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Article
Umbrella Mesh versus Mayo’s Repair in Primary Umbilical Hernia

Author: Mazin H. Al-Hawaz
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2002 Volume: 8 Issue: 2 Pages: 175
Publisher: Basrah University جامعة البصرة

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Abstract

Prosthetic repair has become a promising method for repairing hernias. The present study try to show the benefit of open umbrella mesh repair for umbilical hernia. This is a prospective randomised study comparing umbrella mesh and Mayo’s repair for primary umbilical hernia. Children and those who needed emergency surgery were excluded. The study was conducted on 80 patients (63 females and 17 males) with age range from 18-67 years. The follow up period was 51 months. There were no statistically significant difference between both repairs in regards to operative time, hospital stay, postoperative pain and early complications. There was earlier return to activity and no recurrence in umbrella mesh repair than in Mayo’s repair. Mesh repair represent safe and effective surgical method in repairing primary umbilical hernia

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Article
CLOSED VERSUS OPEN LATERAL INTERNAL SPHINCTEROTOMY IN TREATMENT OF CHRONIC ANAL FISSURE; A COMPARATIVE STUDY OF POSTOPERATIVE COMPLICATIONS & OUTCOME. 24

Authors: Mazin H Al-Hawaz --- Akeel A kataa
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 1 Pages: 24
Publisher: Basrah University جامعة البصرة

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Abstract

Anal fissure is a common and painful disorder. Its relation to hypertonic anal sphincter is controversial. The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy either open or closed methods, associated with a risk of pain, bleeding, recurrence and incontinence. The study was designed to compare the results of open and closed technique of lateral internal sphincterotomy and to find postoperative complications. This prospective clinical trial conducted in the Department of surgery in Basrah General Hospital between January 2006 and October 2008, one-hundredpatients were randomly assigned to open or closed internal sphincterotomy. Standardized questionnaires assessing patients were administered preoperatively and at 1st, 2nd weeks and 1-6 month postoperatively.Out of the 100 patients included in the study, 50 patients underwent open lateral internal sphincterotomy and the other 50 were subjected to closed lateral internal sphincterotomy. There was no significant difference in postoperative acute complications. However, incontinence in terms of soiling and passage of flatus was 14% in open method and 10% in closed method. There was no difference in terms of recurrence rate being 4% both in open and closed methods. In conclusion, there was no significant difference between open and closed methods of lateral internal sphincterotomy in regard recurrence rate, healing rate, hospital stay and other complications, but in view of these findings, closed method of treatment is recommended if the surgeon is experienced.

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Article
IS IT SAFE NOT TO LIGATE THE INFERIOR THYROID ARTERY DURING SUBTOTAL THYROIDECTOMY?

Authors: Ahmed D Chiad --- Mazin H Al-Hawaz
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 2 Pages: 20-33
Publisher: Basrah University جامعة البصرة

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Abstract

Thyroid surgeries are common operations with an extremely low mortality. It is associated withspecific morbidities which are dramatically decreased due to the rapid progression in operativetechniques which helped to make the thyroid surgery less feared and better understood than itonce was. Inferior thyroid artery is one of the vital structures that require special attention duringoperative technique in order to avoid troublesome and in most cases a preventablecomplications.We conducted this study to assess the: Prevalence and significance of post-operativehypoparathyroidism following thyroid surgery, with or without inferior thyroid artery ligation.Incidence of recurrent laryngeal nerve injury with or without inferior thyroid artery ligation.Intraoperative and post operative bleeding with or without inferior thyroid artery ligation.A prospective observational study was done from June 2005 to June 2008, at Basrah GeneralHospital. One hundred and eight patients underwent subtotal thyroidectomy. Majority of them(90) patients were females. Patients were placed in two groups, Group I had inferior thyroidartery ligation whereas in Group II, inferior thyroid artery was not ligated.Analysis of data reveals that (50%) of patients in group I had hypocalcemia, (16.1%) recurrentlaryngeal nerve injury and (4.83%) hematoma, whereas in group II (47.82%) had hypocalcemia,(8.7%) recurrent laryngeal nerve injury and (2.17%) hematoma.Statistically, there is no significant difference regarding post-operative hypocalcaemia,recurrent laryngeal nerve injury and hematoma formation between truncal ligation and nonligationof inferior thyroid arteries.~ �C


