Basrah Journal of Surgery

Robotic and AI technologies are making waves in orthopaedic surgery by enhancing precision in procedures like total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgeries. While these advancements offer improved implant alignment and diagnostics, concerns linger regarding their high costs, steep learning curves for surgeons, and limited long-term evidence surrounding their cost-effectiveness.

Background: Deliberate hypotension to provide bloodless surgical field gives better visibility of the operative field, with reduced risk of injury to adjoining structures. This present study was conducted to compare three loading doses of dexmedetomidine for controlled hypotension in FESS surgery under GA.

Background:
Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are a form of incretin-based therapy that treats
hyperglycemia and, in some situations, cardiovascular risk in persons with type 2 diabetes.
Aim: Is to determine the efficacy and safety of prescribing GLP1-RAs for patients who had suboptimal
initial response or regained weight after bariatric surgery

Background:
Silodosin, a selective α1A-adrenoceptor blocker, improves Lower Urinary Tract Symptoms (LUTS)
in Benign Prostatic Hyperplasia (BPH) by relaxing smooth muscle in the prostate and bladder neck.
Its receptor specificity, however, predisposes patients to ejaculatory dysfunction, particularly
Anejaculation, which may affect compliance. This study aimed to determine the region-specific
incidence and characterize the pattern of ejaculatory changes in Sexually active men receiving
Silodosin 8 mg daily for BPH.
Patients and Methods:
A prospective, questionnaire-based descriptive study was conducted at the Institute of Urology,
Madras Medical College–Rajiv Gandhi Government General Hospital, Chennai ,India, from
December 2023 to May 2024. Sixty-six sexually active men with a clinical diagnosis of BPH, newly
initiated on Silodosin 8 mg once daily, were enrolled. Data on demographic profile, perception of
ejaculatory change, frequency, and type of dysfunction, compliance to treatment were obtained using
a structured questionnaire.

Bleeding into the surgical field is a major issue faced by endoscopic surgeons particularly if it is performed in narrow confines of the nasal cavity. Aim: To determine whether infiltration of a mixture of lidocaine: adrenaline into pterygopalatine fossa has an effect on intraoperative field bleeding during endoscopic nasal surgery. Patients and Methods: A prospective, double blinded study was undertaken to assess 88 patients who had endoscopic nasal surgery indicated for chronic sinusitis with or without nasal polyps and dacryocystorhinostomy. Patients who received injection were selected randomly and the same anaesthetist infiltrated a solution of 2% lidocaine and 1:100,000 adrenaline into pterygopalatine fossa of all patients. All operations were undertaken by the same surgeon who assessed intraoperative bleeding every 15 minutes according to Boezaart and Van der Merwe grading system.

Background Thoracic trauma is a leading cause of morbidity and mortality, second only to head injuries in trauma-related deaths. Blunt injuries, particularly from road traffic accidents (RTAs), are more frequent than penetrating injuries, yet regional epidemiological data remain limited. Objective To evaluate the prevalence, etiology, complications, and management of chest trauma among patients admitted to Shar Teaching Hospital (STH), Sulaimani, Kurdistan Region, Iraq. Methods This cross-sectional study included 152 consecutive chest trauma patients admitted between January and December 2024. Data on demographics, trauma type, etiology, complications, and management were collected using a structured questionnaire. Clinical evaluation included radiological and laboratory investigations, primary and secondary surveys, and emergency protocols. Data were analyzed using SPSS Version 26. Results Males predominated (male-to-female ratio 4.6:1), with a mean age of 34.9 years (range 4–87); young adults (19–30 years) represented 30.9% of cases. RTAs were the most common cause (45%), followed by stab injuries (24%) and falls from height (23%). Blunt trauma accounted for 71.1%, commonly resulting in rib fractures, lung contusions, pneumothorax, and hemothorax. Penetrating trauma comprised 28.9%, most often complicated by hemothorax or hemopneumothorax. Management was conservative in 51.3%, chest tube insertion in 42.8%, and surgical intervention in 5.9% of cases. Conclusion Chest trauma at STH predominantly affects young adult males, with RTAs as the leading cause. Blunt trauma is more frequent, and most patients respond well to non-operative management or tube thoracostomy. Surgical intervention is reserved for severe cases. These findings emphasize the importance of rap

