BASRAH JOURNAL OF SURGERY

3-8

Authors: Thamer A Hamdan*, Mubder A Mohammed Saeed# & Saad J Abdulsalam@

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.

15-20

Authors: Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz

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.

26-33

Authors: Mohamed El Husseini, Taghrid Chaaban

MICRO-ENDOSCOPIC DISCECTOMY, A MODERN APPROACH FOR LUMBAR DISC PATHOLOGY Mohamed El Husseini* & Taghrid Chaaban@ *MD, PhD, Neurosurgeon, Hôpital Libano Français, Zahle, Lebanon. @MS Nursing, IUL, Beirut, Lebanon. Abstract In the last decade, the neuro-endoscope has been used increasingly in the surgical management of spinal diseases, both intradural and extradural. Endoscopic discectomy is increasingly performed in lumbar region. This study included 200 patients with lumbar disc pathology operated upon with both techniques: Classic and Endospine Karl Storz system technique introduced by Destandau. Based on results (Macnab modified criteria), microendoscopic discectomy should be used in properly selected patients. Key words: endoscopic, lumbar disc hernia, Endospine, Destandau technique

40-46

Authors: Isam M Al-Shareda & Ghanem Sikhi Ghanem

Isam M Al-Shareda* & Ghanem Sikhi Ghanem# *MBChB, FICMS, Assist. Prof. of Otolaryngology, Dept. of Surgery, College of Medicine, Basrah University. #MB,ChB, CABS, Basrah General Hospital, Basrah, IRAQ. Abstract Nasal packing is carried out in many nasal surgeries specially in septoplasty for hemostasis and internal stabilization of the cartilaginous & bony skeleton of the nose. However, these packing methods are not a harmless procedures and for this reason their benefit has been tested. The study was performed to compare the use of plastic intranasal splints with or without anterior nasal packing to determine the need of nasal packing after septoplasty. This is a prospective comparative study which was carried out in Basrah General Hospital, Otolaryngology Department, Basrah, Iraq in the period from July 2014 to April 2015. Forty seven patients of different age and gender groups were included in the study. Analysis was done regarding their history and examination including nasendoscopy which was done before septoplasty. The patients were randomly selected at the end of the procedure into two groups; one had plastic intranasal splints without anterior packing and the other had plastic intranasal splints with two different types of packing materials (ribbon gauze impregnated with Vaseline and glove fingers). Patients were compared for postoperative pain, headache, discomfort, bleeding, sleep difficulty, epiphora, septal hematoma on the day of the operation, 24 hours and 48 hours postoperatively. The collected data was analyzed by using SPSS v.17. The age of patients in this study ranged from 18 to 44 years with mean age of (29.6±6.2) years and most of them were between 28 to 37 years (48.9%). Among those 47 patients, 28 (59.6%) were males and 19 (40.4%) were females with male:female ratio was 1.47:1. Pain, headache, discomfort and bleeding was higher in patients in group two with anterior nasal packing materials especially during removal of the packing. there was significant reduction in the frequency of sleep disturbance, epiphora among the patients in group one without nasal packing, however there was no significant difference in septal hematoma between two groups. In conclusion, the plastic intranasal splints can be used alone without the need of anterior nasal packing materials after septoplasty as it can be considered as a type of packing methods that offers the advantages of elimination of pain and discomfort and reduce the complications of packing. The anterior nasal packing should be reserved only for selected cases.

53-61

Authors: Abutalib B Alluaibi, Ali Y Al-Wajeeh & Mansour Amin Mohammed

LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC ULCER Abutalib B Alluaibi@, Ali Y Al-Wajeeh$ & Mansour Amin Mohammed* @MB,ChB, FIBMS, General Surgeon, Al-Mawanee General Hospital, Basrah. $MB,ChB, CABS, General Surgeon, Al-Mawanee General Hospital, Basrah. *MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine, Basrah, IRAQ. Abstract Peptic ulcer is the most common GIT disorder with a prevalence of 2%, peaking around the age of 70 years. Laparoscopic repair of perforated peptic ulcer began to evolve and replace the ordinary upper laparotomy. We studied 47 patients suffering from perforated duodenal or gastric ulcer in Al-Mawanee General Hospital in Basrah in the period 2014-2017, the patients were categorized into 2 groups: 1st group(24 patients) managed laparoscopically and the 2nd group (23 patients) managed by open approach. Perforation found to occur more with duodenal ulcer (29 pt. 61.70%) and more in male patients (26 pt. 55.33%). The peak perforation seen in age group >60 years and the commonest risk factors was the NSAIDs usage. Operative time was insignificantly longer in laparoscopic approach. However, the laparoscopic approach has less post operative pain and less overall complications (4 pt. 16.6% vs. 8 pt. 34.7%). In conclusion, laparoscopic repair of perforated peptic ulcer is a feasible operation and considered promising with less postoperative pain, less postoperative complications and better cosmetic results.

