Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160089
F. Al-Gazgooz, Abdulkareem Jabbar Ghadban Al-Ebadi
Bleeding is a serious complication following bariatric procedures such as Minigastric bypass (MGB), Roux-En-Y Gastric Bypass (RYGB) Surgery, and Sleeve Gastrectomy (SG). Post bariatric bleeding is either acute or chronic. Although this complication is declined now, but still it is important to know because if it is not managed urgently it will lead to serious results. The source of bleeding may be from the staple lines, unexpected injury to the spleen, or to one of the blood vessels around the surgical field. The other source of bleeding may be internal through the GIT and it is presented as hematemesis or melena. Gastrointestinal bleeding in patients underwent bariatric surgery may occur in the esophagus, gastric pouch, new sleeved stomach, the Roux limb just distal to the anastomosis, the remaining of the small intestine. The site of bleeding can be determined and treated mostly by endoscopy but in certain cases may require re-laparoscopy. The aim of this study is to analyze the incidence, types and management of this bleeding. This is a prospective study which has been done in Al-Sadr Teaching Hospital, Basrah, Iraq, from June 2015 to June 2017. The study included 540 case who were subjected to SG, RYGB, MGB and they were analyzed regarding; time of occurrence, postoperative bleeding, types whether intra-peritoneal or intra-luminal and type of approaches for treating this bleeding. In our study we don’t over sewn the staple line and didn't use any buttressing material or synthetic coagulation powder. The total number of patients developed post-operative bleeding were 18 cases out of 540, 12 after sleeve gastrectomy, 3 after mini gastric bypass and 3 after Roux-En-Y. Regarding sleeve gastrectomy; two patients of the required re-laparoscopy and evacuation of hematoma with treating site of bleeding by clipping or suturing according to the condition, three patients required aspiration under ultrasound guide, while the remaining 7 cases were kept only under conservative measures. The 3 patient of the MGB were managed conservatively and the 3 cases of Roux-En-Y were managed either conservatively in 2 cases or by endoscopic intervention in one case. In conclusion, we advise the surgeons to use reinforcement of staple line to decrease incidence of post-operative bleeding. Introduction besity is a major health problem worldwide that leads to increased incidence of morbidity and mortality. People are generally regarded obese when their body mass index (BMI) exceeded 30 kg/m, and above the 25kg/m were regarded as overweight. Obesity is a risk factor of many diseases like cardiovascular diseases, diabetes, sleep apnea, osteoarthritis, depression, and rarely cancer. Life style modification such as change in diet quality and exercise can control obesity. If diet modification, exercise, and medication failed to control morbid obesity, a gastric balloon or surgery should be considered to solve the problem. The choice of procedure depends on BMI, food habit, c