Article
EVALUATION OF ABDOMINAL BULLET INJURIES IN BASRAH GENERAL HOSPITAL (A PROSPECTIVE STUDY)

Authors: Mazin A Abdellah --- Mazin H Al-Hawaz --- Jabar K Jassim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 2 Pages: 14-23
Publisher: Basrah University جامعة البصرة

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Abstract

EVALUATION OF ABDOMINAL BULLET INJURIES IN BASRAH GENERAL HOSPITAL (A PROSPECTIVE STUDY)Jabar K Jassim#, Mazin H Al-Hawaz@, Mazin A Abdellah&#FICMS Candidate, Basrah General Hospital, @Professor of Surgery, Head of Dept.of Surgery, College of Medicine, Basrah. &CABS, Basrah General Hospital, Basrah, IRAQ.AbstractThe incidence of civilian abdominal gunshot wounds is on the increase in many cities, attributed to the increasing rate of unemployment, high rate of corruption in the polity, and political violence. Gunshot wounds of the abdomen are associated with 90% or greater incidence of intra abdominal injury, prompting many trauma centers to routinely explore these patients via laparotomy. The aim of this prospective study was to evaluate the pattern of injuries, treatment, and outcome of patient with abdominal gunshot wounds in Basra General Hospital. This is a prospective study of patients with abdominal gunshot wounds admitted to Basra General Hospital, Department of Surgery, between April 2003 to October 2005. One hundred and sixteen patients were included in this study. Data recorded on database. Patient's characteristics, injury to arrival time, type of weapon, single or multiple gunshot wounds, surgical intervention time, clear urine or macroscopically haematuria, preoperative and postoperative blood transfused, operative finding, and postoperative complications and mortality. The indications for emergency laparotomy after vigorous resuscitation were shock, peritonitis, evisceration, leakage of intestinal content through wound, haematemesis, proctorrehagia, and macroscopical haematuria with entrance wound. The study included 116 patients, Male:Female ratio was 4:1 and 44.8% of patients ranged in age from 20-29 years. The common weapon used was gun in 88.8%patients. Three (2.6%) patients sustained superficial wounds of the abdomen; they were managed by local wound care. Laparotomy was undertaken in 113 (97.4%) patients who presented with acute abdomen. The commonest injured organ was the small intestine (26%), colon (18.8%), liver (11.7%), kidneys (9%) and stomach (6.7%).The mortality rate was 10.6%. shock was the cause of death in 9 patients. It is concluded that Bullet injury is a serious injury which need careful attention by surgeon .Mandatory exploration is the standard method for managing patient with gunshot wounds to the abdomen and back;. Most of the deaths in this study are due to haemorrhagic shock. The unavailability of blood in our hospital blood bank and the delay in bringing blood from the central blood bank add adverse effect on the outcome of patient.

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Article
PORT SITE INCISIONAL HERNIA AFTER MINIMAL ACCESS SURGERY

Authors: Sadiq Kassim Jassim --- Mazin H AL-Hawaz --- Jasim D Saod
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 37-44
Publisher: Basrah University جامعة البصرة

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Abstract

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
7- FACTORS INFLUENCING POST-OPERATIVE COMPLICATIONS AFTER PROSTHETIC "MESH" REPAIR OF INCISIONAL HERNIA (A prospective study).

Authors: Ali K Hasson� --- Jasim D Masoud --- Mazin H Al-Hawaz
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2008 Volume: 14 Issue: 1 Pages: 29-36
Publisher: Basrah University جامعة البصرة