AbstractBackground: Incisional hernias frequently develop after abdominal surgeries, especially in patients with stomas, due to increased intra-abdominal pressure and impaired wound healing.Objective: To assess the safety and efficacy of simultaneous incisional hernia repair during stoma reversal.Methods: Twenty patients undergoing stoma reversal with concurrent primary repair of midline incisional hernias were included. Selection criteria involved the absence of active infection and medical suitability for a one-stage procedure. Postoperative outcomes, including complications and wound healing, were monitored.Results: No anastomotic leaks occurred. Twelve patients recovered uneventfully and were discharged by postoperative day 7. Minor wound discharge was observed in four patients, and localized collections appeared in three, all managed conservatively without fascial dehiscence. One patient developed a small fascial dehiscence, resolved with non-surgical management.Conclusion: Simultaneous stoma reversal and incisional hernia repair is a safe and effective option in appropriately selected patients, with low complication rates and favorable recovery.

Background: Hip fractures are one of the most frequently encountered complaints in both the young and elderly population. USG-guided peripheral nerve blocks help in early surgical fixation by providing perioperative pain relief and early mobilization.
Methods: 60 patients of either sex, ASA 1 to 3, aged 18-65, scheduled to undergo surgery for hip fracture, were randomly allocated into two groups. Group P received a USG-guided PENG block, and Group F received an FIC block.
Results: In the PENG group, 26(86.7%) patients showed grade 1 positioning, 3(10%) patients showed grade 2, and 1 patient showed grade 3 positioning. In the FICB group,11(36.7%) patients showed grade 1 positioning, 17(56.7%) patients showed grade 2, and 2 patients showed grade 3 positioning. Grade 1 (86.7%) was higher in the PENG group, while grade 2 (56.7%) was higher in the FICB group.
Conclusion: PENG block provides better analgesia and better quality of positioning during spinal anaesthesia than FIC block.

Background: EMG assessment has also been applied to study differences between asymptomatic subjects and those suffering from various forms of craniofacial muscle-related dysfunctional symptoms. Aim of Study: To assess application of EMG study of masticatory muscles. Materials and methods: This clinical study included 10 patients, 6 males and 4 females, who were 8 – 62 years old. The mandible has been immobilized for about 5 to 6 weeks. The masseter muscle and anterior fibers of temporalis muscle were chosen as evaluation sites. Results: Thirty-six muscles were taken for EMG analysis, right temporalis (8 muscles, 25%), left temporalis (8 muscles, 25%), right masseter (8 muscles, 25%), left masseter (8 muscles, 25%). Fifty-three percentage of the taken muscles showed positive sharp waves after analysis of the EMG reading. 7 muscles of grade 1, and 10 muscles of grade 2 Fibrillation of taken muscles 16% showed fibrillation potential was seen with grading from 1+ to 4+ Mean MUP duration of temporalis muscles of the examined cases is increased (12.9 ± 6) and the calculated P value is 0.018 (<0.05). Conclusion: MUP onset interval (OI) is a good marker for follow up of muscles in such immobilized cases. Significant decrease in difference of the MUP onset interval (OI) give a picture that the changes occur during period of immobilization are a neuropathic more than myopathic processes. The increase in MUP duration indicates there is increase in number of affected motor units, and this change is of neuropathic. Positive sharp wave and fibrillation potential can be evaluated as indicators of facial musc

Treatment of postoperative pain is one of the concerns of all anesthesiologist since inguinal hernia repair surgery is more done as day case surgery so treatment of postoperative pain is crucial since can reduce hospital stay, improve mobilization and patient satisfaction. Transvers abdomens plane block and ilioiguinal ,iliohypogastric nerves block are two different methods by ultrasound guide required anesthesia used to treat postoperative pain.

