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Article
MANAGEMENT OF COMPLEX POSTERIOR HORSESHOE ANAL FISTULA BY A MODIFIED HANLEY PROCEDURE: CLINICAL EXPERIENCE AND REVIEW OF 28 PATIENTS

Author: Ibrahim Falih Noori
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 1 Pages: 54-61
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The aim of this prospective study was to document clinical experience in the surgical management of posterior horse shoe fistula of cryptogalndular origin with a modified Hanley procedure using hybrid elastic glove as a one stage cutting seton. A modified Hanley procedure was applied to 28 patients (20 males and 8 females) presented with posterior horseshoe anal fistula (mean age 41 years) for the period from February 2007 to March 2012, and the surgical results were analyzes. The seton used was fashioned from a surgical glove and was tied around the sphincter under less tension in addition to the excision of superficial segment of the lateral tract and deeper extension into ischiorectal spaces were curetted and packed with gauze socked with povidon iodine. Complete healing was achieved in all 28 patients within three months post-operative period. Recurrence was found in only three patients after six month follow up period. All patients were discharged on the same post-operative day (day case surgery). None required readmission and post-operative pain was mild and bearable. Narcotic analgesics were not needed after discharge. All patients were able to return to their works and daily activity in 2-3 weeks. In conclusion, posterior complex horseshoe anal fistula can be safely and successfully treated with modified Hanley procedure with the use of the hybrid elastic seton.


Article
Outcome of Anorectal Surgery Under A Mixture of Local Anesthesia: Experience With 350 Patients

Author: Ibrahim Falih Noori
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 4 Pages: 776-784
Publisher: Babylon University جامعة بابل

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Abstract

Background: anal diseases are common surgical problems .Anal surgical operations are usually carried out under general anesthesia and spinal anesthesia. The use of local anesthesia in anal surgery is supposed to be safe, simple and efficient.Purpose: to evaluate the effectiveness and usefulness of local anesthesia for various anal surgeries, and to assess the patient acceptance and satisfaction.Patients and methods: a total of 350 patients with various anal problems presented to different anal surgeries under local anesthetic infiltration for the period from February 2011 to March 2014.Age ranges from 18-72 years (mean 47.7 year).Majority of the patients were males (No. =310, 88.6%) and minority were females (No. = 40, 11.4%).Pain during surgery and postoperatively was evaluated on a visual analog scale. The feasibility, tolerability and patient's satisfaction with the results of operations were assessed and evaluated.Results: The mean operations time was 25 minutes range from 10-45 minutes. The mean pain score in the day of operation was low, (2.8) and the mean pain score in the first postoperative day was also low (3.3).Most patients (82.85%) were satisfied with the results of operations and they would prefer local anesthesia again for anal surgery in the future were necessary. Complications rate in this study was 10.9% and most these complications managed conservatively. Conclusion: perianal block by local anesthetic infiltration is safe, simple and effective for various anal operations with very high degree of acceptance and satisfaction among patients. It had been found to be associated with low pain score and postoperative complications and faster return to daily social activity. The cost saving had been significant.


Article
EFFICACY OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF CHRONIC ANAL FISSURE

Author: Ibrahim Falih Noori
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 1 Pages: 69-75
Publisher: Basrah University جامعة البصرة