69-73

Authors: Ahmed Falih Noori, Nasseif Jassim Mohammed & Zeki A AL-Faddag

EXCISION WITH MIDLINE CLOSURE VERSUS MODIFIED BASCOM PROCEDURE IN TREATMENT OF SACROCOCYGEAL PILONIDAL SINUS Ahmed Falih Noori*, Nasseif Jassim Mohammed# & Zeki A AL-Faddag@ *MB, ChB, #CABMS, FICS, Dept.of Surgery, Al-Sadir Teaching Hospital. @CABS, FRCS, Professor of General Surgery, Dept. of Surgery, Basrah College of Medicine, University of Basrah, IRAQ. Abstract Pilonidal sinus is a frequently encountered condition in young adults. It is commonly found in the mid-line skin that covers sacrum and coccyx. Sinus can be found elsewhere, sometimes between the fingers in hair dressers, and in the umbilicus. It is characterized by chronic inflammation in one or more sinuses in the mid-line of the natal cleft that contain hairs and debris. Pilonidal disease is a significant social and economic problem affecting predominantly young males in the second decade of life. This study aimed to compare the results of excision and midline closure with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro-coccygeal pilonidal sinus in regard to the duration of the procedure and wound complication. This prospective randomized study was performed on 53 patients operated upon for a pilonidal sinus between June 2014 and December 2015 in Al-Sadir Teaching Hospital in Basrah. Patients were divided into two groups randomly. Group A (25) patients underwent modified Bascom procedure and group B (19) patients underwent excision and midline closure. The modified Bascom technique showed a significantly short wound healing time (30±10 days) compared to primary closure (55±25 days), p<0.01. The duration of this procedure was significantly longer(50±15 minute) in comparison with excision and midline closure (30±15 minutes) p< 0.01. No significant differences between the two groups regarding bleeding, wound infection, seroma formation and recurrence were recorded. In conclusion, modified Bascom procedure is feasible, effective and applicable for all patients with pilonidal sinus. It is of particular advantages in the treatment of complex, recurrent and chronic non-healing pilonidal sinuses when wound healing remains an important dilemma in the surgical treatment.

76-80

Authors: Ibrahim Falih Noori

SOLITARY RECTAL ULCER MIMIC RECTAL CANCER Ibrahim Falih Noori MB,ChB, CABS, FICS, DS, Assist. Prof., Department of Surgery, College of Medicine, Basrah University Abstract Solitary rectal ulcer (SRU) is rare benign disease of poorly understood etiology. The term solitary ulcer is misnomer because the lesion is solitary in only 20% of patients and ulcer present in 40% of the patients only. The lesion has various sizes and shapes that ranges from mucosal erythema to single or multiple ulcers to ulcer-nodular lesion or could be a polypoid or fungating mass. The estimated incidence of solitary rectal ulcer is about 1:100000 annually. Males and females are affected equally with slight predominance toward female patients. The disease can affect children and elderly patients also, although rare. The disease involves straining during defecation, a sense of incomplete evacuation, digital evacuation of the rectum, rectal prolapse and occasionally passing of blood and mucus by rectum. Clinical awareness confirmed by flexible sigmoidoscopy and biopsy are main diagnostic tools. Furthermore, the colonoscopic findings may mimic that of rectal cancer and inflammatory bowel disease and the histopathological results are inadequate due to fibrotic rectal mucosa. Treatment of solitary rectal ulcer depends on the severity of the condition with conservative measures, bowel regimen, and change of life style for mild cases and surgical procedure for sever refractory cases.

89

Authors: Salam N Asfar

Dr. Auda Hasan Al-Jabiri 1968-2017 Dr. Khalaf Lefta Hajim 1973-2017