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Article
ASSESSMENT OF INTRAOPERATIVE MANUAL REDUCTION OF INTUSSUSCEPTION IN CHILDREN

Author: Abbas Abdulzahra Alhasani
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 69-76
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Intussusception is the commonest cause of bowel obstruction in children and is the second most common cause of acute abdominal emergency in this age group, mostly it is idiopathic (primary) and of ileocolic type. Typically, colicky abdominal pain, "currant jelly stool" and a palpable abdominal mass are the triad of presentation. The best mean for early diagnosis is abdominal ultrasound scan. Unless contraindicated, non-operative approach (using either pneumostatic or hydrostatic reduction) is the best way for management with a success rate up to 95%, otherwise, surgical intervention is indicated. Unfortunately, non-operative approaches, were not ever safe options in our health institutes because of the lack of the required hospital facilities and trained staff, so all cases of intussusceptions were managed surgically by laparotomy and manual reduction. This study enrolled 70 children with Intussusception who were managed in two main children's hospital in Basrah city between April 2008 and December 2015 by one pediatric surgeon. The mean age of study population was 11.6 months and male to female ratio was 3.6:1. Primary intussusception was found in 91.4% of the patients and the most common anatomical pattern was ileocolic type (62.9%). Intra-operatively, manual reduction was reported to be easy in about half of the patients, those were presented early in the course of the illness (79.4% were presented within the first 24 hours) that made them very good candidates for non-operative management. Both postoperative complications and hospital stay were significantly related to the intraoperative procedure used for reduction, an easy manual reduction was associated with a less incidence of complications and a shorter hospital stay although generally longer hospital stay when compared with other studies in which intussusception is usually managed nonoperatively.


Article
Angiotensin Converting Enzyme Inhibitors, to Continue or Discontinue on the Morning Day of Surgery

Authors: Sabah Noori Al-saad --- Arkan Muhammed Mahdi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 208-212
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND:Angiotensin converting enzyme inhibitors(ACEI) play a pivotal role in the management ofhypertension(11). whether to continue or discontinue them before surgery is an everyday encounteredquestion of both surgeon & patient, this issue is continuously submitting to debate & controversy.OBJECTIVE: To compare between the incidence of intra-operative hypotension in hypertensive patients whocontinue to take ACEI. & those who discontinue, & are undergoing general anesthesia for non-cardiacsurgery.PATIENTS AND METHOD:A comparative study consist of 40 patients presented to the Medical City, Baghdad Teaching Hospital& Surgical specialty Hospital between July 2011,to March 2012.the age of patients range from 38-70years old, they were 10 (25 %) men and 30 (75 %) women , they were divided into two groups;according to mode of medication, cases ( who were continued taking medication ) and control (whowere discontinued medication),twenty patient each, all patients underwent different surgicalinterventions under general anesthesia, they were studied & monitored intra-operatively regardingdevelopment of hypotension, this was done at time interval of 5 minutes & at starting point prior toinduction of general anesthesia until 20 minutes after.RESULTS: By comparing the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in betweenboth groups of patients, those who were continued ACEI (group A) or those who werediscontinued(group B), it had been found that no significant differences in mean SBP neither preoperativelynoratdifferenttimeintra-operatively.P.valueinallcomparisonswas>0.05.CONCLUSION:Continuingor discontinuing ACEI before non-cardiac surgery under general anesthesia has nostatistical significance regarding concern of developing intra-operative hypotension.


Article
Analytic study of the intraoperative surgicalcomplications of elective & emergency cesarean sections: incidence & risk factors
دراسة تحليلية للمضاعفات الجراحية اثناء العمليات القيصرية الباردة والطارئة: نسبة الحدوث وعوامل الخطورة

