Table of content

Basrah Journal of Surgery

مجلة البصرة الجراحية

ISSN: 16833589
Publisher: Basrah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Basrah Journal of Surgery


Editor-in- chief

Prof. Thamer A. Hamdan, FRCS
Prof. Salam N. Asfar, MSc

Information Administrator

Dr. Jasim M. Salman, MB,ChB, DA, FICMS

Associate Editors

Dr. Hashim S. Khayat, FRCS

Prof. Mazin H. Al-Hawaz, CABS, FRCS

Prof. Zeki A. Al-Faddagh, CABS, FRCS

Prof. Issam Merdan CABS, FICMS

Assist. Prof. Ali A. Alshawi, FFDRCSI, FDSRCS

Assist. Prof. Mazin Abdulsattar, CABS

Dr. Zuhair Al-Barazanchi, MSc, PhD



National Advisory Board



Prof. Ahmad M Al-Abbasi, FRCS

Prof. Abdulla M. Jawad, PhD

Dr. Hasan K. Muhamed, FRCS

Assist. Prof. Tahir A Hawrami, DS, CABS

Assist. Prof. Farhad K. Sulayvani, CABS

Prof. Hassan J Hasony, MPhil, PhD

Prof. Nadhim K. Mahdi, PhD



International Advisory Board











Dr. Majeed H Alwan, FRCS, New Zealand

Dr. Luay P Susan, MD, Cleveland, Ohio, USA

Prof. Stewart L Weinstein, MD, USA, Former president AAOS

Dr. Robert W Buchoiz, MD, USA, Former President AAOS

Dr. Cody Bünger, MD, USA, President SICOT

Dr. Scott A Hoffinger, MD, Oakland, CA, USA

Dr. Sebastian Gitter, Dr.med. Biberach, Germany

Dr. Alec Benjamin, FRCS, UK

Prof. W Al-Ma’ani, MD, Jordan

Prof. K Fathie, MD, FACS, USA

Prof. Hikmat Jamil, MD, PhD, USA

Prof. Wajdy L Haillo, MD, PhD, USA

Mr. David Gallaway, PhD, FRCS

Dr. Rick Wilkerson, MD, USA

Dr. Sabri Shukur, FDSRS, USA

Prof. Gary Selnow, USA

Dr. John Howe, USA

Dr. Karim A Shaikley, MD, USA

Dr. John Chalmers, FRCS, UK

Dr. J Frazer, MD, USA

Dr. M Zayer, MD, Sweden

Dr. S Al-Bodur, MD, Jordan




Administrative Secretary

Ms. Elham Altoma
Ms. Salima J Sa’ad
Instructions to Authors

Basrah Journal of Surgery publishes original articles, review articles, leading articles and case reports; all manuscripts are submitted to editorial review. Authors are requested to send two copies of their articles and other editorial material to:

