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A Comparison of Three Methods Of Skin Closure By Using Subcuticular Vicryl Suture, Metallic Skin Stapler And A Steri-Strip Adhesive Tapes
دراسة بحثية عشوائية سريرية. المقارنة بين ثلاثة طرق لغلق الشقوق الجراحية باستخدام خياطة الجلد تحت الأدمة بواسطة خيط الفكريل, كابسة الجلد ذات الكلبسات المعدنية والشريط الجراحي اللاصق

Author: Raad S. AL-Saffar MBChB, CABS
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2008 Volume: 11 Issue: 1 Pages: 508-518
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Several new methods of skin closure had been used in surgical practice, and they are acceptable alternative to conventional trans cutaneous suture method, these are; buried subcuticular vicryl suture, skin clips or stapler, and steri-strip adhesive tape. Thus the objective of this trial was to assess the impact of these closure methods on closure time, postoperative incision pain, potential wound complications, cosmetic outcome, and patient satisfaction.Methods: 75 patients undergoing different elective and emergency operations were enrolled in this prospective randomized trial. They were divided into 3 groups, in each group(n=25), the incision closed by one of 3 methods: subcuticular vicryl suture, skin clips(stapler) or steri- strip adhesive tape. Closure time was assessed in theatre ; postoperative incision pain was assessed at day 1 and day 5 postoperative. wound complications, and procedure patient satisfaction were assessed in the first 10 postoperative days. Assessment of cosmetic scar appearance was evaluated at 4 weeks follow up after operation.Results: There was significant demographic difference among the three groups (p<0.05). There were no significant differences reported in postoperative incision pain (by visual analogue scale), wound complications (seroma, infection, dehiscence, and granuloma), patient procedure satisfaction, and cosmetic scar appearance(p>0.05). The skin stapler method was faster than other 2 methods (p<0.05). Conclusion: The three methods of skin closure (subcuticular buried vicryl, skin clips or stapler and steri- strip) are not routinely plasticizing methods of skin closure in our surgical practice, but they are acceptable new methods and had equal chance of surgeon preference, except in regard to the speed of closure, the skin stapler method is superior to other 2 methods.

الخلاصة:تمهيد: هناك عدة طرق حديثة لغلق الشقوق الجراحية قد تم استخدامها في مجال الجراحة بصورة عملية وهي بدائل مقبولة للطرق العادية المعروفة وهذه الطرق هي: غلق الشق الجراحي بواسطة الخياطة تحت أدمة الجلد باستخدام خيط الفكريل, الغلق باستخدام كابسة الجلد ذات الكلبسات المعدنية, والغلق باستخدام الشريط الجراحي اللاصق. ولذلك فإن الهدف من هذه الدراسة هو تقييم تأثير الطرق الثلاثة هذه على الوقت المستغرق في الغلق, مقدار الألم الناتج عن الشق الجراحي ما بعد العملية, المضاعفات الحاصلة للجرح, المحصلة الجمالية للجرح, ومدى قبول المريض لعملية غلق الجرح.الطرق: 75 مريضاً خضعوا لإجراء عدة عمليات جراحية باردة وطارئة، حيث أدخلوا إلى هذه الدراسة العشوائية البحثية وتم تقسيمهم إلى ثلاث مجاميع, (في كل مجموعة 25 مريضاً). لقد تم غلق الشق الجراحي في كل مجموعة بواحدة من الطرق المذكورة مسبقاً، وتم تقييم قياس الوقت المستغرق في غلق الشق الجراحي خلال العملية، وتقييم الألم الناتج عن الشق الجراحي في اليوم الأول واليوم الخامس ما بعد العملية, أمّا المضاعفات التي حدثت للجرح إضافة إلى مدى تقبل المريض لطريقة غلق الشق الجراحي، فقد تم تقييمة في اليوم العاشر بعد العملية, أمّا تقييم مظهر الندبة فقد تم بعد مرور 4 أسابيع بعد العملية.النتائج: هناك فرق ديموغرافي فعال بين المجاميع الثلاثة (مقدارp (أقل من((0.05. لم يكن هناك فرق فعال في ما يخص الألم الناتج عن الشق الجراحي ما بعد العملية أو المضاعفات الحاصلة للجرح أو درجة تقبل المريض لطرقة الغلق أو تقييم المظهر الجمالي للندبة (مقدارp) أكثر من(5.(0.0إنّ طريقة غلق الشق الجراحي بواسطة كابسة الجلد كانت أسرع من الطريقتين الأخريين (مقدار p) أقل من (0.05).الاستنتاج: إنّ الطرق الثلاثة لغلق الشقوق الجراحية (الخياطة تحت أدمة الجلد بالفكريل, كابسة الجلد, والشريط اللاصق) هي طرق غير روتينية وغير مألوفة في غلق الشق الجراحي في مجال عملنا الجراحي, ولكنها طرق حديثة ومقبولة، ولديها فرص متساوية للتفضيل من قبل الجراح, في ماعدا سرعة الغلق للشق الجراحي فإنّ استخدام كابسة الجلد هي أفضل من الطريقتين الأخريين.