Authors: Basima Shamkhi Al-Ghazali --- Luma Saad Zeiny
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2013 Volume: 3 Issue: 3 Pages: 85-95
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Cesarean section accounts for a substantial proportion of total deliveries & is associated with higher rates of maternal & neonatal morbidity.Objective: to determine the effect of the risk factors on the incidence of intraoperative surgical complications in elective & emergency cesarean sections. Methods: This study was conducted in AL-Zahra'a Teaching Hospital of Maternity & Pediatrics in Najaf city, from June to December 2011. A total of 600 patients who had lower-segment cesarean section (280 patients with elective cesareans &320 patients with emergency procedures) participated in the study. A comparison was done between major & minor surgical complications&neonatal outcome in both groups with estimation of the effect of maternal age, body mass index, parity, previous C/S & placenta previa on the incidence of intraoperative surgical complications. Results:Intra-operative surgical complications& poor neonatal outcomewere more commonly associated with emergency than with elective procedures (P<0.05).Uterocervical laceration& blood loss requiring blood transfusion were the most frequent complications & they were more commonly associated with increased maternal age, parity, body mass index, placenta previa&abruption, previous cesarean & emergency conditions.Statistical analysis: The data were analyzed using spss version 15 with the chi –squared test to determine the association between the various factors under investigation. Conclusion: every effort should be directed to affect planned cesarean section with evaluation of risk factors during the antenatal period if possible, so as to reduce the various problems associated with emergency cesarean section.Recommendations: owing to the higher incidence of intraoperative complications if C/S is undertaken in the emergency situations, it is recommended to be accomplished as an elective procedure.

خلفية الدراسة : تمثل الولادة بواسطة العمليات القيصرية نسبة كبيرة من الولادات العامة مع احتمالية أعلى في حدوث المضاعفات و الوفيات عند الام و الطفل. الاهداف: كان الهدف من الدراسة بيان تأثير عوامل الخطورةعلى نسبة حدوث المضاعفات الجراحية أثناء العمليات الباردة والطارئة.الطريقة:أجريت الدراسة في الفترة من حزيران إلى كانون الاول 2011 واشتملت على 600 مريضة من اللواتي يراجعن صالة الولادة والعيادة الخارجية في قسم النسائية والتوليد في مستشفى الزهراء التعليمي للولادة والأطفال في النجف الاشرف قسموا الى مجموعتين: تضمنت الاولى (280) عملية قيصرية باردة وتضمنت الثانية (320) عملية قيصريةطارئة حيث أجريت المقارنة بين العمليات الباردة والعمليات الطارئة من ناحية المضاعفات الجراحية ومقارنة الحالة العامة للطفل بعد العملية.تم تسجيل المعلومات عن العمر ,عدد الولادات السابقة, عدد العمليات القيصرية السابقة, وزن الأم,حركة الطفل, حالة النزف والأمراض المصاحبة للحمل مثل السكر وارتفاع ضغط الدم.كما واجري الفحص على نسبة الدم ونسبة السكر وفحص السونار لتحديد عمر وحجم الطفل ومكان المشيمة.النتائج:بينت دراستنا من خلال تحليل الإحصائيات التي جمعت خلال العمليات القيصرية إن هناك تأثير واسع وكبير لنوع العملية (باردة اوطارئة) على مجريات سير العملية القيصرية ومضاعفاتها الجراحية الكبيرة والبسيطة بحيث تكون المضاعفات اكثرنسبة مع العمليات الطارئة بفارق معتد به احصائيا كما وجد إن هناك تأثيرواضح ومعتد به احصائيا لعوامل الخطورة (عمر الحامل,عدد الولادات السابقة,وزن الحامل,عدد العمليات السابقة,وضع المشيمة) على المضاعفات الحاصلة أثناء العملية الجراحية.الوسائل الاحصائية: تمت مقارنة النتائج باستخدام اختبارالكاي سكوير.ألاستنتاج: ان أجراء العمليات بطريقة مخطط لها مسبقا مع تحديد عوامل الخطورة اثناء فترة الحمل يقلل من نسب المضاعفات المتوقعة في الظروف الطارئة.التوصيات: نظرا لكون نسب المضاعفات الجراحية الحاصلة اثناء العمليات القيصرية اعلى عند اجرائها في الظروف الطارئة, فانه من الموصى به ان يتم اجرائها في ظروف باردة.


