Iranian Journal of Surgery
Year:2013 | Volume:21 | Issue:2|Papers Count:16

The development of PPI and H2-blockers with their feasibility and better understanding of physiopathology and both endoscopic and laparoscopic means of interpreting dyspeptic symptoms and different modalities in diagnosis and treatment of stomach cancer along with the most commonly used treatment protocols has been discussed. The main objective is proper staging of the patient before surgery with endoscopy, and laparoscopy, as well as imaging and if advanced; consider palliative means of treatment rather than curative resection.

Introduction & Objective: Tracheal disruption due to penetrating and blunt trauma is rare. Delayed diagnosis and treatment can lead to major morbidity and even death. The aim of this study was to assess the treatment and its outcome in 10 patients with trachea and larynx disruption.Materials & Methods: We studied 8 cases of tracheal disruption and 2 cases of larynx disruption which, were treated in our department during 8 years (April 2003- March 2011).Eight patients were immediately transferred and treated in our department and 2 were referred from other departments after initial treatments. The first priority for patients with tracheal disruption was to establish and maintain a patent airway to provide sufficient tissue oxygen delivery and then there was assessment of patient condition and acute problems. Surgical procedures were: tracheal resection and anastomosis for tracheal disruption (8 patients) and laryngeal repair for laryngeal injuries (2 patients). Five patients were treated immediately (few hours to 4 days post injury) and others were treated with a delay of 57 to 730 days. Patients were followed up post-operatively for the development of immediate and delayed complications. The average time between the accident and the surgery was 154.6 days (between a few hours to 370 days).Results: The follow up was carried out for a minimum period of 12 months to a maximum period of 84 months. Eight patients had bilateral vocal cord paralysis before operation. After the surgery 2 cases resumed improved vocal cord function, 2 patients sustained unilateral vocal cord paralysis and in 4 patients vocal cords sustained bilateral paralysis but were in paramedian position. All patients were decannulated finally.Conclusions: In spite of vocal cord paralysis in most of patients, tracheal resection and anastomosis, without tracheotomy, was possible in all cases. With proper treatment, it is possible for all patients to be decannulated with patent airway and acceptable voice.

Introduction & Objective: Inguinal hernia is a common disorder which many surgeons face during their practice. Several methods have been used for the repair of inguinal hernia; however, none of these methods has been introduced as the preferred method. In this study, we compared the recurrence and complications of Bassini, Liechtenstein and Bassini with mesh techniques in the repair of inguinal hernias.Materials & Methods: 246 patients who referred to Shohada Hospital for inguinal hernia were included in this prospective analytical study, and were randomly divided into three groups. Bilateral or recurrent hernias were excluded.25 patients were also excluded due to the lack of follow up. Finally 78 patients were operated with Bassini technique, 70 were operated with Bassini with mesh and 73 were operated with Liechtenstein technique. The patients were followed for 12 months for complications and the recurrence of inguinal hernia after surgery. Frequency and percentage for qualitative variables and mean and standard deviation for quantitative variables were calculated. Chi square test, T test and one way Anova were used to analyse our hypotheses. In this study, P<0.05 was considered significant.Results: Postoperative pain in the first 24 hours after surgery did not differ significantly among the three groups; but after 1 month pain was significantly higher in Bassini with mesh group and this difference persisted even 12 months after the surgery. Pain was less in Bassini than Liechtenstein group in the first 3 months after the surgery. However, after 12 months pain became the same in the two groups. hematoma and seroma formation and ischemic orchitis were the same among the three groups. The recurrence rate was similar in all three techniques.Conclusions: Both Bassini and Liechtenstein techniques have similar complications and recurrence rates. However, given the low cost of Bassini technique, this approach may be more appropriate for inguinal hernia repair in less developed countries. Bassini with mesh method is not recommended, because this technique causes more chronic pain and is more expensive, while its recurrence rate is similar to the other two techniques.

Introduction & Objective: Radical prostatectomy is one of the treatments for localized prostate cancer which has some complications such as urinary incontinence and bladder neck stricture. The purpose of this study was to evaluate the prevalence of urinary incontinence and bladder neck stenosis after radical prostatectomy.Materials & Methods: In a retrospective cross-sectional study, 150 prostate cancer patients, who underwent radical prostatectomy by a surgeon in Imam Khomeini Hospital between 2009 and 2012, were included. The patients were evaluated for post urinary incontinence 2 weeks, 3 months, 6 months, and 12 months postoperatively (withdrawal of the catheter). Also, bladder neck stricture was evaluated by requiring dilation of the urethra.Results: The mean age of the patients was 64.93±6.85 years. The rate of incontinency after two weeks, 3, 6, and 12 months was 25.33%, 13.33%, 10%, and 8.67%, respectively. Totally, 22 patients (14.67%) developed bladder neck stricture after a mean time of 3.97±4.55 months. There was no significant difference between bladder neck stricture and age, PSA, Gleason score and surgical grade.Conclusions: Today, radical prostatectomy surgery is the standard treatment for localized prostate cancer and has an acceptable rate of complications and can prevent the spread of disease and is considered the curative treatment of choice for a large number of patients.

