INTRODUCTIONHypospadias is a congenital defect due to incomplete tubularization of the urethral plate leading to abnormal location of the meatus anywhere along the ventral aspect of penile shaft and down on to the perineum. In the majority of cases (over 80%), the meatus is located distal to the midshaft.The objective of this study was to surgery in hypospadias is to achieve a functional penis with a normal cosmetic appearance. The commonest repairs to correct distal hypospadias are the Thiersch-Duplay, Mathieu, Mustarde, meatal advancement and glanuloplasty (MAGPI) and tubularized incised plate (TIP) urethroplasty.1-4 Of these procedures Mathieu and Snodgrass urethroplasty (Snodgrass repair) have been widely practiced. Snodgrass being now the preferred method since it creates a vertical slit-like normal appearing meatus, unlike a horizontally oriented and rounded meatus ('Fish mouth') produced by the meatal based (Mathieu) flap repair. This procedure allows ABSTRACT Background: Different modalities of procedures for hypospadial repair have been described in the literature. Data about the outcome of two main different procedure of repair are scares from Iraq. The aim of this study is to compare the results of these two methods of hypospadias repairs. The present study compared two single stage hypospadias repairs, namely, tubularized incised plate (Snodgrass) repair and Mathieu's repair. Methods: It involved 50 patients diagnosed with penile hypospadias, from March 2011 to April 2015 at the Department of Surgery, Al-Karama Teaching Hospital. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee, patients were randomly assigned as Group A of 26 patients in whom Snodgrass repair was accomplished and Group B having 24 patients in whom Mathieu's repair was performed. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethra-cutaneous fistula, and stricture formation. Results:The results showed that the mean age of presentation was 7±6 years (range 1-13years). The mean operative time was 90±15 (75-105) minutes and 60±15 (45-75) minutes in Snodgrass and Mathieu's repair respectively. Complications after surgery were urethero-cutaneous fistula in 2(7.69%) and 4 (16.67%), meatal stenosis in 1(3.84%) and 2(8.33%), wound infection in 4(15.38%) and 3(12.5%) cases in Snodgrass repair and Mathieu repair, respectively, wound dehiscence was equal in Snodgrass repair and Mathieu repair. Conclusions: It can be concluded that the cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus.
Background: Colonic injury is one of the frequent injuries affecting different age groups especially young population. It is potentially lethal in its course and commonly associated with significant injuries to other organs. The aim of this study was to describe the pattern of presentation, management modalities and mortality of colonic injuries among a sample of Iraqi patients.Methods: This is prospective study on 75 patients who were admitted to the general surgical ward of Al-Khadimya teaching hospital, Baghdad-Iraq, with colonic injury and had surgical treatment during a period of two years. The clinical parameters included: site of colonic injuries, mode of colonic injury management shock presenting in the emergency room degree of contamination (mild, moderate, and severe), and associated intra-&extra- abdominal injuries.Results: Majority of patients were male. Mean age of sample was 28.47 years. The commonest site of injury was transverse, sigmoid, and descending colon. Primary repair was the first modality followed by repair and proximal colostomy. The overall mortality was 26/75 (35%). Eighteen deaths (71%) occurred in the first 24 hours most of them due to associated major injuries and irreversible shock. Eight deaths (29%) occurred after 24 hours all of them due to septic complications.Conclusions: Primary repair is the main approach in colonic repair. In the absence of shock, associated injuries, or gross faecal soiling, primary repair may be considered. Mortality is considered high and need to be investigated in future research.
