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Between October 1985 and the end of 1998, 259 renal transplantations were performed at Al-Mouassat University Hospital in Damascus, from living related donors (LRD). The age of the patients ranged from 14 to 57 years with a mean age of 31.1 years. There were 208 (80.3%) males and 51 (19.7%) females. The follow-up ranged from 1-159 months. The immunosupression therapy was azathioprine and prednisone in 71 patients, and cyclosporine, azathioprine and prednisone in 188 patients. The one, three and five year graft survival was 98.2%, 92.1% and 85.8% respectively. The one, three and five year patient survival was 99%, 97.2% and 90.1% respectively. The ten years overall patient survival was 70.2%. The incidence of complications encountered was acceptable and similar to that reported in the literature. Our study shows that the efficacy of the overall results in our center is comparable to that published in the western world.

Background: Electrocautery has the advantages of making incisions with less blood loss, and dry and rapid dissection of tissue. Possible postoperative risks associated with electrocautery use are poor wound healing and surgical site infection. Aim and Objectives: To compare diathermy with scalpel in making midline incisions with regard to blood loss, time taken for incision, postoperative pain and wound infection. Material and Methods: Comparative observational study of 100 patients operated on through midline abdominal incision with 50 patients in Group A (the electrocautery group) and remaining 50 patients in Group B (the scalpel group). The dimension of the incision, time taken for making incisions and blood loss were reported. The postoperative pain and wound infection were also monitored. Results: Significant difference was revealed between Groups A and B concerning the mean time for incision per unit area of the wound, 8.26±1.46 and 10.96±1.59 s\cm2 respectively (p<0.0001). An average blood loss per unit area of the wound was found to be significantly lower in the electrocautery group; 0.30±0.041 and 1.29±0.22 ml\cm2 respectively (p-value<0.0001). Postoperative pain and surgical site infection were not significantly different between the two groups (p=0.1508 and 1, respectively). Conclusion: Electrocautery is safe in making abdominal incisions when compared to scalpel, and is associated with less blood loss and incision time with comparable postoperative pain and surgical site infection. [ABSTRACT FROM AUTHOR]

LigaSure® (LS) is an energy-based surgical hemostasis device recently introduced in thyroid surgeries. This study aimed to compare the outcomes of using the LS system and conventional clamp-and-tie (CT) technique for total thyroidectomy in terms of surgical time, hospitalization, blood loss and complications. In this prospective controlled study, a total of 104 patients with benign goiter disorders were enrolled. During the period between January 1, 2018 and December 30, 2020, all participating patients underwent thyroidectomy in the surgical wards of the Baqubah and Kirkuk hospitals, northern Iraq. These study subjects were subdivided into 2 groups each comprising equal number of patients. LigaSure diathermy system was applied to the patients in first group i.e. LS group whereas, conventional ligation was used in the other group i.e. CT group. Surgical outcomes were compared between both groups and the results showed considerable differences regarding the time of surgery, hospital stay, blood loss during and after surgery, hematoma, and laryngeal nerve paralysis (p<0.05). Thus, the study concluded that performing thyroidectomy using the Ligasure system is safe with least possible complications involved.Keywords: Catalase, Autologous platelets, Glutathione peroxidase, Malondialdehyde, Iraq [ABSTRACT FROM AUTHOR]

Thyroid disorders are associated with the abnormalities occur in thyroid hormone concentration and imbalance in their regulation may causes life threatening diseases. Thus, the present study was planned to establish the prevalence of thyroid defects in Diyala, Iraq due to paucity of information is available in our region. Total 67 subjects in the age range of 20-80 years were recruited in Al - Shafa hospital, Diyala, Iraq, suffering from thyroid disorders or suspected with the symptoms favoring thyroid diseases. Thyroid function test and physical examination were performed. Those who were found alteration in thyroid hormones and presence of nodules, further investigation like FNAC of neck was performed for the diagnosis. Once confirmation of thyroid defect, total thyroidectomy was performed as a first line of treatment and malignancy was confirmed using histopathology analysis. The incidence of thyroid diseases in female (86.57%) was found to be more than male (13.43%) and there ratio was 19.3:3. The thyroid defects incident rate was highest in mean 49 years age. Almost 61.2% patients were found affected by thyroid disorders in this age group. The largest number of patients (64.18%) had shown MNG, then other thyroid defects out of which 4 female patients presented very big thyroid multinodular goiter (MNG). Among 43 MNG patients, 86% patients were female and 4% were male. Of the 67 cytologically diagnosed cases, 79.10% cases were found benign cases which are highest among all other types, out of which 91% cases were female. Among the thyroid disorder burden of thyroid carcinoma is very high and common in the enrolled patients in Diyala, further longitudinal studies are required to explore the prognosis and causes of these thyroid defects in the Iraq. [ABSTRACT FROM AUTHOR]

Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair. Objective: we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Patients and Methods:. A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibrocremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications. Results: all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. Conclusion: This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications. [ABSTRACT FROM AUTHOR]

Background: Despite elective laparoscopic cholecystectomy has a low risk for infectious complications, many surgeons' still use prophylactic antibiotics. Prophylactic antibiotics administration has been recommended by the centers for disease control and prevention and commonly used in clean-contaminated surgery such as cholecystectomy to reduce surgical site infections. In contrast, several meta-analyses have recently concluded that antibiotic prophylaxis is not necessary in patients undergoing laparoscopic cholecystectomy. 0bjectives The goal of our study was to prove the safety of omission of prophylactic antibiotics regarding development of postoperative surgical site infection in patients undergoing laparoscopic cholecystectomy. Patient and Methods: This is a cross sectional study of ninety four patients underwent laparoscopic cholecystectomy in Baquba teaching hospital during the period from February 2014 to October 2015. The patients were randomly placed into 2 groups: (group A) 47 patients received prophylactic cefotaxime 1g intravenously at the time of induction of anesthesia, and (group B) 47 patients were not given prophylactic antibiotics. Postoperatively the antibiotics were omitted in both groups. Exclusion criteria were patients older than 60 years; when antibiotics used 7 days before surgery; acute cholecystitis in the 4 -6 weeks before to the procedure; evidence of cholangitis and/or obstructive jaundice and biliary pancreatitis; regular corticosteroid therapy; pregnancy or lactation; previous biliary tract surgery or previous endoscopic retrograde cholangio pancreatography; American society of anesthesia higher than score II; diabetes mellitus; body mass index higher than 30; and conversion to open cholecystectomy. The development of surgical site infection postoperatively was investigated and compared in the two groups. RESULTS No significant differences were found between group A and B regarding gender, age, body weight, American society of anesthesia score, conversion to open surgery, duration of operation, number of intraoperative gallbladder perforations and spill of bile or stones, number of positive bile cultures, mean postoperative hospital stay, or number of infectious complications. Group A had 1 (2.17%) superficial SSIs in the epigastric port site. Group B had 2(4.44%) superficial SSIs in the epigastric port site (P>0.05). There was no significant association between intraoperative gallbladder rupture or positive bile culture and SSI. The rate of gallbladder rupture in groups A and B were (19.56%) and (13.33%) respectively (P>0.05). CONCLUSION Perforation of the gall bladder and possible positive bile culture do not increase SSI rates if the contaminated site was irrigated well. Antibiotic prophylaxis does not seem to affect the incidence of surgical site infection and is not necessary for elective Laparoscopic cholecystectomy in low-risk patients. [ABSTRACT FROM AUTHOR]

Endometriosis is a common gynecological pathology with the abdominal wall endometriosis (AWE) being a rarer one but with increasing frequency probably to the increased rate of deliveries by cesarean sections. Endometrial tissue is hormone responsive and its course of pathology can be directly influenced by hormonal therapy. The aim of the study is to evaluate the effect of using adjuvant hormonal therapy post-surgical excision of AWE regarding patient's wellbeing and the recurrence rate. We reviewed the records of our twenty (20) cases operated in a six (6) years period whom were or weren't subjected to postoperative hormonal therapy, comparing their follow up courses and recurrence rates.20 women in whom 18 women were multiparous (90%), mean age was 30.6years. the previous surgery was cesarean section in 19 patients (95%) with the main complaint as a cyclic pain and swelling at the site of previous surgery scar. The patients were divided in two groups 10 patients in each, group A included the patients who had surgery alone and group B for the patients who had hormonal therapy for nine months postsurgical excision. No recurrence was reported in each group, 60% of group A patients had localized pain and discomfort at the scar site which started six months post-surgery while this complaint wasn't recorded in any of group B patients. No difference was found in the recurrence rate between the two groups, absence of localized wound symptoms may indicate a better course and less future recurrence rate in the second group in the future. Some prophylactic methods are better to be taken seriously to decrease the rate of this complication. [ABSTRACT FROM AUTHOR]

The aim of this study is to report our experience in the use of vascular clipping system (VCS) in kidney transplantation (KT), and to discuss its potential clinical benefits for the patients compared with the traditional anastomosis method (suture method). Between October 1985 and December 2000, 350 cases of KT from living related donors (LRD) were performed in the Kidney Transplantation Unit at the Al-Mouassat University Hospital in Damascus, Syria. Between October 1999 and December 2000, 30 cases (21 males and 9 females) of KT were performed using VCS. The mean age of the patients was 32.7 years (14-52). HLA typing showed HLA haplo-identical matching in 22 patients and HLA identical matching in eight. Twenty left kidneys and 10 right kidneys were resected from LRD. VCS was used in 22 arterial and 30 venous anastomosis. We used the Vascular Clip Applier/large 2.0-Auto suture Company-Connecticut-USA. Vessel anasto-mosis was performed end to end between renal and hypogastric arteries and end to side between renal and external iliac vein for all 30 patients. Immunosuppression treatment was with cyclosporine, azathioprine and prednisolone in all patients. The follow-up period was 5-16 months. All the patients were alive at the end of the follow-up period. The other cases of KT (320 patients) were performed by traditional anastomosis method (suture). The time of arterial anastomosis was 12-20 minutes (mean 16) for the suture method versus 7-10 minutes (mean 7.5) for the VCS method The time of venous anastomosis was 15-25 minutes (mean 20) for the suture method versus 7-9 minutes (mean 8.5) for the VCS method. The number of transfused packed red cell units per operation was 1-2 units in the suture method versus 0-1 unit in the VCS method. We observed 17 cases of acute tubular necrosis (ATN) in the 320 cases in whom the suture method was used versus no case in the 30 patients receiving VCS. Vascular anastomosis using VCS shortens the warm ischemia time, reduces packed red cell units transfused and the occurrence of ATN, and thus improves the function of kidney graft.