{"title":"BLEEDING FOLLOWING BARIATRIC SURGERY (TYPES & MANAGEMENT MODALITIES)","authors":"F. Al-Gazgooz, Abdulkareem Jabbar Ghadban Al-Ebadi","doi":"10.33762/BSURG.2018.160089","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160089","url":null,"abstract":"Bleeding is a serious complication following bariatric procedures such as Minigastric bypass (MGB), Roux-En-Y Gastric Bypass (RYGB) Surgery, and Sleeve Gastrectomy (SG). Post bariatric bleeding is either acute or chronic. Although this complication is declined now, but still it is important to know because if it is not managed urgently it will lead to serious results. The source of bleeding may be from the staple lines, unexpected injury to the spleen, or to one of the blood vessels around the surgical field. The other source of bleeding may be internal through the GIT and it is presented as hematemesis or melena. Gastrointestinal bleeding in patients underwent bariatric surgery may occur in the esophagus, gastric pouch, new sleeved stomach, the Roux limb just distal to the anastomosis, the remaining of the small intestine. The site of bleeding can be determined and treated mostly by endoscopy but in certain cases may require re-laparoscopy. The aim of this study is to analyze the incidence, types and management of this bleeding. This is a prospective study which has been done in Al-Sadr Teaching Hospital, Basrah, Iraq, from June 2015 to June 2017. The study included 540 case who were subjected to SG, RYGB, MGB and they were analyzed regarding; time of occurrence, postoperative bleeding, types whether intra-peritoneal or intra-luminal and type of approaches for treating this bleeding. In our study we don’t over sewn the staple line and didn't use any buttressing material or synthetic coagulation powder. The total number of patients developed post-operative bleeding were 18 cases out of 540, 12 after sleeve gastrectomy, 3 after mini gastric bypass and 3 after Roux-En-Y. Regarding sleeve gastrectomy; two patients of the required re-laparoscopy and evacuation of hematoma with treating site of bleeding by clipping or suturing according to the condition, three patients required aspiration under ultrasound guide, while the remaining 7 cases were kept only under conservative measures. The 3 patient of the MGB were managed conservatively and the 3 cases of Roux-En-Y were managed either conservatively in 2 cases or by endoscopic intervention in one case. In conclusion, we advise the surgeons to use reinforcement of staple line to decrease incidence of post-operative bleeding. Introduction besity is a major health problem worldwide that leads to increased incidence of morbidity and mortality. People are generally regarded obese when their body mass index (BMI) exceeded 30 kg/m, and above the 25kg/m were regarded as overweight. Obesity is a risk factor of many diseases like cardiovascular diseases, diabetes, sleep apnea, osteoarthritis, depression, and rarely cancer. Life style modification such as change in diet quality and exercise can control obesity. If diet modification, exercise, and medication failed to control morbid obesity, a gastric balloon or surgery should be considered to solve the problem. The choice of procedure depends on BMI, food habit, c","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43540779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.33762/bsurg.2018.160114
M. A, H. A, Adnan Mrad A, Taghrid Chaaban A