The Editor
Basrah Journal of Surgery, Dept. of Surgery, College of Medicine, University of Basrah. IRAQ.
salamasfar@yahoo.com
OR basjsurg95@yahoo.com
An article is reviewed for publication on the understanding that the work it reports has not been submitted simultaneously to another journal, has not been accepted for publication by another journal, has not been accepted for publication by another journal nor has it been already published. Any such attempt, when detected, will result in automatic rejection and may prejudice acceptance of future contributions. The articles and their illustrations become property of the journal. The editorial board does not necessarily agree with views expressed by the authors.
A covering letter must accompany all submissions and must be signed by all authors. The first named author is responsible for ensuring that all authors have seen and approved the manuscript and are fully conversant with its contents.
Authors should consult “uniform requirements for manuscripts submitted to biomedical journals” produced by the international committee of medical Journal Editors and published in the British Medical Journal, 6 February 1988, 401-5. Only manuscripts, which comply with this, the Vancouver style, will be considered. The text of the articles is usually divided into sections with the headings, Summary (abstract), Introduc-tion, Methods, Results and Discussion. Long articles may need subheadings within some sections to clarify its content. Two good quality plain paper copies of all written and tubular material should be submitted. The manuscript must be typed double-spaced with a minimum of 3cm margins on A4 paper (210 × 297 mm) in the following order:
1. Title page with name of the author(s). The appointment of each author at the time of performance of the work reported should be mentioned; if an author has since moved then his new address is to be added as footnote. Authors names should be mentioned up to six, if there are more authors then the first three are mentioned followed by “et al.”.
2. Summary should be concise, complete in itself and outline the aim, results and conclusions of the paper. Randomized controlled trials should be identified.
3. The text of all articles should be short and to the point.
4. References should be numbered according to their sequence in the text and not alphabetically. They should be written down in compliance with Vancouver style; i.e.
A) Journal: Ferguson AJ, Mazier WP, Ganchrow MI, Friend WG. The closed technique of haemorrhoidectomy. Surgery 1971; 70: 480.
B) Book: Golgberg SM, Nivato-vongs S, Rothenberger DA, Colon, Rectum and Anus. In: Schwartz SI, Shire GT, Spencer FC, eds. Principles of surgery. 4th ed. Singapore: MacGraw Hill; 1984.
5. Tables should be separately typed each on one sheet and must have a Roman identifying number and a short descriptive title.
6. Illustrations should be submitted in duplicate. Photographs must be of the highest professional quality. Original line drawings may be sent instead of photographs. Never write on the front or back of drawing or photographs.
7. Pagination, all pages should be numbered in the sequence, title page, summary, text, acknowledgment, references, tables and legends for illustrations.
8. Abbreviations should be limited in the text. Terms, which are mentioned frequently, may be abbreviated, and clearly defined on first use.
9. Statistical analysis should include a clear description of which methods were used for which analysis. Results of statistical tests should be reported by stating the value of the test statistic, the number of degrees of freedom and the P value. For example, t=1.34, 16 d.f., p=0.2. There should also be an indication whether the results were statistically significant or not.
10. It is preferable to provide the manuscript on a compact disc using MS Word 2003 version.




Checklist for authors
1-Covering letter.
2-Two copies of the article.
3-Writing style according to the Vancouver style.
4-Tables, graphs and legends for the photos each on separate sheet of paper.
5-A copy of the article on a compact disc.


Announcement
The editorial board would like to inform our readers that the journal has been included in the Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) starting from the March, 1999 issue (Vol.5, No.1). This issue as well as all forthcoming issues of the journal will appear in WHO/EMRO web site on the Internet at the address http://www.who.sci.eg The journal was also included in the collection of the National Library of Medicine, Bethesda, Maryland starting from the same issue (i.e. Vol.5, No. 1) as we were informed by the National Institutions of Health in their letter dated February 2, 2000.

Website: http://basjsurge.com email: basjsurg95@yahoo.com

Mobile: 009647801061850 Editor 009647801018133 Information Administrator

مجلة البصرة الجراحية 2015

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Contact info

Website: http://sites.google.com/site/basjsurg email:basjsurg95@yahoo.com, elhamaltoma74@gmail.com
Mobile: 009647801061850 Editor 009647801002992 Editorial Consultant
009647801537124 Secretary

The Editor: Basrah Journal of Surgery, Dept. of Surgery, College of Medicine, University of Basrah. IRAQ.
salamasfar@yahoo.com, OR basjsurg95@yahoo.com

Table of content: 2011 volume:17 issue:2

Article
Editorial THE SURGEON OR THE SURGERY (THE NON OPERATIVE HAZARDS OF OPERATION)…….1

Authors: Thamer A Hamdan
Pages: 1-2
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Abstract

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Article
Leading Article INFECTION IN ORTHOPAEDIC PRACTICE

Authors: Thamer A Hamdan
Pages: 3-8
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Abstract