ABSTRACTBackground: 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: To evaluate the effectiveness and safety of peripheral nerve stimulation combined with pulse radiofrequency in the management of brachial plexus injury.Patients and method: A clinical therapeutic trial was carried out in Baghdad, Iraq, between the first of April to the first of October 2024. A convenient sample of 50 patients aged 18 years or older with brachial plexus injury was included in the present study. The intervention was done in two sessions at three months intervals and included nerve stimulation, including sensory and motor stimulation, followed by pulse radiofrequency at the same time for the brachial plexus roots.Results: The proportion of patients experiencing sensory impairment significantly declined after the first session (P-value = 0.001) and showed a further significant reduction following the second session compared to the first. According to the electromyography assessment and clinical examination, the proportion of patients with severe motor injury significantly decreased after the first session (P-value<0.01). Then, it significantly decreased after the second session compared to the first session (P-value<0.01). In addition, 32 (64.0%) patients had functional recovery after the second session. An improvement was obtained in the pain after the first session and after the second session compared to the first session (P-value=0.001 for both).Conclusion: Pulsed radiofrequency combined with nerve stimulation offers an effective and safe approach to treating functional disabilities caused by peripheral nerve injuries, including injuries to the brachial plexus. These methods are also effective for managing pain associated with such injuries.Keywords: Pulsed radiofrequency, nerve stimulation, brachial plexus injur

Background: Regional nerve block techniques offer a great degree of postoperative pain relief. Recently, the transabdominal plane (TAP) block has been utilized to put people to sleep for surgery on their abdomen and pelvis.Aim: This study aimed to evaluate the effectiveness of ultrasound-guided TAP block compared to intramuscular tramadol for postoperative pain relief following cesarean section.Patients and method: A comparative clinical trial study was conducted during the period from January 1 to April 30, 2025. The study included 200 patients who underwent elective cesarean section under general anaesthesia. Patients were randomly allocated TAP block group which included 100 patients who received an ultrasound-guided TAP block and tramadol injection group included 100 patients who received intramuscular tramadol. The data included patients registered pain scores at 1, 2, 4, 6, and 8 hours after surgery, the need for a second dose of analgesia, and the incidences of nausea and vomiting.Results: The mean Visual Analogue Scale (VAS) was significantly lower in the TAP block group compared to the tramadol injection group at 1, 2, 4, 6, and 8 hours postoperatively. The incidences of nausea and vomiting were significantly lower in the TAP block group than in the tramadol injection group.Conclusion: The TAP block is more effective than intramuscular tramadol in reducing postoperative pain with fewer side effects. The TAP block is suggested to be used as part of multimodal approaches in the prevention and management of postoperative pain for patients undergoing cesarean section.

Abstract
Background: Neuromodulation alters nerve activity by implanted electrodes that provide regulated electrical pulses, with adjustable parameters including the width, frequency, and amplitude of the pulse.
Aim: To evaluate the efficacy and safety of caudal epidural analgesia compared to peripheral nerve stimulation for alleviation of pain and paresthesia.
Patients and Method: A clinical therapeutic interventional trial study was undertaken between January and December 2024. The study registered 80 patients who were diagnosed with dibatic peripheral neuropathy were enrolled in the current study. Those patients were categorized into two groups: Group A comprised 40 patients receiving caudal epidural stimulation treatment; Group B comprised 40 patients receiving peripheral nerve stimulation treatment.
Results: In both groups, there was a significant number of patients who got sensory improvement after intervention. In both groups, there was significant pain improvement as revealed by the visual analogue scale (P-values were 0.001 for both). After the second session, the patients in group A had a significantly higher improvement in sensation (P-value=0.023), paresthesia (P-value=0.033), and pain (P-value=0.007) than patients in group B.
Conclusion: Both caudal epidural nerve stimulation and peripheral nerve stimulation are safe and active approaches in the treatment of peripheral neuropathy but caudal epidural nerve stimulation is more effective regarding sensory sensation, paresthesia, and pain sensation than peripheral nerve stimulation.