Article
Intraoperative Comparison between Spinal and General Anaesthesia for Lumbar Laminectomy Regarding Effectiveness and Hemodynamic Stability in Karbala

Author: Jaber Mohsin Al-Goraby
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 1 Pages: 2324-2329
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: General anaestheia is the most frequently used method For spinal surgery. Neuraxial blocks have proved most useful in lower abdominal, inguinal, urogenital, rectal, and lower extremity surgery. Lumbar spinal surgery may also be performed under spinal anaestheia.Aim: To assess the notion that spinal anaestheia can be both safe and effective in the treatment of patients undergoing lumbar spinal surgeries.Methods: The study was performed in Al-Imam Al-Hussein medical city, Karbala, Iraq from April 2010 to April 2014, 60 patients in whom either spinal anaestheia SA or general anaestheia GA was induced to perform a lumbar laminectomy. Patients were matched for anaestheia-related class, age, gender and preoperative vital sign. Thirty patients in each group both groups were well matched.Results: The heart rate (HR) and blood pressure (NIBP) was higher in SA during induction, but they were higher in GA during surgery and recovery time. Recovery time was longer in GA group, patient and surgeon were more satisfy with GA p-value <0.05. Conclusion: Spinal anaestheia is a suitable alternative to general anaestheia for lumbar disc surgery, but need cooperative patient.Recommendation: Spinal anaestheia for spinal surgery is good choice for cooperative patient it’s better to avoid if surgical time might be prolonged or in risky patient.


Article
Calculation of the Amount of Fluids Given During Neonatal & Pediatric Surgical Operations (New Formula: Ry Formula)

Author: Riyadh Khudeir Hamed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: supplement Pages: 688-692
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: A new formula (RY formula) for calculation of intra operative fluids given in neonatal & pediatric life threatening surgical operations was enrolled in this study. OBJECTIVE:To find a correct , simple ,easily applicable & understandable formula to avoid all unwanted dangerous mistakes in calculation of fluid requirements in all types of neonatal& pediatric surgical operations . PATIENTS: (Five Thousands Patients) including neonates , infants & pediatric age group presented to CWTH /Medical city /Baghdad for different types of surgical operations were enrolled in this study divided to 3 groups ( Group A ) Life threatening conditions 2300 patients , (Group B) Major& super major operations 700 patients &( Group C ) Different types of elective surgical operations 2000 patients . METHODS: In this new (RY formula) intra operative fluid requirements calculated as : Pre existing deficit (Fasting) : 20 ml/kg this amount is divided over 3 hours : ½ the amount given in the 1st hour of operation , and ¼ the amount is given for each the 2nd& 3rd hours of operations. Maintenance fluid requirements : 4 ml/kg/hr for all weights. 3rd Space replacement : 8 ml/kg/hr for major& super major operations & 4 ml/kg/hr for minor operations .RESULTS : By comparison of this new (RY formula) with most of other anesthesia text books fluid formulas and anesthetic references regarding this aspects the results is that the difference in the amounts of fluid requirements was minute and regarded as negligible difference .CONCLUSION: This new formula has been used for the last six years(2005-2010) in neonatal & pediatric anesthetic department in CWTH/ Baghdad Medical City complex for 5000 neonates ,infants & pediatric patients without any complications.This new formula is correct, simpler, safer ,easily applicable understandable than other formulas. The most important point in this new(RY formula) is that it can be summarized by just 2 numbers( 22- 17) 22 ml/kg for the 1st hour & 17 ml for the 2nd&3rd hour of operation for major operations.


Article
Relation Of Abnormal Fetal Heart Rate & Intra-Operative Findings In An Emergency Cesarean Section
العلاقة بين تغيرات نبض الطفل اثناء الولادة والتغييرات التطبيقية التي تم استنتاجها خلال العمليه القيصرية الطارئة

