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Article
THE PATTERN OF INDICATIONS FOR SPLENECTOMY IN BASRAH

Authors: Ali Jaffer Aliwi --- Zeki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 19-24
Publisher: Basrah University جامعة البصرة

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Abstract

Splenectomy is performed rather frequently in Basrah city, it is indicated for various disorders including abdominal trauma, hematological disorders and others. This study aimed to analyze the experience in splenectomies performed in Basrah and outlining their different indications. This is a combined prospective and retrospective study of patients who underwent splenectomy in the five major hospitals in Basrah over 3 years period (2008–2010). Patients underwent Splenectomy were 213, 54% underwent elective splenectomy while 46% underwent emergency splenectomy. 144 patients were males while 69 patients were females. The most common indications for splenectomy was trauma (44.6 %), B-thalassemia (18.3 %) and sickle B-thalassemia (17.3 %). In conclusion, the most common indication for splenectomy in Basrah was abdominal trauma followed by hematological diseases, most commonly B-thalassemia and sickle B-thalassemia. All patients underwent conventional open splenectomy, no one underwent minimally invasive approach.

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Article
OBSTRUCTIVE JAUNDICE IN BASRAH

Authors: Abutalib Bader Abdullah --- Zeki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 45-57
Publisher: Basrah University جامعة البصرة

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Abstract

Obstructive Jaundice is a common surgical problem presenting to hospitals as it resulted from many etiological factors like choledocholithiasis or periampullary tumors especially CA head of pancreas. According to the difference in these etiological factors and their progress, symptoms and signs vary in different patients. Diagnostic tools like US, CT scan, MRCP, ERCP and others vary in their ability in diagnosing the main etiology and the operative procedures also differs according to the etiologies, ranging from least invasive like ERCP to very sophisticated procedures like Whipple's procedure for CA head of pancreas. Many factors may affect the morbidity and mortality like the age of patients, presenting etiology and the presence of associated comorbid diseases. This study aimed to demonstrate the main etiological factors of obstructive jaundice in Basrah and the commonest presenting symptoms and signs. Also to study the most applicable investigations and compare their results according to their accuracy in diagnosing the etiology, and to study the most common surgical intervention applied to relieve the obstruction in obstructive jaundice and hospital morbidity and mortality. Both retrospective and prospective study was done in Basrah between January 2006 and December 2009, 243 patients with obstructive jaundice were included in this study from the main general hospitals and private hospitals in Basrah. Data were collected about the presenting clinical features, the diagnostic techniques, operative procedures and the causes of in hospital mortality and morbidity and were analyzed so that a complete picture of these details can be assessed for obstructive jaundice in Basrah. The study shows no significant difference between male and female in obstructive jaundice. The majority of cases found in the age group 50-59 years. Most common etiology was choledocholithiasis. The most frequent applied investigation was the liver function test which was done to all patients. Imaging techniques were applied variably with the US was the most applied while MRCP and ERCP were the least; however, the accuracy was higher with the latter two techniques. Intervention depends on the main etiology: for the choledocholithiasis, most common operation was CBD exploration, for CA head of pancreas the most common operation done was bypass procedure and for complicated hepato-biliary hydatid disease the CBD exploration with T-tube was the common. The post operative morbidity was 20.07% mostly due to respiratory complications, while mortality was 9.86 % mostly due to sepsis. In conclusion, the most common cause of obstructive jaundice in Basrah is choledocholithiasis and CA head of pancreas comes second. ERCP and MRCP are the least applied imaging techniques in diagnosis of obstructive jaundice. The threshold for their application was very high. The least applied intervention to treat obstructive jaundice was the therapeutic ERCP, while the most common was open surgical procedures.