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Abstract

Incisional hernia is frequently met by the general surgeon, its frequently complicate (3.8-11.5%)of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgicalproblem with recurrence being a common. Numerous methods of repair have been describedsimple opposition in one layer or complex opposition and the use of prosthetic mesh.The aim of this study is to report our experience with use of mesh repair and risk factors thatinfluence post operative complications.A prospective study done in Basrah General Hospital, Department of Surgery between January2003 to December 2006.One hundred and ten patients with prosthetic repair of incisional herniawere included in this study. History was taken and thorough examination was done, all patientswere asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations,primary or recurrent hernia and examined for their body mass index, size and duration of thehernial defect were recorded. A proforma was completed for each patient, noting prophylacticantibiotics had been given or not, type of the sac and whether opened or inverted, type and sizeof mesh had been used, intraoperative and postoperative complications and postoperativehospital stay.Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years forwomen and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weightand had body mass index equal or more than(30).Forty eight patients (43.6%) were diabeticand (24)patients(21.8%)were corticosteroid used. The original operations were bowel relatedand gynecological in the majority of patients. Previous incisions were long midline in(38).Twenty patients had one past operation, (13)had two,(5) had three and one patient had fourpast repair, the remaining were new Incisional hernia patients. The main hernia size was (12.3)cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients hadadditional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of smallbowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20)patients. In the majority of patients (78), standard polypropylene mesh had been used andvicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperativecomplications were seroma formation (17.3%), wound haematoma (10%), wound infection(9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to beremoved. Five recurrent incisional hernias occurred. Most patients developed complicationswere obese, diabetic and corticosteroid used. No death in our series.It is concluded that tension free incisional hernia repair using prosthetic mesh is a safe andeasy procedure with no major morbidity or recurrence. The patient-doctor should advice weightloss to help reduce risks of surgery and improve the surgical results. Control of diabetes,corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterilecondition, precise and meticulous technique with the use of closed suction drains is important.

Keywords

PROSTHETIC


Article
THE ADVANTAGE OF ACUTE INFLAMMATORY MARKERS IN DIAGNOSIS OF ACUTE APPENDICITIS

Authors: Mazin H Al-Hawaz --- Mazin A Abdulla --- Hyder Dakhel Ali
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 2 Pages: 8-13
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Acute appendicitis is the most common cause of emergency abdominal surgery with an estimated lifetime prevalence of 7%–8%. Despite advances in diagnosis and treatment, it is still associated with morbidity (10%) and mortality (1%–5%). This study was designed to investigate the results of WBC count, platelet distribution width and C-reactive protein values based on the pathology results in patients undergoing appendectomy with an early diagnosis of acute appendicitis. This prospective cross sectional study was carried out in Basrah Teaching Hospital from the period 1st of September 2015 to 1st of June 2017, a total of 154 consecutive patients were enrolled in the study. All patients were admitted to the emergency department with history suggestive of acute appendicitis, blood tests were done for inflammatory markers in form of WBC, CRP and PDW, a period of 24 hours prior to surgery was accepted, histopathological data were used to assess inflammation of the appendix. The majority of patients were males 61% while females were 39%, with age range between 14-46 years (mean 24.28 years). There was a correlation between WBC count and acute appendicitis(P value=0.004), with sensitivity range (53%-69%) and specificity range (25-89%), while positive predictive value (PPV) and negative predictive value (NPV) were 96% and 8% respectively. A significant correlation found between CRP and acute appendicitis (p value less than 0.0001) with sensitivity range (71%-85%), while specificity was (10%-74%) and PPV, NPV were 95% and 9% respectively. Regarding PDW, no correlation was found with acute appendicitis (p value=0.296) with sensitivity range (6%-16%) while specificity (17%-82%), PPV 78%, NPV 2%. There was significant correlation between inflammatory markers (WBC, CRP, PDW) and complication with a p value=0.0001, ruptured appendix and peri-appendicular abscess were the most common complications recorded, only 8(5.2%) patients had normal appendix after histopathological examination. In conclusion, acute inflammatory markers play an important role in diagnosis of acute appendicitis along with history and physical examination.


Article
SUBCUTICULAR WITH INTERRUPTED SUTURING; TECHNIQUE FOR ABDOMINAL WOUND CLOSURE

Authors: Mazin H AL-Hawaz --- , Mushtaq CH Abu-alhail --- Sabah S Jabir
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 55-61
Publisher: Basrah University جامعة البصرة