Authors: Manal Madany A. Qader --- Shatha Sami Hussein
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 2 Pages: 27-31
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Fetal distress in itself is a non-specific term include indicators such as an abnormal intrapartum fetal heart rate pattern, meconium stained amniotic fluid, low apgar scores or placental abnormality , it's not necessarily that an abnormality in one will reflected as an abnormality in the other or their may be none of these findings.Aim of study: To describe the relation between intrapartum fetal heart abnormalities and operative findings and neonatal outcomes in an emergency cesarean section . Patients and methods: A" cross sectional study" performed in Al-Yarmouk Teaching Hospital through the period from the 1st of July 2014 to the 1st of July 2016 on a convenient sample of 638women. Women participated in the study included: women in the labor room who delivered singleton, viable fetus, cephalic presentation, term size pregnancy with gestational age ≥37-40 weeks by emergency caesarian section for abnormal fetal heart rate As a part of the work protocol, the surgeons were instructed to document any findings that may be possible causes for the non-reassuring fetal heart rate as cord abnormality ( occult cord prolapse , true knots or entalengement) , placental abruption and rupture uterus , the placentae of those who have no intraoperative findings were send for histopathology. Results: Mean maternal age was 27.6±8.1 years and mean fetal weight was 3.2±0.6 Kg . 35.2 % of neonates with intra-operative problems needed admission to the neonatal care unit in comparison to 20.3% of those not facing such problems. This difference was significant (p= 0.021) There is significant association between maternal age and intraoperative abnormalities with P-value of 0.009%. No intraoperative findings were seen in 34% and 65.5% no placental finding were found on histopathology.Conclusions: Fetal distress may occur for several underlining causes. However, neither of them may reflect fetal asphyxia or acidosis and an abnormal cardiotocography may carries a false diagnosis of fetal distress.

الخلفية: الضائقة الجنينية في حد ذاتها لتشمل فترة غير محددة المؤشرات مثل السائل الامنيوني الغير طبيعي الذي يحيط بالجنين أثناء الولادة, تغييرات في نبض قلب الجنين، العقي الملون، ضعف الجنين بعد الولادة وشذوذ المشيمة، وليس روتين أن خلل في واحدة سوف بالضرورة أن تنعكس على أنه شذوذ في الآخر أو قد يكون يحدث بدون اي من هذه النتائجالهدف: لتوضيح العلاقة بين النواتج الظاهرة خلال العملية القيصريه وحالة الطفل بعد الولادة للعمليات القيصريه الطارئة الناتجة من تغييرات في ضربات قلب الجنين .التصميم: دراسة مقطعية الاسلوب:أجريت في مستشفى اليرموك التعليمي من خلال الفترة من 1 يوليو 2014 إلى 1 يوليو 2016 على عينة مناسبة من 638 امرأة. وتشمل الدراسة النساء في غرفة المخاض, جنين واحد، الجنين قابلا للتطبيق، والعرض الرأسي، ومدة الحمل تتراوح بين 37-40 أسابيع بواسطة عملية قيصرية طارئة للتغيرات الغير طبيعية لمعدل ضربات قلب الجنين ,وتم اخذ المشيمة من أولئك الذين لم يلاحظ وجود نتائج خلال العمليه وقد تم إرسال النتائج للأمراض الأنسجة. وكانت هناك استبعاد للنساء المصابين بالأمراض الصحية المزمن. النتائج : كان متوسط عمر الأم 27.6 ± 8.1 سنوات، اما وزن الجنين فكان 3.2 ± 0.6 كلغ. .35.2٪ من حديثي الولادة الذين يعانون من مشاكل داخل المنطوق يحتاج دخول في الخدج بالمقارنة مع 20.3٪ من أولئك الذين لا يواجهون مثل هذه المشاكل. كان هذا الفرق معنوي (p = 0.021) هناك ارتباط كبير بين عمر الأم والشذوذ أثناء العملية مع P-قيمة 0.009٪. لم توجد نتائج أثناء العملية في 34٪ و 65.5٪ لم يلاحظ وجود تغييرات في تركيب المشيمة.الاستنتاجات: قد تحدث الضائقة الجنينية لعدة أسباب مؤكدا. ومع ذلك، اختناق الجنين أو الحماض ممكن تحدث بدون اي نتائج خلال العلمية وجهاز مراقبة نبض الجنين قد يحمل التشخيص الخاطئ للضائقة الجنينية.


