Basrah Journal of Surgery

The first time, I saw a Port-à Cath operation, was in 1989. The surgeon did it through the cephalic vein, under local anesthesia. In 1990, I had to do it through the subclavian vein, percutaneously, following the policy of the department, again under local anesthesia. Since 1994, I have been doing this operation, through the cephalic vein. So, I asked myself which technique is better and who should do this operation.

Abstract__________________________________________________________________________________Introduction:Healthcare facilities often face overcrowding and extended waiting times in emergency rooms (ERs). Thisleads to higher patient morbidity and mortality rates and reduces patient satisfaction. Managing patient flowbetween the ER and the Outpatient Department (OPD) at Ibrahim Bin Hamad Obaidullah Hospital (IBHOH)is crucial to addressing these issues. The study analyzes the relationship between ER visits and OPDworkflow from January to June 2024. Seasonal fluctuations, infectious disease outbreaks, and delays in OPDappointments are also considered.Aim:This study explores the connection between ER visits, OPD referrals, and OPD patient volumes at IBHOHover the first half of 2024. The goal is to find trends and correlations and to understand how these factorsaffect hospital operations. Understanding these trends is crucial for efficiently allocating resources,improving patient flow, and enhancing the quality of care at the hospital.Methodology:The study retrospectively reviews hospital records from January to June 2024. Data is segmented by monthand validated against multiple sources to ensure accuracy. The study used SPSS and Python to performstatistical analysis. The trends and correlations are visualized through graphs and charts. To ensure patientconfidentiality, the study will adhere to ethical guidelines using aggregated data without personal identifiers.Conclusion:The study reveals a strong link between ER visits, OPD referrals, and OPD patient volume, suggestingstrategic improvements that can manage ER congestion and improve patient care and flow. To maintainhigh-quality patient care and boost operational efficiency, standardizing referral protocols, adjusting staffingbased on real-time data, and implementing continuous monitoring systems are recommended.

Background: In 2018, Dandin et al. described a new method called the De-epithelialization
technique (DT) for treating patients with pilonidal sinus disease. In our study, we compared
DT to the conventional Limberg flap (LF) procedure. Patients and Methods: The LF and
DT groups each had 20 patients. Patients from the DT group underwent surgery under local
anesthesia and were discharged on the same day. Patients from the LF group were operated
under subarachnoid block and managed as indoor patients. All 40 patients were analyzed for
patients age, sex, weight, body mass index, operative time, and early complications. Results:
The mean age of all patients was 28 years, with a standard deviation of 5.6 years. Moreover,
the mean body mass index was 25.5, with a standard deviation of 3.45. The mean operative
time was significantly shorter for the DT group (45.65 minutes) than for the L.F group (58.5
minutes; p < .001). The DT group had a significantly higher incidence of wound dehiscence
(8/20, 40%) than the LF group did (1/20, 5%; p = .020). Conclusion: Our study determined
that the LF method has a lower complication rate compared to DT, though the latter provides
shorter operative time and hospital stay.

Background:
Sepsis and systemic inflammatory response syndrome continue to be leading causes of death in
critically ill patients. These conditions are characterized by elevated oxidative stress and diminished
levels of antioxidants. Selenium (Se), a micronutrient, plays crucial roles in antioxidation, inflammation
suppression, and immune function, making it pivotal in combating oxidative stress and supporting
overall health in such patients. This study aims to assess the impact of intravenous selenium
supplementation on sequential organ failure assessment score (SOFA) and to investigate selenium's
potential as a biomarker in critically ill patients.
Patients and Methods: Fifty-five critically ill patients received intravenous Se at a dosage of 600
micrograms daily for three consecutive days. Clinical parameters including SOFA score, ICU and
hospital stays, and duration of mechanical ventilation and biochemical parameters such as C-reactive
protein (CRP), Interleukin-6 (IL 6), Se levels, and total leukocyte count (TLC) were assessed before Se
administration and on the fifth day post-administration for analysis.
Results: After administering Se injections, there was a significant increase in serum Se concentrations
from 195.45±64.03 to 295.45±87.81 “p <0.001”. Additionally, a notable decrease in SOFA score was
observed, dropping from 7.21 to 6.41 “p = 0.004”. Furthermore, CRP levels showed a statistically
significant decrease following Se administration.
Conclusions: Our study findings demonstrate significant improvements in SOFA score and CRP levels
among the patients. Se supplementation significantly boosts plasma Se levels, thereby enhancing tissue
Antioxidant Capacity inThese Patients

