Basrah Journal of Surgery

There is a wide range for the cost of ligating the base of the appendix. In this editorial we provide the several available options and suggest using a cost effective method as part of financial stewardship to contain the cost ofsurgeical care.

The function of the appendix and the role it plays in the human body remain a mystery. Recent data have shown a contradicting evidence. On the one hand, removing the appendix lowers the risk for contracting ulcerative colitis, while on the other, it increases the risk for contracting Crohn's disease. We wonder if this would have any bearing on the way we manage acute appendicitis.

Background :Neurosurgery is associated with high incidence of post operative nausea and vomiting. 5HT3
Antagonists are highly specific for the treatment of nausea and vomiting. They are preferred antiemetic
agents in neurosurgical patients due to lack of sedation and extrapyramidal reactions. The aim of the study
is to compare the effect of ondansetron, granisetron and palonosetron on postoperative nausea and vomiting
in patients undergoing elective neurosurgical procedure under general anaesthesia.

Gallbladder cancer (GBC) is an aggressive malignancy with an extremely poor prognosis. It is the most common cancer of the biliary tree. The early symptoms of gallbladder carcinoma are generally nonspecific and often mimic those of more common calculous biliary diseases. As a result, most cases are diagnosed at an advanced stage, leading to a dismal prognosis, with a five-year survival rate of less than 5%.Materials & MethodsThis prospective observational study focuses on the epidemiology and clinical profile of patients diagnosed with gallbladder carcinoma who presented to the Department of Surgery at BPKIHS, Dharan, over a one-year period from September 2017 to September 2018. A total of 30 patients with either diagnosed or incidental gallbladder carcinoma were included in the study.ResultsMost patients (n=26, 86.6%) presented within six months of symptom onset. The median duration of illness was 2±5.89 months, ranging from 0.5 to 24 months. Transabdominal ultrasonography detected the disease in 26 (86.6%) of the 30 cases, with the most commonly affected sites being the fundus and body (76.9%).Among 14 cases deemed resectable based on CT imaging, intraoperative findings revealed that seven (50%) were unresectable—three due to metastasis and four due to locally advanced disease with hilar infiltration. Ultimately, seven patients underwent radical resection with curative intent.ConclusionThis study highlights that gallbladder carcinoma predominantly affects middle-aged individuals, with a higher prevalence among females. The majority of cases are diagnosed at an advanced, often unresectable stage, underscoring the poor prognosis associated with the disease.

Introduction: Bladder trabeculation is a morphological marker of detrusor hypertrophy, hypothesized to correlate with bladder outlet obstruction (BOO). This study investigates the prevalence, severity, and clinical implications of BOO in patients with and without LUTS.Methods: A prospective observational study included 96 patients divided into Group 1 (Patient presenting for treatment of BOO symptoms) (BOO, n = 44) and Group 2 (Patient presenting for treatment of some other urological conditions) (non-BOO, n = 52). Trabeculation was graded via urethro-cystoscopy (Grade 0–3). Follow-up revealed previously unreported BOO symptoms in Group 2 patients with trabeculation.Results: Trabeculation prevalence was significantly higher in Group 1 (70.5% vs. 25.0%, p < 0.001). BOO patients exhibited 7.2-fold higher odds of trabeculation (95% CI: 2.98–17.32). On follow-up, all patients who were initially in Group 2 (non-BOO) with trabeculation (13/13) reported BOO/LUTS symptoms, suggesting underdiagnosis. Severe trabeculation (Grade 3) remained exclusive to Group 1.Conclusion: By this study, we re-confirm that bladder trabeculation strongly associates with Bladder outlet obstruction. Incidental trabeculation in asymptomatic patients may indicate an undiagnosed Bladder Outlet Obstruction, warranting thorough clinical evaluation.

Introduction: The diagnosis and management of cT3a renal cell carcinoma with perirenal fat invasion (cT3a-PFI) remain complex due to the lack of standardized imaging protocols and the ambiguity in surgical decision-making. The aim of this review is to analyze this management approach primarily through European and French guidelines.Methods: A literature search was conducted using PubMed, with keywords including "Renal cell carcinoma," "cT3a," "pT3a," and "perirenal fat invasion." Studies published in English between 2000 and 2024 were included. After screening, 42 articles were selected based on relevance, study design, and level of evidence.Results: Studies report better recurrence-free survival (RFS) and cancer-specific survival (CSS) for cT3a-PFI compared to sinus or vascular invasion. However, preoperative diagnosis remains challenging, with imaging features such as tumor contour irregularity showing low specificity for tumors >4 cm. Partial nephrectomy (PN) offers comparable oncological outcomes to radical nephrectomy (RN) for tumors ≤7 cm, while RN is preferred for larger tumors due to technical complexity and risk of positive margins. The favorable prognosis of cT3a-PFI ≤4 cm suggests these tumors may warrant reclassification within the TNM staging system.Discussion: The retrospective nature of most studies introduces selection bias, limiting the robustness of findings. Despite advancements, the lack of standardized diagnostic criteria remains a major barrier. Future research should refine surgical guidelines and explore advanced techniques such as radiomics and artificial intelligence.Conclusion: An individualized surgical approach tailored to tumor size and technical feasibility remains key to optimizing outcomes in cT3a-PFI RCC. Prospective studies are needed to address limitations and improve management.

