Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Genaral Surgery

Comparative study between sharp dissection and electro cautery dissection in incisional hernia surgery.

Omar Saad Mahmood; khalaf rasheed jadoa

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 169-176
DOI: 10.33899/mmed.2020.128390.1048

Background: Incisional hernia is a common problem in our surgical practice and it poses a challenge due to its high incidence of complications like seroma and surgical site infection (SSI).
The objective of this study is to assess the contribution of diathermy to postoperative seroma formation and wound complications in incisional hernia surgery and also to assess other predictors for wound complications including comorbidities, personal and hernia characteristics.
Patients and Methods: This is a prospective case series study comparing two types of flap dissection in cases of open incisional hernia mesh repair. Sixty patients randomized in to two groups of abdominal flap dissection, one group with electro cautery dissection and other group with sharp dissection by scissors and knife. Surgical procedure was the same between the two groups. Primary outcome measures were postoperative seroma, SSI and wound dehiscence.
Results: There was no significant difference in seroma formation (p=0.738), SSI rate (p=0.641) and wound dehiscence rate (p=0.150) between the electro cautery group and the sharp dissection group. The use of cautery leads to reduction in the intraoperative blood loss (p<0.0001) and operative time (p<0.0001). The relation between body mass index (BMI), diabetes mellitus (DM), hernia length, width and postoperative seroma was highly significant (p=0.002, 0.034, 0.002, Conclusions: The use of cautery instead of scissors during flap dissection does not result in increased postoperative wound complications in incisional hernia patients. The use of cautery lead to reduction in the operative time and intraoperative blood loss. The relation between DM, BMI, hernia defect size and increased rate of wound complications was significant.

Incidentally diagnosed papillary carcinoma in a thyroglossal duct cyst. What is the next step? A case report and review of the literature

Professor Nashwan mahgoob

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 184-189
DOI: 10.33899/mmed.2020.127674.1042

Thyroglossal duct cyst is the commonest congenital disorders of the thyroid gland. Rarely, it can be a malignant tumor which is picked up incidentally in postoperative histopathology. Although management is still a controversy, a careful treatment and follow up planning is necessary for the management of such condition. We present a case of a 16-year-old female patient with thyroglossal duct cyst carcinoma.


Saad Muawafaq Attash; Nazar Mohammed Jawhar; Mohammed tahseen yahya; Professor Muzahm K. Al-Khyatt

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 199-206
DOI: 10.33899/mmed.2020.128441.1050

Objectives: To assess the methods of preoperative parathyroid adenoma localization and to compare it with operative findings.
Patients and methods: Between June 2017 and June 2019, we had operated 8 cases of parathyroid adenomas. Three patients were males and 5 patients were females. Age ranged from 26 year old to 72 year old with average of 42 year old. Seven cases were sporadic while one case was part of MEN2a. All patients had ultrasonography for preoperative localization, all had CT scan and 4 patients had Sestamibi scan. In all patients, intraoperative measurements of parathyroid hormone was done before and 10 minutes after surgical excision.
Results: Ultrasonography was successful in localizing only one case with certainty. CT scan located the adenoma in another 2 patients. In 4 patients who performed Sestamibi scan, the adenomas were located precisely in all of them including one case of ectopic parathyroid adenoma behind the sternum. In one patient, all the modalities failed in localization which was achieved easily intraoperatively. Single adenoma was found in 6 patients and two adenomas in two patients. The adenomas were located in the neck in 7 patients and in the anterior mediastinum in one patient .Surgical removal was done through neck incision in 7 cases while midline sternotomy in one case. All the patients had resolution of symptoms within the follow up period.
Conclusion: Sestamibi scan is the best investigation in preoperative localization of parathyroid adenoma. Ultrasonography and CT scan can aid in the diagnosis with less sensitivity. Intraoperative localization is possible even in cases of negative investigations.

Wide local excision and sentinel lymph node biopsy in early breast cancer in Duhok city

Sardar Hassan Arif; Ayad Ahmad Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 19-26
DOI: 10.33899/mmed.2020.126969.1025

Objectives: Breast conservation surgery widely in form of wide local excision and sentinel lymph node biopsy in the management of patients presenting with early breast cancer.
The aim of this study is to analyze the effectiveness of the of the breast conservation surgery and sentinel lymph node biopsy using the methylene blue dye.
Methods: this retrospective cross sectional study conducted at Nov.2014 – Dec.2019 Ninety-six females Patients with stage I and II breast cancer were included in this, patients with stage III and IV, clinically suspicious axillary lymph nodes, and male patients were excluded from this study.
Injection of methylene blue dye done around the breast mass. Resection of the breast tumor done until negative margins achieved, then dissection of the axilla was done and the stained lymph node or nodes were excised and were sent for frozen section examination, when the result was negative no further axillary dissection were done, but when result was positive we did axillary lymph node dissection.
Results: The current study showed a sensitivity of 93%, specificity of 82%, positive predictive value of 85%, negative predictive value of 92%, and the accuracy of the procedure was 88%.
The most frequent complication was seroma formation and wound infection in 12.5% and 7.3 % respectively, some dye related complications were reported including tattooing of the skin in 10.4% of patients, blue urine in 3.1% of patients and mild allergic reactions in 2% of patients.
Conclusions: The technique of wide local excision and SLN biopsy using the methylene blue dye is safe and effective technique for breast conservation surgery especially in the regions were no facilities are available for the radiolabeled colloid.