Introduction Infection continues to be a real problem in orthopaedic practice. Infection is probably the first cause of failure of orthopaedic and trauma operation, it is behind prolonged suffering for our dear patients because of the morbidity and mortality. Although there have been significant reduction in infection due to better surgical techniques, improved operating room environment, more effective antibiotics and the wide spread use of prophylactic antibiotics, we all will face this bad omen in one of our patients at some time in our practice. Sadly, infection continues to happen despite our strenuous efforts to prevent it. Prolonged hospital stay to treat infection may expose the patients to resistant nosocomial pathogens. The incidence of infection varies considerably worldwide; I think the incidence in our locality is very high. The current use of ultra clean air, antibiotics, and exhaust ventilated suits during implantation of prostheses considerably reduced infection. Nevertheless, lack of agreement and controversies still exist regarding the benefit of these very strict infection prevention techniques. Infections are considered nosocomial if there is no evidence that the infection was present or incubating at the time of hospital admission. Infection is considered related to surgery if that occurs at the incision site within 30 days after surgery, if no implant is left in place or within one year if the implant is in place. Infection may occur at all anatomical levels, from the treatment point of view it is vital to precisely allocate the anatomical site of infection. Infection is usually diagnosed depending on clinical features which are to be confirmed by laboratory tests. The presence of pus does not always mean infection, because necrosis of malignant lesion may simulate purulent material. Frequently, patients who have prostheses may be readmitted to the hospital for medical care or other surgical procedures during that time, the bladder catheter, intravascular line, that involve contaminated areas of the body may increase the risk of nosocomial infection. A high risk of infection is present in collagen disease, malnutrition, steroid dependent and other immune suppression drugs, sicklers, hidden nidus of infection anywhere in the body and any operation that lasted longer than the anticipated surgical time. The presence of diabetes mellitus is a concern in patient for surgery. Diabetes impairs the immune response to infection; therefore, wound healing may be difficult in those patients. In acute infection the influence of diabetes is much than in chronic infection. Some patients may have more than one risk factor.

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Article
Review Article MANAGEMENT OF COLORECTAL CANCER DURING PREGNANCY 9

Authors: Majeed H Alwan
Pages: 9-13
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Abstract

MANAGEMENT OF COLORECTAL CANCER DURING PREGNANCY Majeed H Alwan MBChB, FRCSEd, FRACS, FACS, Gastrointestinal and General Surgeon, Tauranga Hospital, Tauranga, New Zealand. E-mail: majeedalwan@xtra.co.nz Abstract Although cancer in pregnancy is uncommon, several types of cancer were encountered. These include malignant melanoma, breast cancer, carcinoma of the cervix, bladder cancer, renal cancer, lymphomas, thyroid cancer, brain tumours, ovarian cancer, gastric and pancreatic cancer and colorectal cancer. Due to the uncommon incidence of the disease and therefore the limited experience coupled with the complexity of the situation which could affect the wellbeing of the foetus and mother, then the management of the pregnant woman with cancer might result in achieving less than the expected optimum. However, from the experience of single case reports and short reviews a reasonable management approach could be reached through multidisciplinary speciality collaboration. The author had encountered two pregnant women with colon cancer, both of them were symptomatic, and one of them had bowel obstruction. Their clinical presentation, diagnosis and management are described followed by a concise review of the literature.

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Article
ACUTE APPENDICITIS, A QUALITY OF CARE STUDY IN BASRAH GENERAL HOSPITAL

Authors: Ahmed Abdul-Razak Essa --- Mazin A Abdulla
Pages: 14-18
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Abstract

This study is designed to evaluate the parameters that indicate the quality of care in acute appendicitis. It is a prospective study in Basrah General Hospital. One hundred ten patients underwent appendectomy in the period between March and July 2010, were studied according to a data collection sheet. The mean duration of symptoms was 29.2 hours and 10% of patients visited the hospital twice. Decision to operate depending on clinical diagnosis alone done in 14.54% of patients while blood cell count was the most frequent investigation done in 78.18% of the patients. The mean waiting period was 6.6 hours. All patients received antibiotics postoperatively while antibiotic prophylaxis used in 74.5%. Rate of perforation of appendix was 12.7%. Histopathological examination of the removed appendix done in 7.27%. The mean hospital stay was 44.02 hours with 20% of patients developed post operative complications. Most of our patients were satisfied with hospital services, facilities and staff behavior. In conclusion, non-utilization of investigations in some patients, long waiting period, high complication rate and extended usage of antibiotics are aspects among others which need to deal with by conducting hospital audits.