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Abstract

Lateral partial internal sphicterotomy has been the goal standard for the treatment of chronic anal fissure. The main drawback of this approach remains its effect on the anal continence. Intrasphincteric of botulinum toxin seems to be a reliable and safe option resulting in temporary paralysis of the internal sphincter spasm and so promoting the chronic fissure to heal. The aim of this prospective control randomized study was to compare the effectiveness and the outcome of botulinum toxin injection with the lateral internal sphicterotomy in the treatment of the chronic anal fissure. Ninety male patients who have been presented with chronic uncomplicated anal fissure, were randomized to either lateral internal sphincterotomy or intrasphincteric injection of botulnium toxin. Postoperative complications and pain, healing rate of the fissure, anal incontinence and recurrence of the fissure after treatment during six months follow up period were studied and assessed. The healing rate was 95.5% in the surgical group with recurrence noted in only one patient and one patient had a partial permanent incontinence while in the botulnium toxin group the healing rate was 84.4%. Two patients had transient incontinence which improved spontaneously over six months period. Five patients had recurrence within the same follow period. Lateral internal sphicterotomy and botulinum toxin injection both seems to be effective treatment of the chronic anal fissure. Although surgical approach is still the most common and gold standard treatment for the chronic anal fissure, It shows a higher incidence of incontinence and greater morbidity and pain than botulinum toxin injection. We conclude that the use of botulinum toxin to treat chronic anal fissure is safe, simple and effective approach especially in patients older than 50 years or those with risk of anal incontinence despite the higher rate of recurrence which can be minimized by the second session of botulinum toxin injection.


Article
Abdominal Tuberculosis: Clinical Presentation, Diagnosis, Outcome and Experience with 11 Cases

Author: Ibrahim Falih Noori
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 581-591
Publisher: Babylon University جامعة بابل

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Abstract

Tuberculosis is a common health problem. Abdominal tuberculosis constitutes about 2% of all tubercular cases and it’s the sixth most common extrapulmonary tuberculosis. The aim of this study was to evaluate the clinical presentation, diagnosis and effective treatment of abdominal tuberculosis. This is a retrospective study including 11 patients (4males and 7 females), with clinical features of abdominal tuberculosis. They were divided according to the clinical presentation into two groups. The first group included patients presented as acute abdominal pain mainly due to bowel obstruction or as peritonitis and were prepared and treated by explorative laparotomy and definitive diagnosis of abdominal TB was made by tissue biopsy. The second group included patients with chronic symptoms. The results observed in this study were that abdominal pain was the commonest symptom followed by abdominal distention, anorexia, weight loss and fever. Tender right lower abdominal quadrant was found in 7 patients(63.6%) and right iliac fossa mass was found in 3 patients (27.3%). Explorative laparotomy was needed for 5 patients (45.5%) who presented as acute abdomen. Strictures were found in 3 patients (27.3%), adhesion in one patient (9.1%) and peritonitis caused by perforation in the terminal ileum was recorded in one patient. Ascitic fluid analysis for AFB stain and culture confirm the diagnosis of abdominal tuberculosis in patients who presented with chronic symptoms of tuberculosis. All patients showed good response to ATT therapy. No mortality or recurrence was recorded during ATT treatment or during follow up period. We concluded that abdominal tuberculosis is difficult to diagnose due to vague and non specific symptoms and signs such as abdominal pain, anorexia, weight loss and fever. High index of suspicion and clinical awareness is needed for definite diagnosis which depends on PCR or histopathology or AFB stain.


Article
Percutaneous Treatment of Liver Hydatid Disease, Clinical Experience with 22 Patients

Author: Ibrahim Falih Noori
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 522 -530
Publisher: Babylon University جامعة بابل

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Abstract

The purpose of this study was to assess the efficacy and validity of the puncture-aspiration –injection and re-aspiration (PAIR)and catheterization in the percutaneous treatment of hydatid cyst disease of the liver. This is aprospective study that had been performed in a major hospital in Basra city, Iraq for the period between April 2010 and May 2014 in which 22 patients with a diagnosis of hydatid cystic disease of liver subjected to a percutaneous treatment using PAIR technique or catheterization method under ultrasonographic guidance and under cover of albandazol or mebandazol before and after intervention .Following aspiration of the cystic fluid ,hypertonic saline 20% was injected into the cystic cavity and re-aspirated .Subsequent follow up and observation was carried out by ultrasonic examination to assess the efficacy and of this approach.Twenty four cyst (72.7%) in this study was GharbiIcyst, 4 patients (18%) had type II and 2 patients only had type III. The mean reduction in the volume of the cyst after 9-12 months follow up period was 92.6% and 87.5% in catheterization and PAIR method respectively .All patients were in very good condition. Liver and blood tests were normal after intervention. Solidification and pseudotumor was seen in 18 patients (81.8 %) and calcification was seen in 12 patients (54.5%).The mean hospitalization time was 3 days. Percutaneous treatment for selected patients with type I –III Gharbi hydatid liver cyst is effective and safe procedure .It offers complete cure with infrequent complications and short hospitalization. Surgery however, remains the gold standard treatment for multivesicular, infected and complicated cases of hepatic liver cysts.


