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Article
ACCEPTANCE AND RELIANCE OF LAPAROSCOPIC SURGERY AMONG MOSUL CITY POPULATION

Authors: Nashwan Kahtan Mahjob --- & Samer Al-Saffar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 69-74
Publisher: Basrah University جامعة البصرة

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Abstract

The study is designed to evaluate the confidence, reliance and the degree of acceptance of laparoscopic surgical procedures among Mosul city population after 15 years of work in this field of surgery. This is a prospective data collection study. Participants were eight hundred persons, all of them from Mosul city with complete normal health at time of evaluation; all of them were above 18 years of age. The main outcome measures: The persons involved were divided into 4 groups according to their literate and educational level, each group composed of 200 persons, the first group (literate medical personnel) composed of medical doctors of various specialties, the second group (literate non medical personnel) composed of persons who were graduated from various colleges, apart from medical one. The third group (partially literate personnel) included those who did not complete the secondary school. the fourth group (low literate personnel) included those who did not completed the primary school. The questioners asked the following questions: 1- Did you know what laparoscopic surgery means? A special information score was used to evaluate the questioner knowledge. To those who answer yes for the first question and the information score was acceptable, the second question was: 2- Do you prefer this type of surgery to be used on you or on one of your first relative if feasible and needed? 3- If the answer for question 2 is yes, please tell us why. 4- If the answer for question 2 is no, please tell us why. The data were collected and comparison was done among the groups. All the medical persons were aware about laparoscopic surgery, 183 agreed to underwent such procedure if needed during the coming time, 160 of the second group knew what is laparoscopic surgery and 123 accepted to be used on them if needed, 118 of the third group knew what is laparoscopic surgery and 80 agreed to be used on them, while 85 of the fourth group had information about laparoscopic surgery but only 42 of them accepted it to be used on them if needed. Those who accepted laparoscopic surgery did so because they think that, it is more cosmetic, less painful and needs less hospitalization time, while those who refused it, did so because they afraid from dangerous instrument, the risk of complication and conversion. In conclusion, laparoscopic surgery is a well known surgical procedure among population in Mosul city, it gained acceptance and confidence especially in literate persons, but it needs more verification for low literate population. Cosmetic, less hospitalization and less post operative pain are the stocks for acceptance while complications, conversion and untrusting instrument and surgeon are the reasons for refusal of laparoscopic surgery.

Keywords

LAPAROSCOPIC --- MOSUL


Article
Laparoscopic Orchiopexy for High Intra Abdominal Undescended Testis , One Stage or Two Stages Fowler-Stephens Orchiopexy ; A Comparative Study

Authors: Laparoscopic Orchiopexy for High Intra Abdominal Undescended Testis , One Stage or Two Stages Fowler-Stephens Orchiopexy ; A Comparative Study --- Amar H. Howidi**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 581-586
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Laparoscopic management of the high intra abdominal testis is still a matter of controversy. Laparoscopic Fowler-Stephens orchidopexy (FSO) is performed either by one stage (laparoscopic clipping and division of the spermatic vessel and proceed for orchiopexy at the same time) or by two stages FSO (laparoscopic clipping and division of the spermatic vessel only and performing laparoscopic release of the testis along with orchiopexy 3-6 months later ).OBJECTIVE:To study the outcome of Laparoscopic one stage and two stages FSO for the management of high intra abdominal testes.PATIENTS AND METHODS:A prospective comparative clinical Study included 25 patients (21 unilateral and 4 bilateral non palpable abdominal testes , 29 testes in total) and laparoscopic surgical procedures (One stage FSO was done for 18 testicles and Two stages FSO was done for 11 testicles) were performed at the urology department ,Medical city complex, Iraq , during the period between December 2010 and March 2013 . Their mean age was 3.2 years.The comparative criteria include; Time of surgery, postoperative complications, testicular position, and testicular viability.RESULTS:Testicular Doppler study revealed four atrophied testes of one stage F.S.O. (22.2%), two atrophied testes among two stages FSO group (18 %) ,this difference was statistically non significant . The difference in the proper scrotal position also was not significant. The operative time difference was significant between both groups (86.6 ± 10.1 min. for one stage vs 122.7 ± 13.5 min. for two stages FSO).CONCLUSION:One-stage FSO avoids repeated anesthesia and the potential for extensive, sometimes tedious, dissection that is occasionally required during re operation, and shorter operative time, making it more optimal than two stages FSO.