Keywords

OBSTRUCTIVE --- JAUNDICE --- BASRAH


Article
REDUCTION OF POSTOPERATIVE WOUND INFECTION AFTER APPENDECTOMY BY PERITONEAL CLOSURE AND WOUND IRRIGATION WITH NORMAL SALINE

Authors: Ahmad Jaleel Abdul-Razzak --- Zeki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2012 Volume: 18 Issue: 2 Pages: 26-31
Publisher: Basrah University جامعة البصرة

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Abstract

The most common complication following appendectomy is postoperative wound infection andsince it has major effects on patient’s health & recovery and on the health system as itconsumes time and essential resources so from this fact came the importance of the researchesthat are done to find any means to reduce postoperative wound infection and many of themhave been shown to be beneficial in reducing wound infection like the use of prophylacticantibiotics, postoperative antibiotics and laparoscopic appendectomy but in this study we lookfor the effectiveness of 2 simple measures which are peritoneal closure and wound irrigationwith normal saline in reducing the incidence of postoperative wound infection. Aim of the study:to know if peritoneal closure and wound irrigation with normal saline would significantly reducethe incidence of postoperative wound infection after appendectomy.The study had been carried out from January 2010 to January 2012 in Al-Mawanee GeneralHospital and it had been done by the same surgeon and as emergency cases.The study included 297 patients divided into: The control group: include those in whom noperitoneal closure and no wound irrigation were done, patients in this group were 153.Case group: include those in whom peritoneal closure and wound irrigation with normal salinehad been done and it included 144 patients. Comparison between the two groups had beendone according to sex, age, and the state of inflammation of the appendix also factors affectingwound healing and increasing the incidence of wound infection had been taken in consideration.Data were analyzed using P value to determine the significance of the results.Although the incidence of acute appendicitis was slightly higher in males but the incidence ofwound infection was found to be higher in females but it was not statistically different so sex isnot a risk factor for the development of wound infection in both groups. Regarding age, in bothcontrol and case groups, the highest rate of incidence of acute appendicitis was in the agegroup 21-40 years but the highest rate of wound infection was in the age group 60 years andabove, it was 50% in control group and 16% in the case group and so age is a risk factor for thedevelopment of wound infection and there is a clear reduction in the incidence of woundinfection after the use of peritoneal closure and wound irrigation with normal saline and therewere also reduction in the incidence of wound infection in all other age groups after using thesetwo measures. Regarding the state of severity of inflammation of the appendix the highest rateof wound infection was found in the severe appendicitis subgroup in both the control (infectionrate was 31.4%) and case (9.6%) groups but again there was a clear reduction in the incidenceof wound infection.In conclusion: peritoneal closure and wound irrigation with normal saline help in reducing theincidence of postoperative wound infection after appendectomy.


Article
CRITICAL VIEW OF SAFETY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Author: Mohmmed Shaheed*, Mansour Ameen Mohammed & Zeki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 1 Pages: 33-38
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Laparoscopic cholecystectomy has become the preferred choice of management for gallstone disease. In spite of various theories explored trying to assess different aspects of management and outcome to reach the acceptable safest technique in laparoscopic operation and to compare it with its counterpart. Many surgical methods were attempted to clarify their value in counteracting a serious complication of laparoscopic cholecystectomy, mainly is the bile duct injury. This study aimed to evaluate the significance of critical view of safety as a technique of laparoscopic cholecystectomy concerning the issue of preventing bile duct injury in regard to the infundibular technique of dissection. This is an observational study of two hundred fifty patients who were scheduled for laparoscopic cholecystectomy using critical view of safety technique compared with probably matched previously performed two hundred fifty of laparoscopic cholecystectomy using infundibular technique. The incidence of bile duct injury was analyzed in both groups. The results shows that age, sex, body mass index and gall bladder status were comparable in both groups. The Incidence of bile duct injury in infundibular technique was (1.6%), while in critical view of safety technique the incidence was 0% which is statistically significant (P<0.05). In conclusion, critical view of safety technique in laparoscopic cholecystectomy has a significant effect in preventing bile duct injury as compared to infundibular technique with comparable time of surgery and it is best to be the preferred technique in laparoscopic cholecystectomy.

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