Basrah Journal of Surgery

During COVID- 19 era, our routine practice as surgeons has been affected and there is a persistent
need to be modified and this leads different surgical societies to make their recommendations and
guidelines to overcome this challenging situation.

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon
(rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different
procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is
considered the most popular one, and there are multiple variations in this procedure to get high success rate and
decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal
flaps in TIP urethroplasty.
This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal
hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of
double flaps in preventing possible complications in particular, urethral fistula.
A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020.
A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP
urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from
private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap
& (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally
3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative
time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for
group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF)
was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I
and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans
dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups
in the occurrence of UF (P = 0.001).
According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and
meatal stenosis are higher in group II than group I but they were statistically insignificant

This study is to compare the two options of treating urethral stricture; the cold knife and the LASER. The prospective study conducted in the Department of urology of Basrah Teaching Hospital. Patients were divided in two
groups, all patients had urethral strictures one group treated with optical urethrotomy and the second group treated
with laser urethrotomy. Patients were evaluated both pre and post operatively for flow rate and for symptoms and
complications. The number of patients studied was 30, divided in to 15 in each group (cold knife and laser). The
mean peak flow rate in laser group was (12.9 ml/min), and the cold knife group was (15.4 ml/min) after 14 days
post operatively. Both cold knife and laser urethrotomy improves the peak flow rate significantly two weeks after
surgery but the improvement was more noticed in the cold knife group. Bleeding was more (against our expectations), while infection was less, and the operative time was more in the laser group. In conclusion, the cold knife
treatment for urethal stricture is more effective with less complications than laser treatment

This is to evaluate the efficacy & safety of a modified ejaculation preservation Transurethral Resection of Prostate
( epTURP ) , in comparison with the traditional technique - Transurethral Resection of Prostate ( TURP ) .
A prospective controlled clinical interventional study whereby 40 Iraqi male patients scheduled for TURP were
randomly assigned into 2 groups; group 1 treated with epTURP, and group 2 treated with TURP.
Pre & post-operative evaluation of the patients included history taking, filling the international prostate symptom
score ( IPSS ), the international index for erectile function ( IIEF – 15); questions 9,10,13 & 14, measurement of
ejaculate volume, Uroflowmetry (Q-max) & measurement of Post Voiding Residual urine (PVR). Follow up schedule
was at 6 weeks & 3 months post-operatively. The Mean age of patients was 59 year, mean prostate volume was
46 ml. Post-operatively 19/22 patients in the epTURP group & 3/18 patients in the TURP group had preserved their
antegrade ejaculation, which led to a significant difference between the 2 groups in mean ejaculate volume & IIEF
.There was a comparable improvement in post-operative values of IPSS, Q-max & PVR in both groups. Complications were minimal & manageable in both groups.
In Conclusion The epTURP was in our experience a safe & effective technique in preserving antegrade ejaculation
& improving urinary outflow in patients with prostate volume approaches 50 ml .

Anterior cruciate ligament (ACL) injury is a common injury among sport men. Currently the arthroscopic reconstruction is the gold standard treatment in majority of cases. There are different ways to do the surgery, different
approaches and different grafts. Each has its advantages and draw backs. The autologous four strands hamstring
graft is a widely used graft. A new method of using six strands graft is now used to strengthen the graft.
This study is to compare the clinical outcomes of the patients underwent a six strand autologous hamstring graft
ACL reconstruction and those done with four strands graft. It`s retrospective and prospective comparative study
carried out in Basrah Teaching Hospital. Started at January 2015. Twenty one patients with six strands graft included prospectively and 35 patients with four strands included retrospectively from previous study. All patients were
subjected to the same procedure by the same surgeon. The patients are assessed preoperatively by stability tests
and Tegner Lysholm score,then followed up after 6 months and after one year by the same tests and Tegner Lysholm score. Twenty one male patients with six strands graft have age ranging from 20 to 35 years (mean 26.1±3.9).
A thirty five patients with four strands were included, their age were (24.6±2) years. In the six strands group (71.6%)
were sport men versus (82.8%) in the four strands group. The six strands graft size ranged 8-11 mm with mean
(9.9±0.8)mm, while the four strands graft size ranged 7-9.5 mm with mean (8.5mm). After one year the results
was instability (9.5%) of the six strands group versus (25.8%) in the four strands group. The mean post- operative
Tegner Lysholm score in six strands group was (92.9±6) with excellent in (85%) while it was excellent in (22.8%) of
the four strands group, although the mean Lysholm score not mentioned in the previous study.
In conclusions, the six strands autologous hamstring graft is an alternative method for ACL reconstruction particularly when the four strands graft cannot provide sufficient size.