INTRODUCTIONLymphedema is a collection of fluid in some parts of the body especially legs and arms. It is common after radical mastectomy. It was first described by Halsted.1 Axillary sampling (ALNS) is the removal of lymphnode posterior and lateral to pectoralis minor muscle, which is felt hard, enlarged,and fixed. Whereas axillary lymphadenectomy (ALND) which is done in breast cancer is the removal of level I and II lymphnodes from axilla axillary lymphnode dissection (ALND) for staging of breast carcinoma associated with considerable edema of the arm. 2-5The role of axillary surgery in breast cancer is to stage and treat the disease, the treatment of axilla does not affect long term survival suggesting that axillary nodes act not (reservoir) of the disease but amarker for metastatic potential assessment of lymphedema based on circumference of the arm on the side of dissected axilla compare to other side.6-8 Post-operative lymphedema in axillary lymphnode dissection frequently are seen and affect quality of life adversely.The main objective of present study was to know the prevalence of lymphedema after variable method of axillary lymphadenectomy and ALNS in Iraq.Axillary lymphnode sampling of axilla associated with negligible lymphedema compared with ALND the routine performance of axillary dissection in patient with breast ABSTRACT Background: Lymphedema is a collection of fluid in some parts of the body. It is common after surgical intervention. Different approaches of dealing with lymphnode involvement in axilla have been describe. The main objective of present study is to determine the prevalence of lymphedema after different methods of axillary lymphadenectomy and axillary sampling techniques in Iraq. Methods: This was a cross-sectional study in which post-operative lymphedema of the operated arm was compared in 25 patients with breast cancer after axillary ALND (the excised node more than 4 lymph node up to 18 node) and 25 patients following axillary ALNS of only enlarged hard lymphnode. Results:The results of post-operative follow up from three months to three years following ALND patients showed significant increase in the arm circumference over those exposed to ALNS of the axilla. Conclusions: It can be concluded that axillary lymphnode sampling of axilla associated with negligible lymphedema compared with ALND the routine performance of axillary dissection should be considered with caution.
IntroductionEndoscopic submucosal dissection (ESD) is superior to endoscopic mucosal resection(EMR) as it leads to en-bloc resection & reduces risk of recurrence. However, western uptake has been limited due to long learning curve and procedure time.We aim to establish the time required for each component of ESD and identify factors predicting it.MethodsA single, experienced, western Endoscopist performed all procedures for suspected Barrett’s cancers >2 cm. Procedures were recorded in full on a digital recorder. First 30 procedures were considered as a part of learning curve and not analysed. All subsequent consecutive procedures were analysed by an independent researcher with knowledge of ESD.Lesion area was calculated based on length of the lesion and the percentage of the oesophageal circumference involved. Using the equation area = 2*π* r * l *% circumferential involvement / 100. Here r = radius and l = length of lesion. The time for every component of the procedure was recorded: lesion evaluation & marking, submucosal (SM) injection, mucosal incison, SM dissection, haemostasis & post-ESD site evaluation.Results29 consecutive videos were examined. All lesions were Barrett’s cancers (25% T-1b, 75% T-1a). The mean length was 30 mm (range:20-70mm), with mean area of 8.2cm2 (range:1.6-23cm2). The mean procedure time was 81 mins (range:45-142min), equating to 9.9 min/ cm2 .The time taken for each component of the procedure is shown in fig. 1. Only 42% of the time was spent in cutting (Mucosal incision and SM dissection). 24% of time was spent in evaluation and marking the margins. 24% of the time spent in changing accessories & injection. Procedure time was related to lesion area: 100 min for lesions >10cm2 vs 72 mins for lesions <5 cm2(p = 0.0056).Circumferential extension had an effect, with <25% circumference taking 66 min vs 92 mins for lesions with >25% circumferential extension (p = 0.0025)Abstract PWE-072 Table 1Lesion evaluation(min)SM injection (min)Mucosal incision (min)SM dissection (min)Accessory change (min)Haemostasis control (min)Post resection evaluation (min)Mean1910.114.919.39.04.53.8Median208.914.815.59.23.93.8Range5.7–274.2–245.9–26.43.2–64.33.3–17.50.7–201.5–824%13%18%24%11%5%5%ConclusionOur data shows that it takes 9.9 min/ cm2 to perform ESD for Barrett’s cancers. Time taken is directly related to the size and circumferential extent of the lesion. We found that only 42% of the time is spent performing the actual resection and rest of the time is spent in supporting acts. This information can help focus the future research in reducing the ESD procedure time and also help plan appropriate time and remuneration for current ESD procedures.Disclosure of InterestNone Declared
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