Introduction & Objective: The control of external bleeding, despite progresses in surgical science, is still one of the challenges surgeons face in saving patients’ lives. There is a research contest among the researchers in this field to introduce a more effective method. This study attempts to determine the hemostatic effect of ferric sulfate in controlling external bleeding.Materials & Methods: In this clinical trial 60 male Wistar rats were used. A 2-centimeter incision was made on each mouse’s skin and the hemostasis time was measured, using ferric sulfate with different concentrations (5.0%, 10.0%, 15.0%, 25%, and 50%) and the control method (i.e. control of bleeding by suturing). The skin tissue was assessed for pathological changes. Finally, the obtained data were entered into SPSS software and were analyzed by using Kruskal-Wallis test, Mann - Whitney, Kolmogorov -Smirnov test and also Wilcoxon signed ranks test.Results: The hemostasis time of ferric sulfate concentration groups was significantly less than that of the control group (P-value<0.001) and the pathologic examination showed the most frequency of low grade inflammation, based on the defined pathological grading.Conclusions: Ferric sulfate may be an effective hemostatic agent in controlling an external bleeding in mouse.

Introduction & Objective: Wound dehiscence (WD) is a serious complication in abdominal surgeries, which increases mortality and morbidity rates. WD is a multi factorial problem. The aim of this study is exploring the known risk factors of WD complication between cases and control group.Materials & Methods: In this case-control study, 132 cases undergoing surgery’s were investigated during ten years in Alzahra hospital of Rasht city.44 patients with and 88 paients without WD complication were entered in study. Factors such as age, history of cancer, anemia, diabetes mellitus (DM), sepsis, chemotherapy and radiotherapy, steroid therapy and other factors like surgeon type, incision type, type of surgery and its duration were recorded and compared in two groups.Results: Among cases that were studied, 44 were diagnosed with the WD complication and 88 people were selected as control group, and we compared risk factors among these people. Among reocorded data, history of having anemia, DM, emergency operation, increased surgical time and low experience of surgeon was identified as risk factor based on statistical analysis (P<0.05).Conclusions: Controlling and correction of identified risk factors (such as DM or anemia), which can be modifie result in decreasing the incidence of WD post operatively.

Introduction & Objective: Infection after orthopedic surgery is one of the most common complications after surgery that causes increases bed occupancy, the length of stay and the cost of patient.This study was done with aim of "determining the effects of various factors on the incidence of surgical site infection in orthopedic patients of Motahari Hospital in Jahrom during 2011".Materials & Methods: This study is a case control study that sampling method used to was compare in 37 patients with postoperative wound infection in orthopedic surgical site and 37 patients without infection.Both groups were matched for age, gender, surgery site, kind of fracture and the same hospital, where they were referred. Through brain storming, focus groups and fishbone diagram, a questionnaire was prepared in three areas; factors related to patients, hospital and accident. Validity and reliability were calculated and found to be 0.88. For data analysis software, the SPSS 16 was used.Results: The mean age of the patients was 36.36±21.18. Eight patients (81.10%) had an infected patient roommate. Independent t tests and chi square showed that there are significant differences between the two groups in Hematoma at the site of trauma, need for blood after surgery, being in the same hospital before surgery, doing invasive care such as suctioning and tracheal tube, need for a dressing at home, days of stay in hospital before surgery, total dose antibiotic prophylaxis and postoperative antibiotic dose, duration of surgery, duration of hospital stay and frequency of dressing change per day in the hospital (P-value<0.05).Conclusions: Although incidence of postoperative infection depend on the incidence of uncontrollable factors such as patient demographics, risk factors, and injury characteristics but Compliance with care protocols before, during and after surgery, helps to prevent the incidence of even worst possible cases of infection.

Introduction & Objective: Buerger's disease is a chronic inflammatory disease. It is strongly associated with smoking cigarets. Mostly young men (below 40-45 years old) are affected. Based on clinical experience, Iran has a high incidence of Buerger's disease. The aim of this study was to evaluate the clinical manifestations, the clinical course and therapeutic measures taken for these patients.Materials & Methods: In this retrospective study, we evaluated 3125 patients with peripheral arterial disease referred to Shohada Tsajrish Hospital during the last 20 years. The data of these patients were gathered through a direct questioning of the patients.Results: This study included 270 patients with Buerger's disease. The mean age of the patients was 42 years (26-75 years). The mean duration of smoking was 21±0.2 years. The most common clinical manifestations on admission included coldness of extremity (92.2%) color change of extremity (86.2%), necrotic ulcer (63.7%), rest pain (45.5%), intermittent claudication (44.07%) and gangrene (36.2%). Surgical measurements included vascular reconstruction by using saphenous vein (11.8%), sympathectomy (77.03%), and amputation (75.9%).Conclusions: Due to the nature of Buerger's disease that is an inflammatory, segmental and nonatherosclerotic disease and often affects the distal extremity, the vascular reconstruction is rarely possible.Therefore, most of these patients have to undergo sympathectomy and amputation.

