Basrah Journal of Surgery

Kidney transplant considered as alternative treatment in end-stage renal disease. Human leukocyte antigens an important role in graft rejection, donor specific HLA antibodies that measured by panel reactive antibody, lead to increased sensitization. Cytomegalovirus, Epstein-Barr virus, Hepatitis-B, and -C viruses have an association with poor outcome of the transplant. Aim of the study the immunological investigations done before the transplant. The study have carried out in College of Medicine by analyzing the data records for 36 patients undergo kidney transplant in Al-Sadder Teaching Hospital, 5 patients excluded for incomplete data. Data recorded during (2012-2017). HLA matching between recipients and donors including HLA-A, -B, -DR and -DRB1. Presence of PRAs, Hepatitis B virus surface antigen, Hepatitis C virus antibody, Cytomegalovirus IgM and IgG, Epstein-Barr virus IgM and IgG screened in recipients. Out of 31 recipients, 83.9% of were males and 16.1% females. 77.4% of donors and recipients were relatives and 22.6% were not relatives. 22.6% of donors and 25.8% of recipients tested for HLA and only 57.14% showed partially matching within some HLA classes. 9.7% of recipients have PRA. No recipient showed positive results for the presence of HBV sAg and HCV Ab. 6.5% of recipients have CMV IgM, 67.7% have CMV IgG, 9.7% showed positive results for the presence of EBV IgM and 6.5% have EBV IgG. In a conclusion, recipients and donors showed partially matched HLA classes, not all recipients and donors tested for HLA matching. Some recipients have PRA, high percentage of recipients has CMV IgG, and some of them have CMV IgM antibodies. All these factors might effects on the fate of transplant. HLA-DQ have to be tested and screening for the presence of PRA, viral Ag or Abs specific to these viruses in both recipients and donors is recommended.

Abstract Background: One of the most prevalent conditions that affects teeth, periodontitis causes the surrounding and supporting tooth structure to be destroyed. Procalcitonin may be a helpful marker to determine the severity of infection, forecast the prognosis, and track the effectiveness of treatment. Aim of the study: To assess the association between the salivary procalcitonin level and periodontal bacterial infections in diabetic individuals and contrasting it with non-diabetic people. Patient and method: A case control study conducted at the department of periodontics during a period from February to April 2022. It included 70 subjects divided into four groups according to periodontitis and diabetes. Five ml of salivary sample was taken from each participant for the quantitative determination of salivary procalcitonin. Result: In this study, mean of salivary procalcitonin was significantly higher in GP + T2DM group than that in other groups. It was significantly lower in controls than that in other groups and significantly lower in T2DM group than that in GP + T2DM group. There were significant positive correlations between salivary procalcitonin and all of bleeding on probing, probing pocket depth, and clinical attachment loss. Conclusion: An elevated salivary procalcitonin level has been proposed as a possible biomarker for periodontal disorders because it plays a role in periodontal inflammation. Additionally, subclinical, low grade chronic inflammation in diabetes individuals may be mediated by salivary procalcitonin, a possible proinflammatory mediator.

Aim of the Study:
Using anterior segment optical coherence tomography (AS-OCT) to compare the depth of corneal demarcation line (DL) after corneal collagen cross-linking (CXL) with subtotal versus customized corneal epithelium debridement.
Design:
Prospective multi centric case-control study.
Materials and Methods:
The study enrolled 18 patients with bilateral progressive keratoconus. Both eyes treated by CXL using 3 mW/cm2 / 30 minutes setting. One eye with subtotal epithelial debridement ( about 9 mm diameter) and the contralateral eye with customized debridement ( approximately 1 mm single horizontal scratch ). One month postoperatively, patients had AS-OCT imaging to detect and measure the depth of DL.
Results:
Patients’ age mean was 25.17 years +/- 4.81 SD . Epithelial healing completed with in 3-7 days in conventional treatment group and demarcation line was evident in 16 eyes ( 89% ) with a mean depth of 290.31 micro m while in customized epi-off treatment group, the epithelial healing lasted less than 24 hours and DL was detectable in 10 patients ( 55.5 % ) with a mean DL depth of 221 micro m with a statistically significant difference ( p < 0.05 )
Subjective postoperative pain graded as “moderate to severe” in about 77% of eyes underwent 9 mm epi-off CXL compared with 55% of those with customized treatment.