Background: Blunt abdominal trauma is the third most common cause of death resulting from trauma. The Blunt Trauma Scoring System (BATSS) was developed to diagnose intra-abdominal injuries and identify a select subset of patients for further investigations. This scoring system simplifies triage, reduces unnecessary computed tomography (CT) scans, minimizes radiation exposure, and lowers the costs associated with diagnosis and treatment.Aim: To compare BATSS with Contrast-Enhanced Computed Tomography (CECT) of the abdomen in diagnosing blunt abdominal trauma among adults.Patients and Methods: This descriptive study was conducted on a population of 155 adult patients who presented to the general surgery casualty at Government Medical College, Kozhikode.Results: Among the 155 patients, 89.7% were male. The BATSS and CECT identified intra-abdominal injuries in 90.3% (n=140) of the cases. Notably, all patients with intra-abdominal injury had a BATSS score greater than 8. The sensitivity and specificity of BATSS in diagnosing blunt abdominal trauma were found to be 100% and 97.3% respectively, with an optimal cutoff ROC curve value of 8.5. A BATSS score greater than 8 strongly predicts the presence of intra-abdominal injury.Conclusion: BATSS, which incorporates clinical manifestations, pelvic fractures, and Focused Assessment with Sonography in Trauma (FAST), is a highly precise and reliable diagnostic tool for detecting blunt abdominal trauma. It has the potential to reduce unnecessary CT scans and associated costs.

Background:Coblation tonsillectomy is a relatively recently introduced surgical technique which attempts to bridge the gap between hot and cold tonsillectomy methods.Objectives:• To assess the effect of Coblation tonsillectomy on the amount of blood loss intra operatively.• To evaluate the effect of Coblation tonsillectomy on the level of postoperative pain in comparison with cold steel method.• To study the effect of Coblation on the incidence of post tonsillectomy hemorrhage.• To evaluate the effect of Coblation tonsillectomy on the time taken for the dissection and on the healing process in compared with cold steel method.Patients and methods:A prospective randomized single blind controlled trial, the study carried out at Basrah Teaching Hospital between October 2020 and March 2021, which include 44 patients (24 female and 20 male) with female to male ratio is (1.2 :1). We include patients with history of recurrent tonsillitis age from (6-35) years and exclude those patients with blood dyscrasia, diabetes, hypertension, current steroid use, quinsy, heart disease and tonsillar hypertrophy due to neoplastic process.Patients were randomly assigned to have one side of the tonsils to be removed by Coblation and the second by cold steel dissection.Results:Coblation was significantly faster to perform than cold steel dissection and produced significantly less intra-operative blood loss (p value <0.01). Subjective visual analogue scale analysis showed significant pain score difference on day0 between Coblation and dissection (p value <0.01) in favor of Coblation, while there is no significant difference in pain on day3,7,10-14. Also, the study showed that no significant difference in the healing process between the two sideConclusion:It is found that Coblation tonsillectomy is a safe procedure and does have superiority in improving intraoperative efficacy in term of intraoperative time and bleeding compared to cold dissection tonsillectomy.

Background: Fractures of the long bones in the lower limbs, such as the femur and tibia, are common injuries that typically result from high-energy trauma. These injuries often require surgical intervention, with techniques like Minimally Invasive Plate Osteosynthesis (MIPO) being favored due to their ability to minimize soft tissue damage while providing stable fixation. However, the success of fracture healing is influenced by various risk factors, including smoking, age, and body mass index (BMI), which can significantly impact the biological and mechanical processes essential for bone repair.Objective: This study aims to assess the impact of various risk factors, including smoking, age, and body mass index (BMI), on the bone healing process in patients who underwent Minimally Invasive Plate Osteosynthesis fixation for extra-articular long bone fractures in the lower limbs.Methods: A cross-sectional analysis was conducted at Basrah Teaching Hospital from June 2010 to June 2012, involving 76 patients aged 20-60 years. Patients with extra-articular comminuted fractures were treated using the Minimally Invasive Plate Osteosynthesis technique. Data on patient demographics, fracture characteristics, surgical details, and postoperative outcomes were collected and analyzed. Statistical significance was determined using appropriate tests, with a p-value of <0.05.Results: The study found that smoking significantly delayed bone healing, with smokers showing slower healing times compared to non-smokers (p=0.0008). Younger patients (<30 years) demonstrated faster healing compared to older patients (p=0.041). Although BMI did not show a statistically significant impact on healing (p=0.716), trends indicated that underweight and normal-weight patients healed faster.Conclusion: Smoking and age are significant factors influencing bone healing in patients undergoing Minimally invasive plate osteosynthesis fixation for lower limb fractures. While BMI did not significantly affect healing outcomes, the findings suggest that lifestyle factors play a crucial role in recovery after fracture fixation.