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Article
Conversion Rate in Laparoscopic Cholecystectomy: A Review of 300 Cases

Authors: Abbas A. Al-Jubori --- Fadhil A. Al-Janabi --- Raad S. Al-Saffar
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.1 Issue: 6 Pages: 772-778
Publisher: Kerbala University جامعة كربلاء

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background : Prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon to be better prepared for the intra-operative risk and the risk of conversion to open cholecystectomy. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 300 cases since September 2007 to December 2009 in a single center with respect to conversion to open cholecystectomy.
AIM: evaluation of difficult laparoscopic cholecystectomy and conversion rate in different 300 cases of cholelithiasis.
Methods: Patients who underwent laparoscopic cholecystectomy (LC) from September 2007 to December 2009 were analyzed. The cases were analyzed in relation to conversion rate to open surgery; factors affecting pulmonary disease were not included in the study.
Results: Out of 300 cases, 52 patients (17.33%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 295 patients with a completion rate of 98.33%. Laparoscopic procedure had to be converted to the open procedure in 5 patients with a conversion rate of 1.66% of the total LCs performed and 9.6% of the difficult cases. Conversion had been done due to several reasons.
Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.
Key words: conversion, laparoscopy, cholecystectomy.


Article
Incisional local anesthesia for pain control after abdominal surgery

Authors: Emad A.M.Al-Janabi --- Ali M. Al-Saiegh --- Raad S. Al-Saffar
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2008 Volume: 5 Issue: 3-4 Pages: 522-531
Publisher: Babylon University جامعة بابل

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Abstract

Bach ground:-The optimizing of postoperative pain control is an important aspect in perioperative patient care the use of inscional local anaesthesia in post operative pain control after abdominal operations was proved effective method of analgesia Aim:-to evaluate the efficacy of postoperative incisional infusion of local anaesthesia (bupivicain) in reduction of postoperative pain in abdominal surgical wounds as well as the need for systemic analgesia and possible side effects of local anaesthesia. Patients and method:- aprospective randomized placebo controlled clinical trial on 80 patients (39 male 41 female) between 13 –54 years old of different abdominal operations, admitted to El- furat hospital in kufa city from December 2005 to October 2006.The patients were divided in tow groups, intervention group 40 patients and placebo group: 40 patients. The study involve the use of incisional intermittent injection of local anesthesia bupivacaine 0.25% via thin subfascial catheter ( B/BRAUN Melsungen AG), in intervention group , for relieve of postoperative pain and assess need for systemic analgesia ( especially opiate) as compared to placebo group in which we inject normal saline via the incisional catheter. Result:-The study had been discusses age, sex distribution, types of incision, pain assessment by visual analogue score, the need for systemic analgesia & complications of local anesthesia. The mean visual analogue score of pain was measured in 1st 6th, 12th , 18th , 24th hours after surgery in every patient in both groups were significantly decreased in bupivacaine group in comparism to normal saline group P<0.005. There is significant decrease for systemic analgesia requirements after operation in intervention group as compared with placebo group (P<0.05). There is only one minor complication (seroma or wound infection) was reported in each group (2.5%). Conculsion:-Study concludes the effectiveness of incisional bupivacaine intermittent injection in relieve of postoperative pain and decrease need for systemic analgesia. Key words: incisional local anesthesia, abdominal surgery.

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Article
Tension –Free Inguinal Hernia Repair Comparing 'Mesh' with 'Darn' A Prospective Randomized Clinical Trial

Authors: Ali M.Al-Saiegh --- Raad S. Al-Saffar --- Haider T. Al-Khassaki***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 220-227
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Lichtenstein tension free hernioplasty(mesh repair) and Moloney darn repair are commonly practiced repairs for inguinal hernias with acceptably low recurrence rates. Mesh repair is considered more recent than darn repair and both of them are tension free.OBJECTIVE:To compare the number of postoperative complications and early recurrence between Mesh repair and Darn repair, for inguinal hernia.PATIENTS AND METHODS:The study was conducted at Department of Surgery, Al-Sadur teaching hospital in An-Najaf from 1st august 2007 to 1st august 2008 . A total of 104 patients were selected. 51 patients were treated with Lichtenstein tension free hernioplasty (Group A) and 53 with Darn repair (Group B). Cases were followed up for three months to one year. The study design was quasi experimental.RESULT:The male to female ratio was 51:1. The mean hospital stay was 37.18 hours in group A and 47.17 hours in group B. there was statistically significant difference between the groups ( p< 0.05).The mean operative time was 44.7 minutes in group A and 50.9 minutes in group B. There was statistically significant difference between the groups ( p< 0.05). the The total number of postoperative complications was reported in 36 patients, 15 ( 29.42%) complications occurring in group A and 21( 39.62%) in group B. Scrotal swelling was the most common complication followed by urinary retention and wound infection in both study groups. Postoperative complications like scrotal swelling ( 11.77% vs. 16.98%), haematoma ( 5.88% vs. 3.77%), urinary retention (5.88% vs. 9.43%), wound infection ( 1.96 vs. 7.55%) and scar pain ( 3.92% vs. 1.89%) were unsignificantly low in Lichtenstein tension free hernioplasty as compared to Darn repair (P > 0.05). There were no recurrences noted till date in any of the two groups under study.CONCLUSIONOpen inguinal hernia repair with a nylon darn was equivalent to polypropylene mesh with respect to early measures of postoperative outcome and recurrence at 1 year. The mesh was superior to darn in operative time and hospital stay

Keywords

inguinal hernia --- mesh --- darn --- repair.

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