Main Subjects : Surgery


POST OPERATIVE FUNCTIONAL OUTCOME FOR ANORECTAL MALFORMATIONS IN INFANT AND CHILDREN IN ERBIL

salar sabah berdawd

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 109-114
DOI: 10.33762/mjbu.2020.128515.1039

ABSTRACT
Background/aims: Outcomes of anorectal malformations have greatly improved but many children still experience some form of urinary or fecal incontinence despite optimal management. The aim is to evaluate the functional outcome in infants with anorectal malformation for different surgical procedure including traditional and recent operations and outcome for different type of anorectal malformation.

Subjects and Methods : An analytical study include 28 cases of anorectal malformation (16 males and 12 females ) operated by different technique in Erbil city during 2010 - 2016. Cases of cloaca and early deaths were excluded from the study.
Results : In male Rectoperineal fistula (25% ) and in female Rectovestibular fistula (25% ) were the most common anomalies. the most common procedure were primary anorectoplasty for perineal fistula in both male and female infants in 10 cases ( 35.71% ) followed by transfistula anorectoplasty for rectovaginal fistula in 7 cases (25%) and PSARP for rectobladder neck and urethral fistula for male infants in 6 cases. The most common functional complication was constipation in 2 (7.15%) cases and only one case (3.57%) developed fecal incontinence . 89.29 percent of the patients had voluntary bowel movements and were totally continent.

Conclusion : Despite significant developments in the understanding of the pathophysiology and surgical techniques, the results of surgery of ARM remain far from perfect. An optimal operation restores normal anatomy and preserves all potential sphincter structures. Functional complications, especially treatable ones, such as constipation, should be detected and treated early to achieve an optimal outcome.

Hypopharyngeal Foreign Body in A 9-months-Old Male Baby

Raid M Al-Ani

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 127-130
DOI: 10.33762/mjbu.2020.127476.1023

Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy. Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy.

Perioperative Events of Laparoscopic Cholecystectomy in Patients with Hemoglobinopathies

Rafid Mohammed; Habeeb F Al-Ibadi; Ali G Redha

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 80-88
DOI: 10.33762/mjbu.2020.165440

Background: Hemoglobinopathies are common genetic disorders affecting the synthesis of one of the globin chains of hemoglobin molecule. Laparoscopic cholecystectomy is the standard procedure for treatment of patients with normal hemoglobin and symptomatic gall stones, but doubt is still to date regarding safety of this procedure in patients with hemoglobinopathy.
Aims:1. To assess the safety of laparoscopic cholecystectomy for hemoglobinopathic patients, 2. To describe the perioperative events that might happen before, during or after this procedure.
Patients and Methods: This is a record-based comparative study conducted over a period of seven years, involved 62 hemoglobinopathic patients and 148 patients with normal hemoglobin variant. All underwent laparoscopic cholecystectomy and comparison done regarding perioperative events.
Results: The overall complication rate was 56.5% in hemoglobinopathic patients and 21.6% in the other group and the difference was statistically significant (P- value ˂0.001). Vaso-occlusive crisis occurred in 9 patients (14.5%), respiratory complications (atelectasis and bronchitis) in (9.7%), acute chest syndrome in (4.8%) and hemolysis in (4.8%).
Conclusions: 1. Laparoscopic cholecystectomy is safe in well prepared hemoglobinopathic patients but it is associated with significantly higher rate of disease related complications, namely acute chest syndrome, hemolysis and vaso-occlusive crises.2- Hemoglobinopathic patients require special pre, intra and post-operative care which should be offered by the surgeon, the physician and the anesthetist