Article
Clinical Predictors of Malignancy in Solitary Thyroid Nodule, A Study of 146 Cases

Author: Ibrahim Falih Noori
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 1 Pages: 99 -112
Publisher: Babylon University جامعة بابل

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Abstract

Although most of thyroid nodules are benign, 5-10% are malignant. It is important to predict the risk factors and malignant potential of STN to avoid unnecessary surgery with its complications. A prospective study was conducted to assess the rate and malignant potential of STN in 146 patients. They submitted to thorough investigations including a detailed history and clinical examination, thyroid function test, ultrasound examination and FNAC. There were 126 females and 20 males with female to male ratio about 6:1.The rate of malignancy in STNs was 8.9% with males affected more than female (15% Vs7.9%), and more with age above 40 in both sexes. History and clinical exam suspect malignancy in 6% of cases. All patients were euthyroid. Ultrasonic features such as Ill-defined margin, microclcifications, marked hypoechogenecity, and cervical lymphadenopathy are helpful features for prediction of malignancy, but none of these features are specific or pathognomonic. The results of FNAC in this study were:76 benign colloid goiter, 24 follicular tumor, 18 suspicious aspirate ,6 papillary carcinoma and 22 indeterminate cytology. The sensitivity , specificity and accuracy rate of FNAC in this study were 86.4%,96.3 and 92.3% respectively. History and examination are poor predictors of malignancy in STN. Male and increasing age are proved to be risk factors for malignancy in STN. Certain ultrasonic features are helpful in predicting malignancy but neither specific nor characteristics. These include ill-defined and irregular margin, microcalcification, marked hypoechogenecity, hyper-vascularity and cervical LAP. FNAC is highly sensitive in predicting malignant nodule. FNAC must be the first and could be the only test required to evaluate STN.


Article
Ibrahim Falih Noori

Author: Ibrahim Falih Noori
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2017 Volume: 23 Issue: 2 Pages: 76-80
Publisher: Basrah University جامعة البصرة

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Abstract

SOLITARY RECTAL ULCER MIMIC RECTAL CANCERIbrahim Falih Noori MB,ChB, CABS, FICS, DS, Assist. Prof., Department of Surgery, College of Medicine, Basrah University AbstractSolitary 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.


Article
LigaSure Hemorrhoidectomy versus Excisional Diathermy Hemorrhoidectomy for All Symptomatic Hemorrhoids

Author: Ibrahim Falih Noori
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 1 Pages: 83-88
Publisher: Babylon University جامعة بابل

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Abstract

Background: Hemorrhoidectomy by LigaSure electrosurgical unit seems to be very effective treatment and results in better surgicaloutcomes when compared with the conventional excisional hemorrhoidectomy. Objective: The aim of this study was to compare thefeasibility and the surgical outcomes of LigaSure hemorrhoidectomy with that of conventional diathermy excisional hemorrhoidectomy.Materials and Methods: Patients characteristics were comparable in both groups. Ninety six patients with symptomatic mainly grade III andIV piles were randomized for either conventional excisional hemorrhoidectomy (48 patients) or to LigaSure hemorrhoidectomy (48 patients)for the period from April 2014 to July 2016. The surgical outcomes of both procedures including the operative time, intra-operative bloodloss, postoperative pain, analgesic requirements, early and late postoperative complications, wound healing, recovery time and return towork, recurrence and patient satisfaction were recorded, compared and evaluated. Results: The mean operative time and amount of intraoperativeblood loss were significantly lower in LigaSure hemorrhoidectomy group. Postoperative pain and need for parentral analgesiawere comparable in the first 24 -48 hours postoperatively, but they were significantly lower in LigaSure group after the second postoperativeday. Faster wound healing and early return to work were obviously noted among patient subjected to LigaSure hemorrhoidectomy. Earlypostoperative complications were lower in LigaSure group while late complications were comparable in both groups. Lastly, LigaSure groupshowed high satisfaction rate compared to conventional hexcisional hemorrhoidectomy group. Conclusion: LigaSure hemorrhoidectomy issuperior and more advantageous in term of operative time, blood loss, post-operative complications, faster wound healing and return to work.It is simple, feasible and easy to learn.


