAQ. Abstract The creation of pneumoperitoneum is an essential step in laparoscopy, Veress needle, direct trocar entrance and modified open methods with their different modifications are the three widely used methods nowadays. Each method has its own advantages & disadvantages and each surgeon has his own preferred method of creating pneumoperitoneum based on his training and experience. The aim is to compare the safety and efficacy of modified open insertion technique (MOIT) with the direct trocar insertion (DTI) and Veress needle techniques (VN). From January 2013 to December 2015, two hundred ten patients with different indications for laparoscopic surgery were included in this study for evaluation of three different methods of creating pneumoperitoneum, one hundred forty of them were operated upon in Al-Sadir teaching hospital by same laparoscopic surgeon with closed technique, this group was equally divided in to two groups; Veress needle technique (VN group) and direct trocar insertion technique (DTI group) each group included 70 patients, the remaining seventy patients were operated upon in Al Shiffa general hospital by same laparoscopic surgeons with modified open trocar insertion technique (MOTI group). Of the 210 patients; 70 (33.33%) patients operated with Veress needle (VN) technique in patients, 70 (33.33%) patients operated with Direct trocar insertion (DTI) technique and 70 (33.33%) patients operated with Modified open trocar insertion (MOTI), the patient’s ages ranged from 17 to 76 years, 172 (82%) patients were females and 38 (18%) patients were males. The mean time required for entry in patients subjected to VN technique was 3.63±0.64 minutes in comparison to 1.79±2.39 minutes and 2.01±1.82 minutes for (DTI) and (MOTI) techniques respectively, this difference is statistically significant (p-value <0.001), the VN technique associated with high rate of minor complications 32 (45.71%) patients in comparison with 7 (10%) patients and 5 (7.14%) patients reported during DTI and MOTI respectively, this difference is statistically significant (p-value <0.001), there were no reported major complication in this study like visceral or vascular injury and gas embolism. In conclusion, both DTI and MOTI techniques are safe and effective procedures to create pneumoperitoneum during laparoscopic surgery, they are associated with few minor complications and no failer rate in comparison to VN technique.