Article
Management of Obstractive Jaundice Due to Common Bile Duct Stone in Baghdad Teaching Hospital
علاج اليرقان الانسدادي الناتج عن حصاة القناة الصفراوية المشتركة في مستشفى بغداد التعليمي

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Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm) Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.Key wards: CBD stones, endoscopic management, surgical intervention

خلفيه الموضوع: اكثر اسباب اليرقان الانسدادي هو حصا القناه الصفراء,وهذا يمكن ان يولد مضاعفاه ووفياه مهمه.معالجه اليرقان الانسدادي الناتج من حصاه ه قناه الصفراء في تطور,عده طرق تشخيصيه وعلاجيه ادخلت في هذا الموضوع وكل منها له فوائده ومضاره.هدف الدراسه:لغرض دراسه وتقييم معالجه اليرقان الانسدادي الناتج عن حصاه القناه الصفراء في مستشفى بغداد التعليمي.المرضى والوسائط :دراسه مستقبليه مكونه من 111 مريض لديهم اعراض سريريه ونتائج مختبريه وصوريه تقترح وجود يرقان انسدادي ناتج عن حصاه القناه الصفراء عولجو في مستشفى بغداد التعليمي في الفتره من كانون الثاني 2011 الى تشرين الثاني 2011 14 مريض اخر ابعدو من الدراسه بسبب ثبوت ان سبب اليرقان الانسدادي لديهم كان باسباب اخرى.العمل المبذول لكل مريض كان اخذ تاريخ المرض والفحص السريري وفحوصات مختبريه فحص الامواج فوق الصوتيه (السونار) للبطن.نفس المرضى تعرضوا لعمليه تنظير القناه الصفراء لسببين لغرض التشخيص واستخراج حصاه قناه الصفراء .مريضين فقط ارسلوا مباشره الى العلاج الجراحي كان لديهم (متلازمه ميريزي).كذالك اجريت العمليات الجراحيه للمرضى الذين فشلت لديهم المعالجه الناظوريه.النتائج:من ال125 مريض الذين لديهم يرقان انسدادي والذين انضموا لهذه الدراسه ,14مريض لديهم اسباب غير حصاه القناه الصفراء ابعدوا من هذه الدراسه, فاصبح العدد الكلي للمرضى 111 مريض46 ذكر و65 انثى .جميع المرضى ليهم اعراض سريريه ولديهم نتائج تحاليل وظائف كبد غير طبيعيه , اجري الفحص السوناري لجميع المرضى ,وفحص الرنين المغناطيسي للقنوات الصفراء والبنكرياس اجري ل26 مريض وفحص السونار عن طريق ناظور المعده والاثني عشر ل9 مرضى ,4 مرضى كان لديهم حصاه القناه الصفراء الاوليه, 95 مريض كان لديهم حصاه القناه الصفراء الثانويه , 9 مرضى كان لديهم حصاه القناه الصفراء المحفوظه , و3 مرضى لديهم (متلازمه ميريزي ).المعالجه المنظاريه اجريت ل 108 مريض نجحت في 90% من المرضى.العلاج الجراحي اجري ل 13 مريض 10 منهم بعد فشل العلاج المنظاري و3 مرضى كان لديهم (متلازمه ميريزي) .الاستنتاجات:العلاج الناظوري لاستخراج حصاه القناه الصفراء المتبوع برفع المراره ما زال الطريقه الرشيده في علاج حصاه القناه الصفراء . حصاه القناه الصفراء الكبيره وتعددها ما زالا الاسباب الاكثر شيوعا لفشل العلاج المنظاري لاستخراج حصاه القناه الصفراء والعلاج الجراحي ,في هذه الدراسه كان هنالك نسبه حصاه محفوظه في القناه الصفراء اعلى من الدراسات المذكوره في الدول الغربيه,بسبب عدم وجود فحوصات خلال العمليه تجرى لغرض تشخيص حصاه القناه الصفراء لغرض تلافي ترك حصا في القناه الصفراء في مستشفانا مفتاح الكلمات: حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

Keywords

Background: the most common cause of obstructive jaundice is CBD stones --- and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution --- several methods of investigations and treatment have been introduced --- and each one has its own advantages and disadvantages. Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital. Patients and methods: a prospective study of 111 patients with clinical --- laboratory --- and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011 --- other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them --- MRCP for 26 patients --- and EUS for 9 patients. Four patients had primary stones --- 95 patients had secondary stones --- 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions --- and they were excluded from the study --- so the total number of the patients was 111 --- 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients --- 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone --- more than 15mm Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries --- because there is no intraoperative screening to avoid missing CBD stones in our hospital. Key wards: CBD stones --- endoscopic management --- surgical intervention --- حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

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