Long bone fractures are witnessed almost every day in the orthopedic practice. Femoral shaft fractures (FSF)
generally are due to high energy trauma in working age group patients. Variety of fracture patterns are encountered with different treatment choices are available, however, non-union of FSF is not infrequently encountered
challenge. This study reviews cases of FSF that ends up with non-union in Basrah Teaching Hospital in an attempt
to explore some factors associated or probably led to non-union.
This is a retrospective case series study were conducted in Basrah Teaching Hospital from January 2012 to June
2014 including 124 patient with FSF. Thirty three patients were identified during the study period (18 months),
demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate
of the patients are described.
Among 33 patients with nonunion FSF, 23 were males and 10 females, aged from 15 to 60 years (mean = 35),
10 (31%) were active smokers during the period of treatment. High energy trauma is the chief source of FSF in
this analysis ,27(82%), middle third fracture is the commonest site 20(60%), although 17(52%) was initially closed
fracture , 16(48%) open fracture and 14/33 (42%) comminuted fracture.
All patients with closed fractures as well as 4 patients with compound fractures had been treated by open reduction with internal fixation, and other patients treated by external fixation. The most commonly documented complication was the development of surgical site infection in 13 (39%) patients. After the elapse of 9 - 12 months from the
time of initial trauma, the patients ends up with a diagnosis of non-union, 9(27%) patients developed atrophic nonunion, 13(39%) patients developed hypertrophic non-union and 11 (33%) patient developed infected non-union.
Thirty patients underwent revision surgery, with addition of bone graft in most of the instances, and three patients
no revision surgery, several types of bone grafts had been utilized during the revision surgery in 28 patients (out
of 30) , within the study period ( 18 months ), 25(75%) patients achieved successful union or showing signs of
progressive union , 3 (10%) patients had united fractures with chronic osteomyelitis , while 5(15%) patients still
with non-united fractures .
In conclusion; the nonunion of FSF is still a great challenge to the orthopaedic surgeon and unlimited obstacle to
the patient life and development, therefore from 124 who sustained fracture femur thirty three developed nonunion
and after numerous sessions of medical and surgical interventions only five patients still non united fracture, thus
to overcome this problem both the surgeon and the patient should cooperate to avoid this tragedy story.

Quality of life issues are increasingly being recognized as critical in the spectrum of cancer treatment that the
prolongation of survival cannot be the only therapeutic objective. In some cases, patients and physicians may have
to choose between the prospects of longer survival or better quality of life during the remaining time.
This is a cross sectional study carried out to measure health-related quality of life in 275 women with breast cancer attending Al-Basrah oncology center during six months period, data were collected through direct interview using the standard European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire
(EORTC-C30) and its complementary questionnaire specific for breast cancer (QLQ -BR -23).
The study showed that the mean score for global QoLwas52.39 ±17.1 indicating that the patients had average
scale score. The most important predictors of global QoL were physical, role, cognitive and sexual functions in addition to future perspective and arm symptoms.
In conclusion the most important determinants predicting global QOL were role, physical, cognitive and sexual
functions in addition to future perspective and arm symptoms

Tubeless percutaneous nephrolithotomy (PCNL) is the non-placement of a nephrostomy tube at the end of the
procedure. The benefits of a nephrostomy tube placement are numerous as it provides adequate renal drainage.
It may also tamponade bleeding and allow for an easier second-look nephroscopy. However, majority of authors
consider the nephrostomy tube as a source of morbidity. Tubeless PCNL is an effective and safe procedure for
treatment of renal stones in selected cases. This procedure can even be chosen for patients with previous renal
surgery, and hemorrhagic tendency. By using this method, less postoperative pain and a shorter hospital stay can
be achieved, when compared with conventional PCNL.
This study is to prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy
(PCNL) Vs standard PCNL. A 220 patients undergoing PCNL were randomized into two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with
nephrostomy tube placement postoperatively with 110 patients in each group. Inclusion criteria were a stone size
more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter <25mm and
minimal bleeding at completion. The two groups were comparable in age and sex, operative time, access tract,
stone size, stone disease in the opposite kidney and ureter, preoperative creatinine and associated comorbidities
were recorded. Patients were followed up in the post-op period with a drop in Hb, need for blood transfusion, need
for analgesia, hospital stay, complications and need for the ancillary procedure.
There was no significant difference between the two groups for patient demographics and stone characteristics.
There was no statistically significant difference between the two groups for the complications, stone clearance,
need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean
postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the
tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively. Inconclusion, Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower),
in patients with bilateral disease and effective procedure if done in a selected group of patients.

Tympanometry is an objective test measure the mobility (compliance) of the tympanic membrane as a function
of applied air pressure in external canal, It is particularly useful in assessing the secretory otitis media during childhood. This is a prospective study performed at ENT department of the Basrah Teaching Hospital for the period
from November / 2013 to February / 2014. The study is to assess the advantage of tympanometry as a diagnostic
tool and to audit the uses of tympanometry in the ear diseases in ENT department of Basrah Teaching Hospital.
The statistical calculations were carried out using chi-square test. The p value >0.05 was considered statistically
insignificant. Fifty patients aged (4—84years) who were referred by otolaryngologist to our audiological unit for
audiological assessment were included in the study. Out of these 50 patients (55 ears had otitis media with effusion, 12 ears had Eustachian tube dysfunction, 4 ears had barotraumas, 7 ears had acute otitis media, 4 ears had
chronic suppurative otitis media, 2 ears had otosclerosis and 15 ears were normal on clinical examination). The
clinical diagnoses was compared with tympanometric findings and the coincidence between two, was as follow;
80% in otitis media with effusion, 75% in barotraumas , 100% in acute otitis media.
In conclusion; tympanometry is an important tool in the diagnosis of some of the ear diseases. It is not necessary
to performed in every case as the clinical examination could clarify the diagnosis in most cases