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Abstract

Closure of the wound after surgery is a routine procedure and one of the first things that asurgeon in training should learn. A surgeon will successfully closes a thousand of woundsduring his career, but the problem of wound infection remains challenging.This study was conducted to compare between two methods of skin closure which aresubcuticular alone and combined subcuticular with interrupted suturing regarding; woundinfection, cosmesis &speed of wound closure.Between December 2006 and October 2009, two hundred and two patients were admitted inBasrah General Hospital, department of surgery. They underwent elective abdominal operationand were randomized into two groups, group A (abdominal skin closure by subcuticular suturingonly) and group B (combined subcuticular with interrupted suturing). There were 102 cases inthe subcuticular group, 50 cases of them were males and 52 cases were females, while ingroup B there were 100 cases,42 cases of them were males and 58 cases were females. Meanage was 38.9 (range 4-66) for group A and 41.6 (range 8-67) for group B. The mean BMI was25.2 (range 17.4-34.8) for group A and 26.4 (range 18.7-39) for group B.Results: Wound infection: The total number of early wound infection for the six �weeks follow �up period was 12 cases (11.7%) for the subcuticular (group A),and 4 cases (4%) for thecombined (group B)_(P=0.036). Cosmoses: There was no significant difference in cosmeticresult in both groups. Speed of wound closure: Combined (group B) closure was accomplishedat significantly faster rate (mean 35.6 sec/cm) than subcuticular (group A) closure (mean46.8sec/cm) (p=0.001). Conclusion: From this study we conclude that the choice of techniquefor wound closure did not affect the final cosmetic outcome of the wound but the incidence ofpostoperative wound infection significantly reduced by combined subcuticular and interruptedsuturing. The closure of wound is rapid in combined group than in subcuticular group alone.


Article
PREVALENCE OF HEPATITIS B AND HEPATITIS C AMONG PREOPERATIVE SURGICAL PATIENTS AT BASRAH GENERAL HOSPITAL

Authors: Mazin H AL-Hawaz --- Mohammed H AL-Hijaj --- Shatha A AL-Mansori
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 1 Pages: 62-65
Publisher: Basrah University جامعة البصرة

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Abstract

Viral hepatitis is a worldwide health problem which requires a thorough knowledge and orientation. Clinical awareness of medical and paramedical staff regarding hepatitis portfolios so important to avoid serious short and long term sequel of hepatitis distribution to other individuals therefore a fundamental strategy has been planned and made in our local surgical field to highlight that issue in different types of surgery. Patients and methods: Retrospective descriptive study was carried out at Basrah General Hospital; Department of Surgery between Sept 2012 and Sept 2013 for patients underwent elective surgery in surgical department. Data was collected on the patients’ clinical history and laboratory findings of hepatitis screen for preoperative patients. The findings were recorded in a structured compilation. Results: A total of one thousand and seven hundred and thirty patients entered the study and those were analyzed in terms of general patient data in respect to age and sex as well as analysis of hepatitis screening findings. There were 1034 (59.7 %) males and 696 (40.3 %) females, with ages ranging from 8 months -70 year. The highest prevalence of Hepatitis B and C occurred in the same age group of 40 to 49 years. The sex related distribution of Hepatitis in general patients revealed more female patients than male ones (45/43).This figure is similar among patients in Hepatitis C (22/19) and both Hepatitis B and C (2/1). Hepatitis B showed a reverse pattern of being male predominance with a male to female distribution (23/21). In conclusion: Clinical awareness is the master of prevention of Hepatitis spread as proper knowledge about transmission and precautions could be of value in reducing disease transmission.


Article
ATROPINE IN LAPAROSCOPIC CHOLECYSTECTOMY: IS IT SIGNIFICANT?

Authors: Mazin H AL-Hawaz --- Mohammed H AL-Hijaji --- Anna W Krikor
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 2 Pages: 75-80
Publisher: Basrah University جامعة البصرة

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Abstract

Bradycardia is a known problem in laparoscopic cholecystectomy especially during pneumoperitoneum and gall bladder dissection which might necessitate the use of intravenous atropine. The clinical significance of the latter as prophylactic issue in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used. We conducted a prospective study to evaluate the significance of preoperative intravenous atropine sulphate to reduce bradycardia during laparoscopic cholecystectomy. One hundred and forty patients were analyzed in a prospective study; seventy of them were atropine group and another seventy were non atropine group. Heart rate changes were studied in both groups in respect to preoperative, pneumoperitoneum and postoperative period. As well as the heart rate changes were evaluated separately in each group in concern of preoperative and pneumoperitoneum period. The results showed that age, sex, body mass index, duration of surgery and previous operations were comparable in both groups. Significant bradycardia was seen in non-atropine group during pneumoperitoneum as compared to atropine group (p<0.05), while insignificant heart rate changes were observed in both groups across preoperative and postoperative period (p>0.05). In conclusion, this work shows that a preoperative intravenous dose of atropine sulphate might be of value in preventing bradycardia during laparoscopic cholecystectomy.

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