With particular attention to detail, sufficient length can be achieved to permit safe anastomosis in most patients.

Objective:To assess the postoperative outcome between pudendal nerve block and caudal block after open lateral internal sphincterotomy for chronic anal fissure.Methods:Our prospective, randomized and double blind investigation included 123 patients, of both sexes, aged 25-56 years, classed I-II by the American society of anesthesiologists and scheduled for elective open internal lateral sphincterotomy for anal fissure at King Hussein hospital, KHMC, Amman, Jordan, during the period from Jan. 2013 to Feb. 2015. Patients were divided into two groups. Group I included 62 patients (GI, n=62) operated under pudendal nerve block with local infiltration anesthesia and group II included 61 patients (GII, n=61) operated under caudal block. Postoperative pain, surgical duration, period of hospital admission, back to regular working activity and 4 weeks evaluation were compared between the two groups.Results:Postoperative outcome was more enhanced in group II but not significant than in group I. Patients in G-I experienced moderate pain for a mean of 5. 3 days in comparison with 4. 3 days in G-II. P>0. 05. Three patients (4. 9%) in G-II in comparison with 5 patients (8. 1%) in G-I had more hospital stay than 24 hours. Patients in G-II went back to normal activity after a mean of 7. 5 days in comparison with 8. 0 days in G-I.Conclusion:Undergoing open lateral internal sphincterotomy with the aid of Pudendal nerve block is an excellent, easy and safe alternative anesthesia to caudal anesthesia.

Background: Laparoscopic cholecystectomy is taken into account as a standard method of performing cholecystectomy and has substituted the old method throughout the world, while laparoscopic appendectomy still not attaining that reputation. In this paper, a retrospective study was done to compare between both laparoscopic and open appendectomy.Methods: Two hundred eighty-five patients were analyzed after appendectomy using either open or laparoscopic procedures. The data was compared over a period of 36 months. Surgical technique was the same among 6 surgeons, standard postoperative care for all patient groups. The outcome measures included comparing of mean operative time, days of hospitalization, postoperative pain and rate of wound infection.Results: Concerning open appendectomy the mean time was 28 minutes with 2 days of hospitalization. The postoperative pain extent was for 36 hours and rate of wound infection was 8/159. While in laparoscopic appendectomy the mean time was 55 minutes with one day hospitalization. The postoperative pain was for 12 hours and zero rate of wound infection.Conclusions: In general laparoscopy has plenty of gains over open surgery as discussed before but laparoscopic appendectomy is not easier, nor does it avoid general anesthesia. The cost for laparoscopic appendectomy is higher than for open appendectomy. The operative and post-operative complications are more critical (e.g.: intra-abdominal abscesses & perforation of bowel) as compared to open appendectomy. We have to assess the advantages and disadvantages, indications and contraindications when taking a decision for laparoscopic surgery. We suppose it would be very early to say that laparoscopic appendectomy is superior or can replace open appendectomy.

Objective: To evaluate the usefulness of non-enhanced spiral CT (NECT) and compare it with that of excretory urography (EU) in patients with acute flank pain. Methods: Ninety five patients presenting with acute flank pain underwent both NECT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. Result: Seventy eight of the 95 patients had one or more ureteral stones and 17 had no stones. CT depicted 79 of 83 calculi in the 78 patients with a stone and no calculus in all seventeen without a stone. The sensitivity and specificity of NECT were 95% and 100%, respectively. EU disclosed 73 calculi in the 78patients with a stone and no calculus in fifteen of the seventeen without a stone, with sensitivity and specificity 89% and 88% respectively. Conclusion: For the evaluation of patients with acute flank pain, NECT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.

Objectives: To present the learning style of surgeons and compare it to their medical colleagues. Methods: This study was conducted at King Hussein Medical Center between 1-15/July 2014. An equal number of randomly selected surgeons and physicians received Honey and Mumford learning style questionnaire. The participants were asked to fill the questionnaire with their name initials, age, gender, specialty (surgeon or physician) and scientific medical level (specialist or consultant). The results between these two groups were compared using statistical methods. Results: A total number of 40 participants filled the questionnaire, 20 in each group. Thirty six (90%) were males, with a mean age of 37.6 years (SD ± 6.32). There were 7 consultants and 33 specialists. The majority (80-90%) of surgeons and physicians showed reflector and theorist learning styles. When grouping them into activist/ pragmatist, reflector/ theorist or mixed learning styles; 80% of surgeons and 90% of physicians demonstrated mixed learning style. Conclusion: Both surgeons and physicians demonstrated a mixed learning style. This means that doctors in both specialties use all four learning styles which inevitably will bring the best learning results. We suggest the application and appreciation of all learning styles in the surgical curriculum as the most educational and practical approach.