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Article
THE PATTERN OF INDICATIONS FOR SPLENECTOMY IN BASRAH

Authors: Ali Jaffer Aliwi --- Zeki A Al-Faddagh
Pages: 19-24
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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
THE EVALUATION OF THE EFFECT OF BUSCOPAN (HYOSCINE-N-BUTYL BROMIDE) ON THE DURATION OF LABOUR

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Abstract

A double-blind study included 200 women attending labour ward. They were divided into two groups; group A (cases) received Buscopan 20mg I.V and group B (controls) received placebo intravenously. Assessment of cervical dilatation was carried out every hour post injection. The duration of the stages of labour, maternal and neonatal outcome was determined. The study revealed that cervical dilatation at 1 hour was significantly lesser in group A (6.8+1.8) cm compared to (7.6 + 2.1) cm in the control group (P<0.05). The duration of the first stage of labour was significantly longer among group A (4.1+1.8) hours as compared with the controls (3.4 + 1.6 hours) P<0.05. The frequency of caesarean section was significantly higher among group A (12 %) compared to controls (4%), P.value < 0.05. Fetal heart rate was significantly higher among group A (137.8+11.2 beat/min) compared to control (133.5+9.9 beat/min), P < 0.001. We conclude that the administration of Buscopan decelerate the cervical dilatation in the first stage of labour and causes prolongation in its duration. Also it is associated with small, but obvious fetal risk, and an increase in the rate of Caesarean section.

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Article
THE IMPACT OF THE GALLBLADDER WALL THICKNESS ASSESSED BY SONOGRAPHY ON THE OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY

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Abstract

Laparoscopic cholecystectomy first became popular during the late 1980s and now the procedure is consider the standard approach for symptomatic cholecystolithiasis. This study aimed to assess the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to open cholecystectomy. This prospective clinical trial conducted in the Department of Surgery of Al-Sadir Teaching Hospital, Al-Mousawi private Hospital and Ibn Al-Baitar private Hospital in Basrah, Iraq, between January 2006 and October 2007. Abdominal sonography performed in 100 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic findings in the operating room. Out of 100 patients with cholecystolithiasis on sonography, we encountered straightforward laparoscopic cholecystectomy in 72 patients (72%), difficult laparoscopic cholecystectomy in 20 (20%) and the procedure was converted to open cholecystectomy in 8 patients (8%). Forty two patients had sonography revealing gallbladder wall thickness (>4 mm). The accuracy of sonography for cholecystolithiasis was 99%. In conclusion, an accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gallbladder surgery to provide information for the selection of the most appropriate approach and to avoid intraoperative difficulties and surprises. On sonography, gallbladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy, such difficulties may require conversion to laparotomy.

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Article
PORT SITE INCISIONAL HERNIA AFTER MINIMAL ACCESS SURGERY