Article
Laparoscopic Orchidopexy: Current Surgical Opinion

Author: Saad Dakhil F
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 232-237
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:With the use of diagnostic laparoscopy widely accepted in the setting of the non palpable testes, now day's laparoscopic orchidopexy is an efficient and logical alternative to open orchidopexy.OBJECTIVE:We reviewed the efficacy of laparoscopy for diagnosing the intra abdominal testes.Also we review the efficacy of primary orchidopexy, one stage and two stages laparoscopic orchidopexy for the management of the intra abdominal testes.PATIENTS AND METHODS:Prospective Study includes 20 boys with 23 impalpable testes (3 patients were bilateral). underwent laparoscopy for a non palpable testes at urosurgical department between June 2007 and February 2009.Their age ranged between 3years and 7 years. Eight patients had primary laparoscopic orchidopaxy without division of spermatic vessels .twelve patients had one stage Fowler Stephen method, and Two patients had two stages Fowler Stephen method.RESULTS:During diagnostic laparoscopy: Bilateral abdominal testes was found in 3 patients, Left intra abdominal tests was found in 10 patients, while right intra abdominal testes was found in 7 patients .With the use of laparoscopic orchidopexy : twenty two testes were brought down to the scrotum: sixteen testes (72.7%) brought down to the normal scrotal site, while six testes (27.2 %) were placed at high scrotal position. Orchidectomy was done for one (4.3%) intra abdominal testis.CONCLUSION:Laparoscopy is extremely effective for diagnosis and treatment of patients with non palpable testes.Laparoscopic orchidopexy is the logic extension of diagnostic laparoscopy for intra abdominal testes.


Article
Laparoscopic Management of Symptomatic Renal Cysts

Author: Saad D. Farhan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 163-168
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Simple renal cysts are common, with incidence increasing with age. Symptomatic renal cysts have traditionally been initially treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.Open surgical cyst decortication for pain relief through a flank or chevron incision is associated with considerable morbidity and protracted convalescence.OBJECTIVE:To assess the efficacy of laparoscopic Surgery in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population.METHODS:From April 2007 to July2009 ,11patients (7 males and 4 females) underwent laparoscopic decortications of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan.RESULTS:Of the 11 procedures were completed laparoscopically , the mean operative time was 100 minutes (range 80 to 120). Symptomatic and radiographic success was achieved in 90.9% of patients, with a median follow-up of 12 months (range 6 to 18).CONCLUSION:Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.


Article
8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

Authors: Hashim S Alkhayat --- Jassim H Salim --- Mohammad M Mohammad --- Salim M Albassam
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 1 Pages: 54
Publisher: Basrah University جامعة البصرة

