The aim of this study is to compare between excision followed by primary closure as the first type of treatment and excision with laying the tract open, to heal by granulation, as a second type of treatment of pilonidal sinus.Seventy three patients were included in the study. They were divided randomly into two groups, group A and group B, the first group was treated by closed method and the other by open method.Data were collected and analyzed regarding recurrence rate, time needed for full healing, infection rate and duration of hospital stay.Thirty-five patients comprised group A (30 males and 5 females) compared to 38 patients in group B (31 males and 7 females). The mean hospital stay for group A ranged from 3 to 6 days (mean=4.4 days) while for group B it ranged from 1 to 2 days (mean=1.2 days), a difference that is statistically extremely significant (P value <0.00001). The rate of wound infection was similar (2.8%) in both groups (one in 35 patients of group A and one in 38 patients of group B).Primary closure has the advantages of quicker healing time, shorter post operative specialized medical care and less time off work.

Anal fissure represents one of the most common diseases of the ano-rectum in which there is denuded epithelium of the anal canal overlying internal sphincter. In this study 110 patients underwent posterior midline sphincterotomy as the treatment for their chronic anal fissures. Mean operating time was 5 minutes and no patient stayed at hospital overnight. All patients were followed-up for 6 months. Symptoms were relieved right following surgery. Four patients developed wound infection. Other 4 patients experienced some difficulty in micturition but none had retention. Six patients experienced relative incontinence to flatus for a couple of weeks postoperatively but all of them regained their sphincter control after that. No patient complained of incontinence for feces. There were no serious scarring of the area like keyhole deformities or its variants and none of the patients developed recurrence. Almost all the patients were satisfied with the outcome. We recommend posterior midline internal sphincterotomy as the surgical treatment of choice for chronic anal fissure because it is simple to perform and results in quick relief of pain and rapid healing in almost all cases, with very few complication and negligible recurrence.

The medical records of 324 diabetic patients admitted to Al-Sader Teaching Hospital (Saddam Teaching ‎Hospital previously) with foot lesions between April 1994 and April 2004 were studied retrospectively. ‎Data were collected for various parameters, both personal and medical. The majority of patients were ‎males, over fifty years of age and known diabetics. Peripheral neuropathy was the main predisposing ‎factor while infected ulcer and gangrene of toe / toes were the most common forms of presentation. ‎Wound swabs were positive for bacterial culture in 215 pts. (66.3%), 97.2% of which were polymicrobial. ‎Dibridement was the most common surgical procedure. There were 6 deaths (1.85%) in the study group ‎mainly due to uncontrolled sepsis with concurrent medical illnesses. It is concluded that foot ‎complication is a common problem in elderly Iraqi diabetics, particularly males, peripheral neuropathy is ‎the most common predisposing factor, foot infections are usually poly microbial and that the majority ‎will need some form of surgical intervention that is mostly conservative rather than a major amputation. ‎We suggest a team approach in the care for these patients which can be provided by establishing foot ‎care clinic in large hospital. ‎

ROUX-EN-Y ESOPHAGOJEJUNOSTOMY AFTER TOTAL GASTRECTOMY FOR GASTRICMALIGNANCY.Hashim S Khayat# & Safwan A Taha**CABS. Professor, Dept. of Surgery, University of Basrah, College of Medicine; #FRCS Ed. Consultant Surgeon and Chairman, Basrah General Hospital, Basrah; IRAQ.AbstractOut of 62 patients who underwent total gastrectomy for gastric malignancy, 40 patients had roux-en-y esophagojejunostomy. Their age ranged from 32 to 70 years. Seventeen patients were less than 60 years old and 27 were older. There were 23 males and 17 females. Operations were done through thoraco-abdominal incisions in 28 patients and upper midline incisions in 12. The anastomoses, on the other hand, were hand sewn in 34 patients and stapled in the other 6. The procedure included splenectomy in 37 patients, distal pancreatectomy in 6 and transverse colectomy in 2 patients. Postoperative complications included chest infection (8 patients), wound infection (7 patients) and anastomotic leak (1 patient). Eleven patients died postoperatively, the leading cause being pulmonary embolism, respiratory failure and over-whelming sepsis. Out of our surviving patients, 4 (10%) are still alive 5 years or more after surgery and are enjoying good health. Our results are well within the international figures although we think that the outlook could have improved had we gained access to certain facilities like hyperalimentation, chest physiotherapy units and measures that could prevent deep venous thrombosis. Roux-en-y esophagojejunostomy is a safe method to restore the continuity of the alimentary tract after gastrectomy. It requires less time than “pouch-forming” procedures, has less incidence of anastomotic leakage, produces acceptable morbidity and mortality, gives good nutritional value and does not require the special expertise needed to perform the “pouch-forming” procedures.

Four hundred cases of laparoscopic cholecystectomy candidates wereprospectively followed at the time of surgery by obtaining a data sheet for thepatient’s age, sex, time from the introduction of ports till decision of conversionand the cause of conversion if present in two years (2006 & 2007) period.From 400 laparoscopic cholecystectomy, 20 conversions were obtained and thecauses were; wide cystic duct, empyema of the gall bladder, severe obesity, livertumor, abnormal position of gall bladder, vascular variation and dense adhesionswith disturbed anatomy. The percentage of conversion was 5%. Eight conversioncases were males from the total 45 male patients underwent laparoscopiccholecystectomy. Twelve cases were females out of 355 female patientsunderwent laparoscopic cholecystectomy. The percentage of conversion for malepatients was 17.7% while in female patients was 3.3%. Our results showed thatthe conversion rate in this study was 5% and the most common cause forconversion is dense adhesions. No biliary duct injury or severe bleeding thatneed conversion is found in this study and the rate for conversion is higher inmale patients.

LAPAROSCOPIC --- CHOLECYSTECTOMY --- CONVERSION