Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Laproscopic Surgery

Bowel Injuries after Laparoscopic Ovarian Drilling: Observation of Three Cases with Review of Literatures

karam Kamal younis

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 42-47
DOI: 10.33899/mmed.2022.133534.1145

Background : Bowel injury remains a potential serious complication of gynecological laparoscopy. Electro thermal energy, especially in the form of monopolar diathermy, is used widely during Laparoscopic Ovarian Drilling (LOD) by diathermy for clomiphene-resistant polycystic ovary disease (PCOD). Occasionally there can be unrecognized transfer of energy in the operating area, resulting in electro thermal bowel  injury. If iatrogenic bowel injury  is not recognized  at the time it occurs, it can have devastating consequences.
Objectives : Through personal observations of 3 patients who underwent (LOD) for clomiphene-resistant (PCOD) followed by bowel perforation ,we highlighted their  ways of presentation , recognition ,  avoidance  and management  of such complication.
Setting : Surgical wards of Al-Jamhoori Teaching Hospital in Mosul City  
Patients and Methods : Through personal observation, we report a series of 3  infertile women   who underwent laparoscopic ovarian drilling for clomiphene resistant infertility  but were readmitted 2-3 days later with pinhole leaks from perforated bowel  .
Results : After (LOD ) ,two patients out of three were urgently explored via laparotomy and multiple  bowel perforations were found and  repaired. Consequently they improved .The third patient presented lately after rupture of  bowel and peritonitis. Although she underwent explorative laparotomy but her condition was potentially fatal and died from sepsis.
Conclusion : Gynecologists should be aware for the proper, safe and judicious use of diathermy during (LOD) to avoid complications with consultation and involvement of surgeons early following the procedure. High clinical suspicion is crucial for early diagnosis of bowel injuries. When diagnosis is delayed, then morbidity and mortality rises.

A successful Laparoscopic surgery for multiple hydatid cysts (7 cysts) of liver : Case Report

Sameer Hasan

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 2, Pages 212-215
DOI: 10.33899/mmed.2021.131592.1114

Case report : To the best of our knowledge this could be the first report of a successfully performed laparoscopic surgery for female patient having had multiple  liver hydatid cysts ( 7 in number) in both lobes of liver.
Background: Laparoscopic hydatid surgery ( LHS) was almost gaining acceptance all over the world. But still there are contraindications to this approach of particular are those with multiple cysts ( >3 cysts)1.On reviewing the literature most of the reports of LHS were for patients with solitary hydatid cyst and  exceptionally for a maximum of  three cysts. Herein an initial effort to expand the application of  LHS in managing multiple hydatid cysts of  liver (>3)  with all the advantages of laparoscopic approach; less pain, good cosmetic results, rapid recovery and less complications

The white banner test. A simple intra-operative leak test during laparoscopic sleeve gastrectomy.

Professor Nashwan mahgoob

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 190-194
DOI: 10.33899/mmed.2020.127882.1043

Objective: To evaluate the efficacy of a simple intra-operative test (white banner test) for the detection of a leak during laparoscopic sleeve gastrectomy.
Design: A prospective case series study.
Setting: Obesity center at Soran private hospital, Erbil, Iraq, during the period from January 2017 to June 2019.
Participants: eighty patients underwent the white banner test during laparoscopic sleeve gastrectomy. The records of intraoperative findings and post-operative follow up were analyzed.
Patients and methods: After completing the sleeve process and hemostasis, a gauze of 4*12 cm was introduced through the 12mm trocar and displayed along the course of remaining sleeved stomach, nasogastric tube inserted to the upper portion of the stomach, compression of the pylorus by grasper against the vertebrae, 100 milliliters of saline stained by methylene blue dye were injected slowly by the anesthetist through the nasogastric tube, waiting for 30 seconds, any discoloration of the gauze was recorded and the site of leak (if any) was identified and managed. If the gauze appeared white, gauze withdrawn and the procedure finished.
Results: In 80 patients, only two patients showed a blue spot at the gauze, which were fixed by suture. In all other patients, the gauzes were completely clean and (white). Postoperatively no early leak was detected.
Conclusion: This is a simple and not time-consuming intraoperative procedure that can be used to detect intra-operative leaks during laparoscopic sleeve gastrectomy.
Keywords: obesity. Sleeve gastrectomy. Leak. Intraoperative test.
Acknowledgment: The author thanks all the staff who works at the obesity center at Soran Private Hospital for their unlimited support for this study.
The study received no outside funding and no relevant financial disclosures.
The researcher declares that there is no conflict of interest regarding the publication of this research

Glycosylation Gap in Gallstone Patients

Ahmed T. Hamed; Muzahm Al-khyatt; Muhammad A. Alkataan; Israa Al-banaa

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 1, Pages 86-90
DOI: 10.33899/mmed.2019.161331

Background: Gall stones are one of the commonest biliary diseases. Interest in the formation and clinical management of the disease dates back to ancient times. Gall stones continue to be one of the major health problems in the world today, although the exact number of patients is unknown, because there are no signs and symptoms related to the disease when there are no complications. The majority of the patients are diagnosed incidentally. However, some patients come with acute complication of gall stones. Gall stones are classified into; cholesterol gall stones, pigment gall stones, and mixed gall stones. However, all stones even pure cholesterol gall stones usually contain bilirubin (conjugated and unconjugated bilirubin) and cholesterol.
Aim: To determine the changes in glycosylation gap and glycation profile and the relation of this change to the changes in age and BMI on the measured parameters.
Patients and methods: Serum samples were collected from 40 individuals included in this work. They are divided into 2 groups. The first group included 20 apparently healthy individuals (10 males and 10 females). The second group included 20 individuals (5 males and 15 females) with Gall stone diagnosed in out-patient Clinic at Al-Jamhoory General Hospital and Neinawa private Hospital. Gall stone patients with metabolic diseases, infections and other inflammatory diseases were excluded.
Results: The study demonstrated a significant elevation in serum glucose, mean blood glucose, serum fructosamin, measured and predicated HbAc1 in GS patients in comparison with controls. Regarding the relation between age and measured parameters, the study showed a non-significant correlation between age and measured parameters in the control group, while in GS group there were a significant correlation (r = 0.05) between ages and predicted HbAc1 and BMI (p ≤ 0.03). Regarding the relation between BMI and measured parameters, the study showed a significant correlation between measured parameters and BMI in GS individuals, while in control group only serum glucose and MBG in control group (r = 0.01) (p ≤ 0.01) with MBI.
Conclusion: The study shows that there is a significant change in glycosylation gap and glycation profile in gall stone patients.