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Incisional hernia is a common sequel to open abdominal surgery, affecting 5–15% of patients. The introduction of laparoscopic surgery into clinical routine more than 20 years ago has dramatically changed the field of surgery. It is commonly held that the frequency of incisional hernia has been reduced since the introduction of minimal access surgery. The incidence of port site hernia ranges from 1% to 6%. The aim of this study is to identify most common causes of port site incisional hernia. This is a retrospective study of 2116 patients who underwent laparoscopic surgery between January 2006 and December 2010. The information obtained according to indication of surgery, onset of hernia, clinical risk factors for incisional hernia like age& sex, BMI, co-morbidity, and those related to surgical factors such as port site, port size, port site infection and abdominal access techniques. The data were retrieved for patients who developed port-site incisional hernia (PSIH). The incisional hernia rate for the entire series was 2.5%. Most port site hernias developed in the 10 mm port, in the umbilical and supra umbilical, midline and 0% for the off-midline. There was statistically significant difference in patient’s related risk factors regarding age, BMI and wound infection with development of port site hernias. Conclusion: In this series, the 10mm port in midline site is a significantly higher cause for incisional hernia than the off-midline and smallest port size. Open first access technique, obesity and port site infection also significantly increase the incidence of port site incisional hernia. Introductio


Article
OBSTRUCTIVE JAUNDICE IN BASRAH

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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
INTERNAL FIXATION FOR UNSTABLE PELVIC FRACTURE: THE VALUE OF ANTERIOR APPROACH AND SMALL FRAGMENTS BIOSYNTHESIS

Authors: Medhat Mohammed Mahdi
Pages: 58-63
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Fifty patients with unstable pelvic fracture were subjected to internal fixation through anterior approach by small fragment biosynthesis over sixteen year of experience. Their age, range between 15–45 years. Forty patients were males and ten patient females. Thirty patients with type B rotationally unstable fracture pelvis, 15 patients with type C vertically unstable and 5 patients with combined rotationally and vertically unstable fracture. In type B fracture, 30 patients were surgically approached anteriorly by pfennenstiel incision, while type C (15) patients required ilioinguinal extension to fix anterior and posterior ring. Combined unstable fracture in 5 patients require anterior and posterior approach as two stages surgical exposure with one week interval. It is concluded that anterior approach to displaced pelvic fracture was good and suitable for young and thin patients. In addition anterior ring fixation was the key for anatomical reduction of displaced fracture and horizontal application of small fragment implant across the sacroiliac joint and anterior ring could be achieved and maintain the stability if full weight bearing is delayed to 6 month. Other advantages and limitation of the procedure were discussed.

Keywords

UNSTABLE --- PELVIC --- FRACTURE


Article
EFFICACY OF DIODE LASER TRANSCANALICULAR DACRYOCYSTORHINOSTOMY FOR THE TREATMENT OF ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION

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This study designed to determine the surgical outcome of transcanalicular dacryocystorhinostomy for the treatment of blocked lacrimal pathway. This is a prospective study of 36 patients admitted in Basrah General Hospital from March 2008 to May 2010. The age of the patients was in range from 6 to 60yrs. Forty five (31.25%) were males and 99(68.75%) were females. All of these cases were unilateral. Thirty three (93.05%) of the total patients were operated general local anesthesia and the rest 3 (6.94%) were under local anesthesia. The overall success rate was 62.5% in non-intubated patients and 93.75% with intubation. It is concluded that Diode Laser Transcanalicular dacryocystorhinostomy is still a new surgical procedure for the treatment of nasolacrimal duct obstruction and need further refinement of the surgical procedure and studies for evaluation of effectiveness and success.

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Article
ACCEPTANCE AND RELIANCE OF LAPAROSCOPIC SURGERY AMONG MOSUL CITY POPULATION