INTRODUCTION: Acute appendicitis is one of the commonest causes of acute abdomen encountered in surgical practice, requiring emergency surgery. Open appendicectomy by Grid Iron incision had been gold standard for many years. Laparoscopic technique provided an opportunity to explore new method of management of the suspected cases of the acute appendicitis.
AIMS & OBJECTIVES: To compare laparoscopic and open appendicectomy in terms of intra-operative duration, complication of surgery and post operative outcome.
MATERIALS AND METHODS: A total of 50 patients with clinical diagnosis of appendicitis were studied. After pre-operative work up, patients were randomly assigned for laparoscopic appendicectomy or open appendicectomy. All cases were observed in the intra- and post-operative period till they were discharged and then later followed up for a period of 4 weeks in the outpatient department.
OBSERVATIONS AND RESULTS: A total of 25 patients assigned for laparoscopic appendectomy and 25 patients assigned for open appendectomy were analysed. Majority of patients were male in 3rd or 4th decade of life and had acute appendicitis. There was statistically significant difference of duration of surgery, post-operative pain, duration of hospital stay and return to work in both the groups. There was statistically insignificant difference of post-operative complication in both the groups.

CONCLUSION: laparoscopic appendectomy is better than open appendectomy in a properly prepared and selected patient in terms of Duration of surgery, Post operative pain & need of analgesic, Post operative complications like wound infection, Duration of the postoperative hospital stay and Time period to return to work.

BACKGROUND: Laparoscopic cholecystectomy has become the treatment of choice for cholelithiasis. Some reliable factors are needed to predict difficulties during laparoscopic cholecystectomy. So, our aim was to study various preoperative ultrasonographic parameters which may predict difficulties in performing laparoscopic cholecystectomy. METHOD: One twenty five patients of cholelithiasis admitted for elective laparoscopic cholecystectomy were studied. Preoperative ultrasonographic parameters such as gall bladder(GB) wall thickness, transverse diameter of GB, pericholecystic fluid collection, gall stone mobility, number of stones & size of largest stone, common bile duct(CBD) diameter and emphysematous cholecystitis were given a score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated with the difficulties faced during laparoscopic cholecystectomy. RESULT: Out of 125 cases, 42(33.6%) cases were found to be difficult during laparoscopic cholecystectomy and 6 cases (4.8%) required conversion to open cholecystectomy. GB wall thickness (p value= 0.00001), transverse diameter of GB (p value= 0.001), pericholecystic fluid collection (p value= 0.00001), dilated CBD (p value=0.007), size of stone (p value= 0.007) found to be statistically significant in predicting difficulties during laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the chances of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy. CONCLUSION: Pre operative ultrasonography in the form of a formulated score is a good predictor of difficulties during laparoscopic cholecystectomy.