Spinal dural arteriovenous fistulas (SDAVFs) are rare acquired vascular malformations of the spinal cord which if not treated properly, can lead to inevitable severe morbidity with progressive spinal cord symptoms. The management is still at high interest among specialists. If microsurgical treatment is still considered as a treatment of choice for SDAVFs, endovascular treatment is increasingly growing in interest with the development of endovascular techniques and new embolization materials. In this article, a short discussion is made about the spinal dural arteriovenous fistulae in respect to anatomy, etiology, diagnosis and treatment. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications. Introduction ascular malformation of the spinal cord represents rare clinical condition characterized by a difficult diagnosis and complex management. Spinal dural arteriovenous fistulas (SDAVF) are the most common condition in these pathological entities with important clinical implications. These direct communications between radicular artery and medullary vein usually results in myelopathy due to venous hypertension. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. With the advances in neuroimaging, micro neurosurgery and neuro endovascular techniques, the complete treatment of these pathological situations is very feasible with the possibility of complete remission of clinical symptomatology. Endovascular embolization was reported as an effective therapy in the treatment of SDAVFs that can be used as singular and definitive intervention in some particular cases. We present a particular case with SDAVF treated by endovascular embolization and discuss the treatment possibilities to more fully understand the optimal management of these lesions. Vascular Anatomy: Spinal cord vascularization is provided by the anterior spinal artery (ASA) and the paired posterior spinal arteries (PSA). The ASA consists of the junction of two branches originating from the two vertebral arteries proximal to the vertebra basilar junction. On its path, it receives contributions from branches of vertebral and ascending cervical arteries in the cervical region as well as from intercostal and lumbar arteries at the corresponding levels. The spinal meningeal arteries are branches of the segmental arteries founded at almost every spinal level supplying the dura in the spinal canal. Unlike these, spinal medullary arteries, which exist only at some levels, are implicated in spinal cord vascular perfusion. The artery of Adamkiewicz (great anterior spinal V Bas J Surg, June, 24, 2018 63 Management of spinal dural arteriovenous fistula M El Husseini, H Mouawia, A Mrad & T Chaaban Bas J Surg, June, 24, 2018 64 medullary artery) is the dominant thoracolumbar segmental artery with variable origin from T8 to L1 vertebral segments that
脊髓硬膜动静脉瘘(SDAVFs)是一种罕见的脊髓获得性血管畸形，如果治疗不当，可导致不可避免的严重并发症和进行性脊髓症状。专家们对管理仍有很高的兴趣。如果显微手术治疗仍然被认为是sdavf的治疗选择，随着血管内技术和新型栓塞材料的发展，血管内治疗越来越受到关注。本文就硬脊膜动静脉瘘的解剖、病因、诊断和治疗作一简要讨论。仔细的患者选择，多学科的方法和标准化的手术技术可以导致良好的结果，几乎没有并发症。摘要脊髓血管畸形是一种罕见的临床疾病，诊断困难，治疗复杂。脊髓硬膜动静脉瘘(SDAVF)是这些病理实体中最常见的疾病，具有重要的临床意义。神经根动脉和髓静脉之间的直接交流通常会导致静脉高压引起的脊髓病。由于非侵入性成像方式的非特异性发现，对SDAVF的评估通常很困难。随着神经影像学、神经显微外科和神经血管内技术的进步，这些病理情况的完全治疗是非常可行的，并且有可能使临床症状完全缓解。据报道，血管内栓塞是治疗sdavf的一种有效方法，在某些特殊病例中可作为单一和明确的干预措施。我们提出一个特殊的病例与血管内栓塞治疗的SDAVF和讨论治疗的可能性，以更充分地了解这些病变的最佳管理。血管解剖学:脊髓血管化由脊髓前动脉(ASA)和成对的脊髓后动脉(PSA)提供。ASA由起源于椎基底连接处近端的两个椎动脉的两个分支的连接处组成。