Introduction & Objective: One of the chronic diseases which increases the risk of depression is cancer. In many studies, different kinds of cancer have been suggested as critical risk factors for depression.This survey was done in Hamadan with the aim of determining the frequency of depression in and patients with breast cancer, some of the effective factors on it in patients with breast cancer.Materials & Methods: In a prospective study 111 involving patients with breast cancer, who were going to Oncologists' or Surgeons' offices or Department of Oncology in Farshchian Hospital for continuing their treatment or follow up were surveyed. To collect data for depression, Beck Depression Questionnaire was used. Data in questionnaire and forms were analyzed with SPSS software and descriptive statistics and if needed for the evaluation of significance, statistical T-test, non parametric test (Mann Whitney) and chisquare test and even accurate test of Fisher were used.Results: Totally 68 patients (61.3%) were considered depressed (their grade was more than 15). Among 43 patients who were not depressed (their grade was less than 15), 15 patients (34.9%) got a score in the internal 0-10, that is they were not depressed at all. The rest got a score 11-15, which means that they had borderline symptoms for depression. Among 68 depressed patients 23 patients (33.8%) had minor depression, 26 (38.2%) had moderate depression, 16 (23.5%) had severe depression and 3 patients (4.5%) had very severe depression.Conclusions: Considering the results of this study and that the screening of patients with breast cancer for depression, with Beck questionnaire, doesn’t need much time or cost, we suggest that the screening of these patients at different levels of their treatment or follow up be done by timely reference of depressed patients to psychologists for consultation.

Introduction & Objective: An ectopic pregnancy (EP) is a pregnancy which occurs outside of the uterine cavity and more than 98% cases is implanted in the Fallopian tube. EP is still the most common cause of first trimester maternal deaths. The purpose of the present study was to determine the risk factors of ectopic pregnancy in women who referred to Azahra's hospital during 2001-2006.Materials & Methods: In this analytic cross-sectional study, 180 patients with EP who referred to Azahra’s hospital during 2002-2007 were studied in two groups, with and without tubal rupture. The questionnaire was designed by our researchers. Statistical analyses were performed with SPSS.Results: Frequency of ruptured EP was 44.4% (80cases). There was significant difference between the maternal age, Gravid, parity, history of infertility and history of tubal ligation with tubal rupture. However, there were no significant differences between gestational age, abortion, ectopic pregnancy history, history of pelvic or abdominal surgery, history of OCP consumption, intrauterine device usage with tubal rupture.Conclusions: Maternal age, Gravid, parity, history of infertility and tubal ligation history of EP were all significantly associated with the tubal rupture EP; so they should be considered as associated risk factors. It seems that a careful surveillance in women with these factors can help in prevention, earlier diagnosis and less complications of EP.

Despite the development of non-invasive methods of treating stones of urinary tract, surgery is still needed in some cases, indicated. Even in these cases, non invasive surgical procedures, such as laparoscopy, is preferred. In this article we are going to report on the case of a person who underwent laparoscopic management for his proximal ureterolithiasis, and which resulted in a rare complication of this therapeutic procedure; duodenal perforation. The patient is a 49-years old man that a few days after undergoing laparoscopic treatment, referred with acute abdominal symptoms. The laparatomy revealed traumatic duodenal perforation that was repaired. Persistent abdominal pain obligated the performance of an imaging study, which identified a loci of fluid accumulation in the anterior aspect of the right ureter. Trying to resolve the fluid accumulation, a CT-guided pigtail was embedded. Fistulography was performed. The source of fluid accumulation was attributed to the leakage of the repaired duodenum. During the treatment course an enterocutaneous fistula appeared. Duodenal injury is one of the very rare complications of laparoscopic ureterolithotomy, which should be considered in those presenting by acute abdominal pain after a laparoscopic intervention.Therefore due to the difficulty of duodenal injury management, care is neededduring laparoscopic interventions.

Body packing was first described in the medical literature in 1973. However since Sep 11, recognition of body packers has become more in order of tight control in airports and stations.Approach to the body packers has made significant changes in recent 2 decades. Furthermore, because of the new technology of packing, rupture of packs and obstruction become less.Drugs divide in 3 groups: cocaine and amphetamine with fatal toxicity effects without antidotes, opioids which have antidotes and the last group is canabioids which don’t have any fatal toxicity. In all cases with obstruction or peritonitis sign and symptom surgical treatment is suggested. In cases without any signs and symptoms it is better to use laxatives. Surgical managements are recommended for toxic cocaine and amphetamine body packers. Approach to the opioids body packer is to use antidotes. Medical treatment is the best for canabioids body packers. Surgical treatment is recommended in patients with complete bowel obstruction and peritonitis.