Groin hernias are the commonest abdominal wall hernias; these hernias are known to develop various complications. Strangulation is a serious and life-threatening complication. Various surgical procedures like primary tissue repair, mesh repair, keep open with secondary repair, etc. are in practice for strangulated groin hernias. Post-operative infection and recurrence are the main concerns with these procedures. The aim of conducting this study was to compare the outcomes of the mesh hernioplasty with Desarda’s purely tissue hernioplasty in the treatment of strangulated inguinal hernia. A total of one hundred and twenty-four patients were included in the study. These patients were grouped into group A (mesh hernioplasty group) and group B (Desarda’s tissue repair group) and randomization was done. Results of these two techniques were compared with respect to post-operative seroma, surgical site infection, recurrence, and chronic pain. Seroma formation was more in group A, which accounts for 35.48%(22) of patients than in group B patients accounts for 19.35%(12). Operative site infection was more in group A, which accounts for 35.48%(22) patients than in group B 9.67%(6) patients. Recurrence was more in Group A patients which accounts for 22.58%(14) than in Group B patients which accounts for 3.22%(2). More patients account for 19.35%(12) in group A experienced chronic pain than the patients 1.61%(1) in Group B. The current study showed that Desarda’s technique is a safe, effective, and single-sitting technique with a significantly reduced risk of seroma, surgical site infection, chronic pain, and recurrence than mesh hernioplasty for strangulated inguinal hernia

The major problem following bowel anastomoses is the anastomotic failure leading to leakage peritonitis, fistula,
abscess, sepsis, necrosis, stricture etc. adding to the morbidity and mortality. (e.g., 22% mortality in patients with
a leak vs. 7.2% mortality in those without leak).The present study compares the complication rates of sutured and
stapled anastomotic techniques in an emergency setting of a tertiary care institute in Kerala.
The study evaluates the complications (leak /intra-abdominal abscess) of both stapled and hand-sewn techniques
of intestinal anastomosis in emergency setting. The study is conducted in a tertiary care centre in Kerala and the
data is collected from the medical records and emergency register. A total of 112 cases that meet the inclusion and
exclusion criteria are included during the period from 2017 to 2021
Among the 61 patients who had undergone hand sewn anastomosis 7 (11.5%) had anastomotic leak and 54
(88.5%) patients had no leak. Among the 51 patients underwent stapled anastomosis, 6 (11.8%) had anastomotic
leak and 45 (88.2%) patients developed no leak. This data is statistically analyzed using Chi Squared test and
found that there is no significant difference between the occurrence of anastomotic leak between the two study
groups irrespective of whether the anastomosis is hand sewn or stapled.
The average time taken for surgery in the hand sewn group is about 192.1 minutes and in stapled group is 162.5
minutes. This difference in the average duration of surgery is analyzed statistically and it showed that the difference
in of the duration of surgery is statistically significant.
In conclusion; there is no significant difference between the complication rates of both type of anastomosis is identified in the emergency setting. But there is a clear advantage of less operating time for stapled anastomosis..

A three months old female presented with irreducible right groin swelling diagnosed as strangulated inguinal hernia. Doppler sonography confirmed the diagnosis. On exploration the ovary found gangrenous and oophorectomy performed.

ABSTRACT Aims and Objectives: To compare the outcomes of the usage of the negative pressure wound therapy (NPWT) using vacuum assisted wound closure/ Collagen granules/ Offloading techniques with the conventional moist gauze dressing in the treatment of diabetic foot ulcers (DFU). Methods: Prospective, interventional study. Study conducted at B.L.D.E (DU)’s Shri B.M.Patil Medical College Hospital and Research Center, Vijayapur over a period of 5 years. The demographic characteristics, type of foot lesions and treatment with different modalities of dressings and outcome were studied. 50 cases in each group – NPWT/Collagen granules dressing/ offloading techniques and conventional moist gauze dressings were allocated alternatively. Results: 200 patients were included in the study, saw the gradual increase in the granulation tissue development, but the results were better in other groups than the conventional group and the collagen dressing group had more granulation tissue from week 1. There was early recovery among the other groups when compared to the conventional methods. The mean recovery were least in the collagen dressing group. 90% had good outcome in the negative dressing group. The outcome was 92% among the off loading group and 96% good outcome among the collagen group. But the conventional group had only 64% good outcome. And the difference was statistically significant. Conclusion: The comparison of different methods to treat the diabetic foot ulcer showed that collagen method of dressing to be superior to others followed by offloading and then by topical negative pressure dressing. The conventional method had less favorable and slow outcome.