Article
Comparison between Open Mini-incision Thyroidectomy and Conventional Thyroidectomy: Clinical Experience and Literatures Review

Author: *Ibrahim Falih Noori, MBChB, CABS, FICS, DS
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2016 Volume: 12 Issue: 2 Pages: 70-76
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Thyroid surgery is most common endocrine surgery in general surgical practice. Objectives: the aim of this work is to evaluate the feasibility, benefits and outcomes of open mini-incision thyroidectomy and compared the results with that of conventional thyroidectomy. The comparison between the two groups was in term of incision length, amount of blood loss, time of operation, postoperative pain, hospital stay and the cosmetic outcomes.Type of the study: this is a single-blinded randomized controlled studyMethods: This study compared the advantages and outcomes of 22 patients subjected to mini-incision thyroidectomy (Group A) with the equal numbers of patients subjected to conventional thyroidectomy (Group B).Results: the operative time was statistically longer in minithyroidectomy than with conventional thyroidectomy. Postoperative pain score in the operative day and 24 hours postoperatively showed a significant difference in favor of mini-incision thyroidectomy. The cosmetic outcome and patients satisfaction was significantly and far better in minithyroidectomy group. The results between both groups were comparable regarding the postoperative complications. The hospital stay was shorter in the mini-incision group than in conventional group but the difference was not significant.Conclusions: mini-incision thyroidectomy is simple, safe and practical procedure that achieves the same results and the rate complications to the conventional thyroidectomy with less post operative pain and better aesthetic results. It is easily converted to conventional technique when necessary without added risks .


Article
Sutureless Focus Harmonic Thyroidectomy versus Conventional Clamping and Knot‑Tying Technique

Author: Ibrahim Falih Noori, Mansour Amin Mohammad
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 4 Pages: 300-305
Publisher: Babylon University جامعة بابل

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Abstract

Background: Thyroidectomy is the most frequent procedure in endocrine surgery. Since thyroid is the highly vascular organ, therefore, promptand meticulous hemostasis is extremely important. Although conventional thyroidectomy is used frequently with acceptable outcomes, it istime‑consuming and resulted in significant intraoperative blood loss with possible risk of injury to parathyroid glands and laryngeal nerves. Theadvent of ultrasonically activated focus harmonic device in thyroid surgery was encouraging for improving safety, effectiveness, and reductionof operative time. Aim of this Study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonicharmonic scalpel for thyroid surgery compared to conventional techniques (clamping and suture ligation (knots tying) and electrocautery.Patients and Methods: This is a prospective, randomized study in which 64 patients with various types of goiters presented for thyroidectomy.The patients were divided into two comparable groups. Group A (32 patients) included patients who had focus harmonic thyroidectomy andGroup B (32 patients) included patients who received conventional thyroidectomy. Results: Focus harmonic thyroidectomy showed significantreduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage, and postoperative pain scores compared withconventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia and laryngeal nerve injurybetween both the groups. The total cost of focus harmonic thyroidectomy and hospital stay were also less compared with conventional techniques.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and beneficial alternative to conventional technique since it reducesthe time of surgery, blood loss, postoperative drainage, and pain with comparable postoperative complications

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