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Article
Anal Fissure Treatment by Medication and Surgery

Author: Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 323 -329
Publisher: Babylon University جامعة بابل

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Abstract

Anal fissure is a most common cause of anal pain [1].This prospective study includes 236 patients complaining of anal fissure treated from a period of September 2013 to December 2015 to assess options of management of anal fissure. Male patients were 121 (51%) and female were 115 (49%). All patients were clinically assessed in an outpatient clinic and conservative treatment started to all patients that shown to be effective in 141 patient (60%). Surgical treatment applied to 95 patients (40%)whom not responded to conservative treatment, or, patients with recurrent fissure. Lateral sphenectrotomy was the surgical procedure applied in open or close method (62 and 33 patients respectively), under local or general anesthesia (54 and 41 respectively). Local anesthesia was associated with a significant low duration of admission from 1 to 24 hours (mean of 3 hours) while general anesthesia with a significant higher duration of 12 to 36 hours (mean of 19 hours). The healing rate following surgery in a local or general anesthetic approach was 95%. No difference in a healing rate between open or closed technique of sphenectrotomy. Flatus incontinence was reported in 3 patients. Initial treatment of anal fissure should be conservative, lateral sphenectrotomy is a safe procedure with a high cure rate, low incidence of complications and could be performed under local or general anesthesia.


Article
Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.

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