在其路径上，它接受颈椎区域的椎动脉和上行颈动脉分支以及相应水平的肋间动脉和腰椎动脉的贡献。脊膜动脉是节段性动脉的分支，几乎在每个脊柱水平处都有，供应椎管中的硬脑膜。与这些不同的是，脊髓髓动脉仅存在于某些水平，与脊髓血管灌注有关。M El Husseini, H Mouawia, A Mrad & T Chaaban Bas J surgery, 2018年6月24日64髓质动脉)是主要的胸腰椎节段动脉，从T8到L1椎段有不同的起源，连接ASA并供应脊髓(图1,2a和b)。脊髓后动脉起源于小脑后下动脉或椎动脉(V3或V4节段)，当它们在脊髓背外侧表面两侧下降时，它们被节段/神经根分支加强。它与它的同伴和脊髓前动脉吻合。图1、2 a和b:脊髓血管解剖图，摘自:j.c asc.黄铜，2015,14(3):248-252病因学、流行病学和病理生理学:脊髓血管畸形的病因尚未明确定义。硬膜内实质畸形出现在年轻的患者人群，被认为是先天性的。然而，脊髓动脉硬膜瘘管常见于老年人，被认为是由于创伤。这些AVF畸形发生在脊髓硬膜动脉附近，形成与静脉循环异常的动静脉交通。SDAVF占脊柱动静脉分流的70%，通常发生在中年男性的胸椎和腰椎。然而，这种疾病似乎没有得到充分的诊断。大多数sdavf是自发发生的，但其中很大一部分不能排除创伤后病因。这种疾病通常影响男性患者(80%的病例)。脊髓静脉高压的病理生理是由于脊膜动脉和脊髓静脉之间的一个或几个小的低流量动静脉分流，通常位于硬脑膜内的椎间孔。SDAVF的逆行静脉引流回路由脊髓髓静脉进入髓周静脉系统，最后进入髓静脉。M . El Husseini, H . Mouawia, A . Mrad和T . Chaaban的脊髓硬脊膜动静脉瘘处理的静脉引流缓慢且扩张，可通过上升或下降的血液反流到达颈椎管或马尾。 由于脊髓静脉在解剖学上并不多，SDAVF的存在通常与硬膜外静脉充血和血栓形成有关。这就解释了为什么SDAVF的低流量动静脉分流术会引起静脉压升高(平均动脉压的74%)，从而导致动静脉梯度降低，节段性脊髓水肿可能发展为充血性缺血和坏死性脊髓病。静脉高压可以通过Adamkiewicz动脉血管造影证实，显示静脉期严重延长。脊髓无瓣静脉系统导致这些静脉“动脉化”，壁增厚和弯曲，有利于脑脊液的尾-颅进展。引流静脉的压力也随动脉压力变化，可能导致症状加重。由于SDAVFs是一种慢流瘘管，出血是一种罕见的临床表现。蛛网膜下腔出血是罕见的，特别是在高颈椎定位。分类:随着时间的推移，许多分类系统在文献中被报道和改变。1971年至2011年间，根据脊髓房室分流的诊断方法和治疗方法的发展，提出了七种主要的分类系统。最常用的是将椎管病变分为savf和savm。savf根据其硬膜外和硬膜内位置进一步细分。由于与脊髓的关系，硬膜内savf分为腹侧或背侧。反过来，根据进食分支的数量和大小，硬膜内腹侧SAVFs进一步分为A、B和C型。硬膜外SAVFs表现为根状动脉分支与硬膜外静脉丛之间的直接连接(图3)。这是一种罕见的实体，其特征是硬膜外静脉扩大，伴髓静脉充血，可能导致脊髓或神经根受压。最近，这些病变被分为;A型(savf同时流入硬膜外静脉丛和髓周静脉丛)和B型(savf仅流入巴氏神经丛)。由于硬膜外静脉丛的扩大，B1型病变压迫硬膜囊，而B2型病变缺乏这种压迫。硬脊膜内背侧SAVFs是最常见的脊髓血管畸形类型，由硬脊膜神经根套的脊髓髓动脉背侧与髓静脉直接连接组成，如图4所示。图4 SAVF:脊髓髓背动脉与髓静脉的连接图3 SAVF:神经根动脉与硬膜外静脉丛的连接[J] .外科学，2018/6/24 [J] . M El Husseini, H Mouawia, A Mrad, T Chaaban静脉高压进展到冠状静脉丛导致静脉阻塞，进行性脊髓病。硬膜内腹侧SAVFs是ASA和冠状静脉丛之间典型的高流量直接瘘管。病变发生于腹侧蛛网膜下腔，根据其大小可进一步分为三种亚型;A型瘘管是一种单血源性病变，血流缓慢，伴有轻度静脉高压。B型瘘管是渐进式高流量病变，有多个小的喂食器。C型瘘管通常是大瘘管，静脉引流明显扩大。临床症状:avf患者年龄一般大于40岁。这些avf在男性中比在女性中更常见。大多数临床报告显示，这些血管病变的临床症状和诊断之间的延迟(12至44个月)，主要是由于非特异性的临床表现。症状通常包括单侧或双侧下肢运动无力，并因剧烈运动而恶化。步态障碍、感觉症状(疼痛、感觉异常、弥漫性或不规则感觉丧失、感觉亢进)和括约肌/膀胱障碍也可见，这通常导致临床医生在考虑sdavf之前考虑或排除许多其他疾病。通常误导，单发或多发神经根病和腰痛遇到，并有助于真正诊断的困难。大小便失禁、性功能障碍和尿潴留在疾病过程的后期出现。症状通常是进行性的，未经治疗的患者在6个月至2年内自然发展为严重恶化。自发恢复尚未见报道，突然恶化已越来越普遍。误诊通常包括退行性脊柱疾病、脊髓肿瘤、神经肌肉疾病、周围血管病变或神经源性跛行。影像学诊断:通常，脊柱MRI是评估脊髓病和诊断sdavf的一线筛查方法。 在2加权序列上，脐带发育
{"title":"MANAGEMENT OF SPINAL DURAL ARTERIOVENOUS FISTULA, A REVIEW WITH ONE CASE REPORT","authors":"M. A, H. A, Adnan Mrad A, Taghrid Chaaban A","doi":"10.33762/bsurg.2018.160114","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160114","url":null,"abstract":"Spinal dural arteriovenous fistulas (SDAVFs) are rare acquired vascular malformations of the spinal cord which if not treated properly, can lead to inevitable severe morbidity with progressive spinal cord symptoms. The management is still at high interest among specialists. If microsurgical treatment is still considered as a treatment of choice for SDAVFs, endovascular treatment is increasingly growing in interest with the development of endovascular techniques and new embolization materials. In this article, a short discussion is made about the spinal dural arteriovenous fistulae in respect to anatomy, etiology, diagnosis and treatment. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications. Introduction ascular malformation of the spinal cord represents rare clinical condition characterized by a difficult diagnosis and complex management. Spinal dural arteriovenous fistulas (SDAVF) are the most common condition in these pathological entities with important clinical implications. These direct communications between radicular artery and medullary vein usually results in myelopathy due to venous hypertension. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. With the advances in neuroimaging, micro neurosurgery and neuro endovascular techniques, the complete treatment of these pathological situations is very feasible with the possibility of complete remission of clinical symptomatology. Endovascular embolization was reported as an effective therapy in the treatment of SDAVFs that can be used as singular and definitive intervention in some particular cases. We present a particular case with SDAVF treated by endovascular embolization and discuss the treatment possibilities to more fully understand the optimal management of these lesions. Vascular Anatomy: Spinal cord vascularization is provided by the anterior spinal artery (ASA) and the paired posterior spinal arteries (PSA). The ASA consists of the junction of two branches originating from the two vertebral arteries proximal to the vertebra basilar junction. On its path, it receives contributions from branches of vertebral and ascending cervical arteries in the cervical region as well as from intercostal and lumbar arteries at the corresponding levels. The spinal meningeal arteries are branches of the segmental arteries founded at almost every spinal level supplying the dura in the spinal canal. Unlike these, spinal medullary arteries, which exist only at some levels, are implicated in spinal cord vascular perfusion. The artery of Adamkiewicz (great anterior spinal V Bas J Surg, June, 24, 2018 63 Management of spinal dural arteriovenous fistula M El Husseini, H Mouawia, A Mrad & T Chaaban Bas J Surg, June, 24, 2018 64 medullary artery) is the dominant thoracolumbar segmental artery with variable origin from T8 to L1 vertebral segments that ","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69678359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.33762/bsurg.2018.160106
A. A, Husam Haider Salman A, Jaafar Muhsen Khalaf A
{"title":"EVALUATION OF HEARING IN PATIENTS WITH BETA THALASSEMIA MAJOR","authors":"A. A, Husam Haider Salman A, Jaafar Muhsen Khalaf A","doi":"10.33762/bsurg.2018.160106","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160106","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69678257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.33762/bsurg.2018.160105
Falih Waheed Hashim A
{"title":"OPEN REDUCTION AND INTERNAL FIXATION WITH CORTICOCANCELLOUS BONE GRAFT FOR TREATMENT OF VOLARY MALUNITED FRACTURE OF DISTAL RADIUS","authors":"Falih Waheed Hashim A","doi":"10.33762/bsurg.2018.160105","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160105","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48807181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.33762/bsurg.2018.160113
A. A
{"title":"COMPARISON BETWEEN SINGLE DRAIN VERSUS TWO DRAINS IN THE PREVENTION OF POSTMASTECTOMY SEROMA","authors":"A. A","doi":"10.33762/bsurg.2018.160113","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160113","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69678316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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