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Article
Risk Factors of Wound Dehiscence After Laparotomy and the Role of Prophylactic Retention Sutures

Author: Haider Abdulhussein Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 1 Pages: 67-72
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACK GROUND :(laparatomy wound dehiscence) is a serious postoperative complication which is associated with high morbidity and mortality rates.OBJECTIVE: To evaluate abdominal wounds dehiscence in term of risk factors and to assess the role of prophylactic retention suture in prevention of wound dehiscence.PATIENTS AND METHOD: Prospective study done in the General Surgical unit of Al–Imamain Alkadhmain medical city on 167 patients with 20 patients underwent prophylactic retention suture, from the 1stof July 2013 to the 1st of July 2015.and to know the effect of different factors on incidence of wound dehiscence.RESULTS: The number of wound dehiscence cases was 19 patients out of whole total 167 patients which represent 11.38%. Wound infection was present in 63 patients out of 167 patients (37.2%) and 19 patients out of 63 patients (30.2%) developed wound dehiscence. The other risk factor was chest complication which was present in 76 patients out of 167 patients (45.5%). and 17/76 patients (22.4%) developed wound dehiscence. Smoking was present in 92/167 patients, anemia was present in 80/167 patients and 13/80 patients (16.3%) developed wound dehiscence. Age > 50 years was present in 53/167 patients and 10 /53 patients (18.9%) developed wound dehiscence. steroid usage found in 17/167 patients and 5/17 of them patients (29.4%) developed wound dehiscence, and jaundice was present in 8/167 patients and two/8 patients (25%) developed wound dehiscence. Prophylactic retention sutures were done for 20 patients all of them were male with generalized peritonitis and emergency cases. 19 patients were anemic. 18 patients were smokers and 15 patients were above 50 years of age; from these 20 patients only one patient who had all listed risk factor developed wound dehiscence after prophylactic retention suture wound inspected from 2ndpost-operative day on wordCONCLUSION:Post-operative wound dehiscence rate in the surgical unit of Al–Amamain Alkadhmain medical city is 11.38% and that wound infection, emergency operations and compromised immunity, are factors which increase the rate of wound dehiscence; and prophylactic retention sutures is a valuable maneuver to reduce it.


Article
Evaluation of Sublay Mesh Repair in Comparison with Onlay Mesh Repair for Incisional Hernias

Author: Haider Abdulhussein Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 180-184
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The sublay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates and minimal complications.OBJECTIVE: To study the advantage and complications of sublay mesh repair of incisional hernias in comparison to onlay mesh repair.METHODS: Record of 110 patients undergoing repair of incisional hernia from 1st Jun 2013 to 1st Jun 2015, excluding very large incisional hernia with defect more than 10 cm. 62 cases of incisional hernias were managed by onlay mesh repair and 48 cases of incisional hernia were managed by sublay mesh repair.RESULTS: Post-operative complications like seroma and wound infection were comparable in both groups. In sublay group, Seroma formation was 2 patients (4.3%) . wound infection was 2 patients (4.3%). No septic mesh was removed in the series. In onlay group seroma formation was in 12 patients (19.4%) most of seroma occur in large incisional hernias repair, wound infection was in 5 patients (8.1%) and 2 septic mesh was removed. In sublay, recurrence rate was one patient (2.1%), in onlay, recurrence rate was in 5 patients (8%). CONCLUSION: Sublay mesh although it is more time consuming and technically more difficult, however it carries low recurrence rate and few post-operative wound complication ..


Article
Relaparotomies in Abdominal Trauma, Systematic Review

Authors: Haider Abdulhussein Ahmed --- Sajid Hameed Abd Al-Helfy**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 123-130
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Treatment of a number of complications that occur after abdominal trauma surgeries may require that Urgent Abdominal Re-explorations, the life-saving and obligatory operations, are performed.OBJECTIVE: To evaluate the reasons and incidence of re-operations in abdominal trauma cases and their outcomes in our centre, so that more preventable morbidity can be avoided.METHODOLOGY:A retrospective study of all trauma victims who sustained laparatomies and relaparatomies in the Emergency Department of Al-Imamain Al-kadhymain Medical City, Baghdad, over a 2 years period. A review of the case sheets of these victims has been reviewed to identify the various circumstances of trauma cases and the detailed operative findings and definitive causes of relaparatomies were noted.RESULTS: The study included 21 relaparatomy cases out of 244 laparatomy for various abdominal trauma reasons ; 180 patients (74%) males and 64 (26%) females, with a male to female ratio of about (3:1). The commonest causative accidents were missile inury 97pt (39%), gunshot injuries 58 (24%), road traffic accidents 43pt (18%), stab wound 32 pt(13%), and. Fall from height 14 pts (6%) . Reoperations were performed in 21 cases Incidence (8.6%), finding in reoperation including second look operation (which constituted 4 patients) were as the followings: Bleeding 11 pts ( 52%), peritonitis from missed bowel injuries & anastomosis leak 5 pts (24% ), small bowel obstruction one pt (5%), IAC(abscess) 2pt (9.5%) and prolonged ileus & peritonism 2 Pts (9.5%). Overall mortality in the reexplored patients was 8 patients(38%). Incidence of missed injuries 24% of reoperation and 1.6% of total trauma cases.CONCLUSION: many pt can be saved from repeat laparatomy by avoiding missed injuries. The main reason for immediate reoperation is bleeding and lately is peritonitis and sepsis.

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