Background: Macular edema is a significant cause of visual impairment, often associated with conditions
such as diabetes mellitus, retinal vein occlusion, and wet age-related macular degeneration (AMD). AntiVEGF therapies like bevacizumab have been widely used to manage macular edema; however, some
patients may show resistance to this treatment, necessitating alternative therapeutic options. Aflibercept,
another anti-VEGF agent, has emerged as a potential alternative for patients unresponsive to bevacizumab.
Aim: This study aims to evaluate the efficacy of aflibercept in treating resistant macular edema following
repeated intravitreal injections of bevacizumab.
Patients and Method: We conducted a prospective study involving patients with macular edema
secondary to diabetes mellitus, retinal vein occlusion, or wet AMD. All participants had either a partial or
no response to bevacizumab, indicated by minimal improvement in central subfield thickness on SD-OCT
images or fewer than two lines of improvement in best corrected visual acuity (BCVA) prior to switching
to intravitreal aflibercept.
Results: A total of 40 patients were included in the study, with no restrictions based on age, sex, or
diabetic control. All participants exhibited macular edema resistant to prior bevacizumab injections, both
anatomically and clinically. Following the switch to intravitreal aflibercept, a majority of patients
demonstrated a favorable response, with improvements observed after both initial and subsequent
injections.
Conclusion: Aflibercept appears to provide significant functional and anatomical improvement in cases
of macular edema that do not respond to frequent bevacizumab injections, indicating its potential as a
valuable treatment option for this patient population. Further studies may be warranted to confirm these
findings and establish long-term efficacy.

Background: One of the most common surgical emergencies include acute appendicitis which has a lifetime prevalence of one in seven with mortality rates ranging from 1-5% and morbidity rates of 10%. The diagnosis of acute appendicitis is challenging as it mimics many other acute medical and surgical conditions. This study aims to compare the diagnostic accuracy of both scoring systems to avoid potentially serious outcomes by analysing clinical and laboratory parameters.Aim: This study aimed to compare the usefulness of the RIPASA score and Alvarado scores for diagnosing patients with abdominal pain and suspected acute appendicitis to increase diagnostic accuracy.Patients and Methods: This is a retrospective observational study conducted in the Department of General Surgery for one year duration in. 500 patients with Acute Appendicitis.Results: The sensitivity of the RIPASA and Alvarado score was 41.1% and 17.8% respectively. Specificity of the RIPASA score and Alvarado score was 93.4% and 98.9% respectively. The diagnostic accuracy of the RIPASA score is 50.6% compared to 32.6% for Alvarado score. Five patients (2%) with acute appendicitis were misdiagnosed using the Alvarado score compared to the RIPASA score. Conclusion: RIPASA scoring system provides more accuracy in the diagnosis of acute appendicitis with detailed clinical and laboratory details especially in the South Indian population compared to the Alvarado scoring system.

Osteoporosis is widely distributed in our communities due to a lot of causes like aging of the population, lack of physical activities, limited outside life and avoidance of sun exposure.Osteoporosis causes a lot of clinical disorders like backache, bone pain, and generalized fatiguability. In addition to that we face a lot of osteoporotic fractures with catastrophic sequalae on personal and community levels that cause increased morbidity and mortality rate which cost billions of dollars each year. Prevention of this disorder is highly recommended to improve people’s health and to decrease financial burden upon the society. Modifiable factors can be worked on to achieve the goal.One of the best ways to prevent osteoporosis is optimization of people’s dietary habits by inclusion of food rich in vitamin D and calcium which need special effort by medical personnel. So that, the primary care for osteoporosis needs to include good food habits.The fracture risk assessment algorithm is a tool used by medical professionals to predict people at risk of fracture due to osteoporosis and to take steps to prevent that. The steps include antiresorptive drugs in addition to food supplements.Treatment of osteoporosis by antiresorptive drugs like bisphosphonates and monoclonal antibody need special consideration regarding patients' general conditions and his serum calcium and vitamin D level.This paper reviews the recent data regarding vitamin D and calcium supplements that utilized to prevent and treat osteoporosis