Background: Tracheal intubation remains a cornerstone of airway management. Nasotracheal
intubation (NTI) offers specific advantages, including reduced need for neck extension, making
it particularly useful in patients with cervical spine instability or limited mouth opening. To
guide the endotracheal tube (ETT) into the trachea, Magill forceps or gradual cuff inflation
may be used. While Magill forceps are effective, they carry risks of mucosal trauma and cuff
damage and require adequate mouth-opening
.Objective: To compare the performance of video-assisted NTI using Magill forceps versus the
cuff inflation technique in terms of intubation time, number of attempts, and complications
Patients and Methods: This prospective, randomized study was conducted in the intensive care
unit of a tertiary hospital. Fifty adult patients requiring NTI were allocated into two equal
groups (n=25): one undergoing intubation with Magill forceps, the other using the cuff inflation
technique. All procedures were performed under video laryngoscope guidance.
Results: Smooth intubation was achieved in 64% of the Magill group and 48% of the cuff
inflation group. Absolute failure occurred in one Magill case and two inflation cases. Bleeding
occurred equally in both groups (12%). A second intubation attempt was required in 24% of
the Magill group and 32% of the cuff inflation group. Cuff damage occurred in three cases in
the Magill group but was not observed in the inflation group. No statistically significant
differences were found between groups in primary outcomes (p > 0.05). One patient
experienced transient hypoxemia (SpO₂ <92%) and was managed with oral intubation. No
serious complications were recorded.
Conclusion: Both techniques are feasible and safe when combined. The cuff inflation method
offers advantages in patients with limited mouth opening and reduces the risk of ETT cuff
damage. However, tip misdirection during inflation can occur and may require additional
manipulation

Background: Pulsed radiofrequency is an interventional pain management technique that has been successful in treating radicular pain brought on by nerve damage, trigeminal neuralgia, and thoracic postherpetic neuralgia.Aim of the study: To examine both the therapeutic benefits and potential risks of pulse radiofrequency in the management of pain and paresthesia in patients with diabetes mellitus.Patients and method: A clinical therapeutic trial study was done in Baghdad, Iraq between April 1 and October 1, 2024. A convenient sample of 80 patients who had diabetic neuropathy were enrolled. The intervention included pulse radiofrequency for two sessions at three months intervals.Results: The proportion of patients with severe paresthesia significantly decreased after the first session (P-value=0.006). Then, it significantly decreased after the second session compared to the first session (P-value=0.029). There was an improvement in the pain as estimated by the VAS score after the first session and after the second session compared to the first session (P-value= were 0.003 and 0.004, respectively).Conclusion: About 50–70% of the patients had pain reduction with improved mobility and reduced medication dependence. It is recommended to repeat pulsed radiofrequency if pain returns (every 3–6 months if needed).

Background:The neurotoxic snakes, cobra and krait, are most commonly found in the northern
India. The incidence of snake bites increases drastically in the rainy months of July to September.
Respiratory paralysis is the most common cause of mortality in snake bite venomation. It can be
preventable by timely arrival at the hospital and timely administration of anti snake venom.
Material and methods
All the snake bite victims, 18 years and above, who presented in the medicine emergency with
neurological signs and symptoms in the time period June 2023- may 2024 were screened by the
researcher and data of those patients who were subsequently shifted in the ICU after management
in the medicine emergency was recorded and further analysed for demographic, snake bite
characteristics, hospital stay and ASV administration.
Results
Thirty patients (21.4%) met the inclusion criteria with the complete records and were included for
the final study. 86.66% patients presented in the early morning hours between 12 am to 6 am
Eighteen patients were male and twelve patients were female, with 56% patients in the age group
ranging from 25-50 years. 80% of the patients presented in the monsoon months of July and
August. Association between time taken to reach hospital and duration of mechanical ventilation
and time to complete resolution of symptoms was noted and it was found to be highly significant
(p<0.05)