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Abstract

Salim M Albassam*, Mohammad M Mohammad@, Jassim H Salim@&Hashim S Alkhayat@*Department of surgery, Basrah Medical College, Iraq. @Department of surgery, Basrah GeneralHospital, Iraq.Correspondence to: Dr. Salim M Albassam, e-mail: albassamsalim@yahoo.caAbbreviation: Hb= Hemoglobin. ACS = Acute Chest Syndrome. ASA = American Society of AnesthesiologistsAbstractThe aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment ofgall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients fromboth sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladderstones were included in this study in Endosurgery Center in Basrah General Hospital. Thepatients were divided into three groups, group one (19 patients) were selected for laparoscopiccholecystectomy on random preoperative background, the same thing was applied in group two(21 patients) whose patients were subjected to open cholecystectomy while patients in groupthree (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection.Three mortalities and two serious morbidities were encountered in the group one and one mildmorbidity seen in group two and no mortalities or morbidities in group three. Laparoscopiccholecystectomy in sickle cell patients is a debatable issue, an increasing controversy aboutserious perioperative and postoperative morbidity were mentioned. The procedure itself wasaccused and an entirely opposed results were emerged from different studies all are debatable.In this study we noticed the big influence of the risk factors, preparation of patients for surgeryand the adherence to the principle anesthetic rules on the outcome after laparoscopiccholecystectomy in patients with sickle cell disease. This influence was limited in openprocedure. The controversy in the different trials lies on wither the problem is confined to thedisease itself or to the surgical method used for cholecystectomy or both.According to the results obtained from our study we believe that both the severity of the diseaseand the surgical procedure affecting the results, application of intra and post operative protocol(blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting generalanesthesia rules are mandatory for the safety of the patients.


Article
SURGICAL SITE INFECTIONS AFTER LAPAROSCOPIC CHOLECYSTECTOMY 87

Authors: Jasim D Saud --- Mushtaq Ch AbuAl-Hail
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 1 Pages: 87-90
Publisher: Basrah University جامعة البصرة

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Article
4- CAUSES AND INCIDENCE OF LAPAROSCOPIC CHOLECYSTECTOMY CONVERSION

Authors: Adnan Y Abdulwahab --- Safwan A Taha --- Salam T Mutlak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 20-24
Publisher: Basrah University جامعة البصرة

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Abstract

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.


Article
Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Author: Mohamed Salih Younis
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 196-201
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment ofgallbladder diseases. However, LC may be rendered difficult by various problems encountered duringsurgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gallbladder, or extracting the excised gall bladder.OBJECTIVE:Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphycan predict difficult LC. PATIENT AND METHODS: 100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospectiveanalyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC wereperformed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomesincluded the following operative parameters: access to peritoneal cavity, adhesion and difficultdissection, bleeding during surgery, bile leak, and conversion to OC. RESULTS: Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributedto difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common typeof difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC(1%).CONCLUSION: Clinical and ultrasonographic findings can help to predict difficult LC .This information may be usefulto both the patients and surgeons in being better prepared for the intra-operative risk includingconversion to OC


Article
The benefit and feasibility of early laparoscopic cholecystectomy

Author: Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 40-45
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Acute cholecystitis is a common disease. The best managementin early cases is surgical, but the optimal timing for surgery remainscontroversial. With advances and increased experience in laparoscopicsurgery, laparoscopic cholecystectomy is increasingly being used in themanagement of acute cholecystitis.Aims: To determine the best time to operate in acute cholecytitis (early vs.delayed) and to compare the results of laparoscopic approach with those ofopen surgery in the treatment of acute cholecystitis .Patients and Methods: This was a prospective study done at al‐Yarmoukteaching hospital, Baghdad from Sep. 1st 2012 to Sep. 2nd 2013. All patientsadmitted with a proved diagnosis of acute cholecystitis were included. Thepatients were divided into two groups, the first group had earlycholecystectomy, laparoscopic (LC) or open (OC). The second group wastreated conservatively and delayed cholecystectomy was done. Detailedclinical, investigative and imaging data were recorded. The details of theoperative findings, procedures and early post‐operative complications, weredocumented.Results: There were 146 patients, 82.2% female and 17.8% male. The mean agewas 40±2 years. Early surgery was done for 32.8% of patients, 58.4% as alaparoscopic procedure, and 41.6% as an open procedure. Delayedcholecystectomy was done in 67.2% of cases. In the early group,the difficultywas minimal in 27.2%, moderate in 39.5%, marked in 25 % and very difficult withconversion done in 8.3%. Early complications were noticed in 4.2% in the earlyLC group, and 8.3% in the early OC. For delayed LC, 8.1% had earlycomplications vs. 6.1% for delayed OC.Conclusions: Early laparoscopic cholecystectomy is a safe and feasibleapproach to the management of acute cholecystitis.


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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