Authors: Nashwan Kahtan Mahjob --- & Samer Al-Saffar
Pages: 69-74
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The study is designed to evaluate the confidence, reliance and the degree of acceptance of laparoscopic surgical procedures among Mosul city population after 15 years of work in this field of surgery. This is a prospective data collection study. Participants were eight hundred persons, all of them from Mosul city with complete normal health at time of evaluation; all of them were above 18 years of age. The main outcome measures: The persons involved were divided into 4 groups according to their literate and educational level, each group composed of 200 persons, the first group (literate medical personnel) composed of medical doctors of various specialties, the second group (literate non medical personnel) composed of persons who were graduated from various colleges, apart from medical one. The third group (partially literate personnel) included those who did not complete the secondary school. the fourth group (low literate personnel) included those who did not completed the primary school. The questioners asked the following questions: 1- Did you know what laparoscopic surgery means? A special information score was used to evaluate the questioner knowledge. To those who answer yes for the first question and the information score was acceptable, the second question was: 2- Do you prefer this type of surgery to be used on you or on one of your first relative if feasible and needed? 3- If the answer for question 2 is yes, please tell us why. 4- If the answer for question 2 is no, please tell us why. The data were collected and comparison was done among the groups. All the medical persons were aware about laparoscopic surgery, 183 agreed to underwent such procedure if needed during the coming time, 160 of the second group knew what is laparoscopic surgery and 123 accepted to be used on them if needed, 118 of the third group knew what is laparoscopic surgery and 80 agreed to be used on them, while 85 of the fourth group had information about laparoscopic surgery but only 42 of them accepted it to be used on them if needed. Those who accepted laparoscopic surgery did so because they think that, it is more cosmetic, less painful and needs less hospitalization time, while those who refused it, did so because they afraid from dangerous instrument, the risk of complication and conversion. In conclusion, laparoscopic surgery is a well known surgical procedure among population in Mosul city, it gained acceptance and confidence especially in literate persons, but it needs more verification for low literate population. Cosmetic, less hospitalization and less post operative pain are the stocks for acceptance while complications, conversion and untrusting instrument and surgeon are the reasons for refusal of laparoscopic surgery.

Keywords

LAPAROSCOPIC --- MOSUL


Article
TRANSVERSE PREPUTIAL ISLAND PEDICLE FLAP (TPIPF) IN TREATMENT OF FAILED HYPOSPADIAS REPAIR: PERSONAL EXPERIENCE

Authors: Safaa A Mohssin
Pages: 75-81
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This is a study to review the local experience with the use of TPIPF in the repair of failed hypospadias in order to improve the results in the future. A total Number of 20 cases of failed Hypospadias was repaired during the period between 2001-2009 done in the public and private hospitals in Tikrit and Basrah. The repair was accomplished via Duckett method (transverse preputial island pedicle flap). The medical and operative records of each patient were registered and followed for 6 months. The success rate was 47% (9 patients). The complication rate was 55% in which urethro-cutaneous fistula was the commonest in 32% of the cases, meatal stenosis in 16%, urethral stricture in 10% and breakdown of the tube in 5%. In conclusion, TPIPF remains a viable option in the management of failed hypospadias especially in the proximal type, the complications can be avoided by using the magnification loupes with perfect surgical technique and mandatory proximal urinary diversion.

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Article
THE EFFECT OF DEXAMETHASONE ON POST TONSILLECTOMY MORBIDITIES IN CHILDREN

Authors: Raid Yaqoub Yousef --- Saffaa Khalaf Faleh
Pages: 82-86
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Abstract This study aimed to evaluate the effect of preoperative single dose of Dexamethasone on postoperative morbidities in children undergoing tonsillectomy. This is a prospective study considering 90 children with chronic tonsillitis who underwent tonsillectomy between June 2010 and December 2010 at the Department of Otolaryngology in Al-Diwaniah Teaching Hospital in Al-Diwaniah city, Iraq. Compared with placebo, Dexamethasone group have lower percentage of post tonsillectomy morbidities (pain, postoperative nausea & vomiting and uvular edema) but without statistical significant. In conclusion, there is no statistical beneficial effect of preoperative dexamethasone on the postoperative morbidities in children undergoing tonsillectomy.


Article
I Read For You

Authors: Salam N Asfar --- Jasim M Salman
Pages: 87-90
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Abstract

MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART II: TACHYCARDIA & BRADYCARDIA

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Article
Obituary :Prof. Dr. Khalil Al-Shabender 1925–2008

Authors: Thamer A Hamdan
Pages: 91-91
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Article
Obituary : Dr. Nabil Majed Nasir

Authors: H S K
Pages: 92-92
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Table of content: volume: issue: