BACKGROUND: Many studies have shown that open and laparoscopicsurgery for resection of colonic cancers produce similar short- and long-term results, but no data have been reported from Saudi Arabia.OBJECTIVE: Compare 3-year disease-free and overall survival after laparoscopic versus open curative resection for potentially curable colon cancer.DESIGN: Multicenter retrospective cohort study.SETTING: Tertiary academic hospital.PATIENTS AND METHODS: We analyzed data of patients who underwent curative resection for potentially curable colon cancer using the laparoscopic or open approach at three tertiary care centers during the period 2000-2015.MAIN OUTCOME MEASURES: Overall and disease-free 3-year survival were the primary endpoints. Secondary endpoints included conversion rate, duration of surgery, length of hospital stay, rate of wound infection, resumption of bowel function, number of lymph nodes retrieved, adequacy of resection and rate of recurrence. Risk factors for recurrence, including complete mesocolic excision, were assessed.SAMPLE SIZE: 721.RESULTS: Patient and tumor characteristics were similar in the two groups except for ASA class (P<.01), weight (P<.05) and tumor stage (P<.05). Over a median follow-up of 46 months, the 3-year overall survival was 76.7% for open resection and 90.3% for laparoscopic colon resection (P<.05). The 3-year disease-free survival was 55.3% for open colon resection and 64.9% for laparoscopic colon resection (P=.0714).CONCLUSION: Overall and disease-free survival after the laparoscopic approach for curative resection of colon cancer is comparable to the open approach.LIMITATIONS: Retrospective design and the possibility of selection bias.CONFLICT OF INTEREST: None.

Background: Management of rectal cancer has been evolved over the past two decades with the introduction of total mesorectal excision (TME) and laparoscopic resection. Objective: This study aims to assess the difference in the long term outcomes after laparoscopic and open resection for potentially curable, non-metastatic rectal cancer patients.Methods: This is a retrospective study which has been conducted in a single tertiary care center where the patients were recruited from the colorectal database of the Section of Colon and Rectal Surgery at King Faisal Specialist Hospital & Research Centre (KFSH&RC). It included all the patients who had non-metastatic rectal cancer and underwent laparoscopic or open curative resection regardless of their age or the comorbid status during the period from January 2012 – December 2015. We studied the long-term outcomes for those patients which included the completeness of resection of the tumor, overall 3-year survival, 3-year disease free survival, local recurrence and distal recurrence of the cancer.Results:120 patients were included in this study, 69 of them were males and 51 were females. 86 (71.7%) of them underwent open surgery while 34 (28.3%) underwent laparoscopic surgery. After a mean follow up of 32.4 months: 104 patients were alive, 7 deceased and 9 were lost of follow up. Local recurrence in the open approach (OA), and laparoscopic approach (LA) groups was 3/86 (3.5%) and 4/34 (11.8%) respectively. Distal recurrence occurred in 12/86 (14%) of OA and 5/34 (14.7%) of LA. Overall 3-years survival for OA and LA was 89% and 97% respectively and the 3-years disease free survival was 49% and 57% respectively.Conclusion: Laparoscopic and open rectal excision were similar in their outcome.  

Introduction: Pseudoexfoliation syndrome is a recognized risk factor for developing glaucoma, cataract and lens dislocation. Pseudoexfoliation syndrome is also associated with increased risk of complications during cataract surgery due to poor mydriasis and zonular weakness. Objective: The aim is to find out the prevalence of glaucoma in Pseudoexfoliation syndrome patients attended to Shaheed Doctor Aso hospital, Sulaimaniya city, Kurdistan region of Iraq and Azadi Teaching Hospital, Kirkuk city-Iraq. Patients and Methods: This cross sectional study encompassed 378 patients (756 eyes) with whom the pseudoexfoliation syndrome was detected as an incidental finding aged 50 years or older. A detailed evaluation including general and ophthalmic history, slit lamp biomicroscopy, intraocular pressure measurement (TOPCON computerized tonometer CT-80 and Goldmann Applanation tonometer), gonioscopy (Goldmann three mirrors goniolens) and dilated eye examination were performed. Oral informed consent was obtained from all participants. Results: Out of the 378 patients who had pseudoexfoliation syndrome, 58 (15.3%) were diagnosed with pseudoexfoliation glaucoma and 34 patients (9%) with ocular hypertension. In the glaucomatous patients, men to women ratio was 2:1, this was statistically significant (p = 0.001). Most of patients in the age group (70-79) years of age, represent 23.3%. Bilateral Pseudoexfoliation syndrome was associated more with pseudoexfoliation glaucoma (58.6%), while unilateral pseudoexfoliation syndrome was associated more with ocular hypertension (64.7%). The Kurdish race patients expressed the highest prevalence of pseudoexfoliation glaucoma and ocular hypertension (31.5%) followed by the Arabic race (20%) and lastly the Turkmen (16%). Conclusion: Pseudoexfoliation syndrome showed to be a significant glaucoma risk factor locally, with a prevalence of (15.3%), and if we added the Ocular hypertension (9%), it will be (24.3%). Recommendation: Patients with Pseudoexfoliation syndrome should be informed and examined at least annually as the risk may be present throughout their life and increasing with age.

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Background: Isolated intestinal injury after blunt abdominal trauma is a rare challenging clinical entity. Patients with Crohn’s disease (CD) are considered more prone to spontaneous intestinal perforation rather than normal population However, spontaneous intestinal perforation remains rare. In the literature, there are few cases reports discussing intestinal perforation after blunt abdominal trauma in CD patients. Objective: Herein, we report a young male patient with CD who had missed traumatic intestinal perforation along with literature review of similar cases. Case Presentation: A young male patient, known to have CD, was brought to the emergency department after a road traffic accident. He had mild tenderness over his right iliac fossa with no signs of peritonitis. His chest X-rays revealed right-sided pneumothorax. His pan-computed tomography revealed thickened terminal ileum and minimal collection between the intestinal loops that were interpreted as interval regression of his Crohn’s disease. On the second day, he remained hemodynamically-stable with no signs of peritonitis but his chest X-rays showed air under diaphragm. A repeated CT showed pneumoperitoneum, air foci around the terminal ileum and mild free fluid. An ileal perforation was found around 25 cm from the ileo-cecal valve. The involved ileal segment was completely resected with double-barrel ileostomy. Conclusion: Traumatic intestinal injury in patients with Crohn’s disease represent both diagnostic and management dilemma. Inaccurate interpretation of radiological signs may lead to a delayed or missed diagnosis and surgical intervention. Abdominal CT scan should be routinely repeated, within 24 hours, for such patients, regardless absence of symptoms or signs suggestive of intestinal perforation.