BACKGROUND: Laparoscopic cholecystectomy considers a golden surgery for gallbladder removal nowadays, and it carries some complications like biliary injuries, which can manage successfully by endoscopic retrograde cholangiopancreatography. AIM: To estimate the role of endoscopic management of bile duct injury (BDI) following laparoscopic cholecystectomy. PATIENT AND METHODS: A prospective study conducted at Al-Sader Medical City, Najaf City, Iraq, during the period between September 2018 and December 2020, included 44 patients complicated by the biliary injury resulting in a persistent biliary leak and/or jaundice after laparoscopic cholecystectomy and evaluated by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Findings revealed that 25% of cases had complete BDI, only one managed by plastic stent placement, the other 10 referred for open surgical constructions, 61% had partial injury associated with the biliary leak, all managed by sphincterotomy and plastic stent placement through ERCP, almost 7% had a partial clipping of bile duct all managed with sphincterotomy, balloon dilatation/stone extraction, and plastic stent placement, 5% had slipped clips of cystic duct stump, are managed with sphincterotomy and plastic stent placement. Moreover, only one patient, 2%, had distal common bile duct stone with bile leak, managed by sphincterotomy and stone extraction. CONCLUSIONS: Laparoscopic cholecystectomy, a gold standard therapeutic option for symptomatic cholecystolithiasis, is associated with an increased risk of biliary injury due to many factors. ERCP is a safe means of diagnosing the cause of bile leakage after laparoscopic cholecystectomy. It also offers definitive treatment in most cases by endoscopic sphincterotomy and plastic stent placement.

Introduction: The term sepsis has a deep root all over medical history. It defined by a many physician and myth such as Homer’s Iliad. Sepsis defined as a clinical syndrome as an outcome from both systemic inflammatory response syndrome and infection. It can complicate by disturb the function of the organ (severe sepsis) and shock (septic shock). Aim: Our study aims to recognize sepsis cases in Al-Sader Medical city during 2019 and evaluate the management’s management and the weak point in this management. Methods: It is a cross-sectional study done in Al-Sader Medical city; data collected from the archived files in the hospital during 2019, 100 cases reported in this period diagnosed and admitted as sepsis or admitted with other diagnosis evolved sepsis. Results: We found that one-third of the patients diagnosed as sepsis admitted to the intensive care unit, the mean duration of management 15.8 days. Many investigations did for these patients, the treatment which given to the patients was iv. fluids and antibiotics for entire patients, we also noted that death occurs in more than half of the patients in our study and death were prevalent among patient with a negative result in blood culture also the male patient was more predominant than the female patient and Najaf residency is more than three-quarters of them. Finally, we found that admission to the intensive care unit from units other than emergency or intensive care unit itself found is nearly one-third of the patient diagnosed as sepsis and the respiratory system was commonly involved and presented as pneumonia. Conclusion: More than half of the diagnosed cases died. The maximum common source of admission was from other hospital units, the severe sepsis and no growth of blood culture closely associated with death.

Bariatric surgeries such as sleeve gastrectomy; mini-gastric bypass surgery are successful weight reduction surgeries which significantly impact metabolic syndrome. The purpose of this research was to assess the impact of laparoscopy gastrectomy and mini-gastric bypasses on weight decrease and diabetes remission of diabetic mellitus type 2 through two years of monitoring. Furthermore, this study looked at the difference between the two procedures regarding their efficacy and identify which one is proper for patients according to their comorbidities. A prospective study was held in Al Sadder Medical City and Al-Gadeer private hospitals in Al-Najaf city, Iraq, from January 2016 to February 2018. The study included 35 obese and morbidly obese patients with a known history of diabetes mellitus type 2, diagnosed from at least two years before surgery. 15 patients undergo uneventful laparoscopic sleeve gastrectomy (6 females and 9 males). 20 patients underwent uneventful laparoscopic gastric mini bypass surgery (6 females and 14 males). In addition, the patients were followed in the short-term postoperatively (3, 6, 12, 24 months) by monitoring their BMI, weight loss, and HbA1c. There was a decrease in BMI of about 45% from the baseline BMI in sleeve gastrectomy surgery and a decrease in HbA1c of about 45%, less than 6%. In gastric mini-bypass surgery, there was a decrease in BMI of about 47% from the baseline BMI and a decrease in HbA1c of about 45% from the baseline less than 6%, during a 24-month monitoring. Both surgeries were fruitful and had efficient results on patients, but the gastric mini bypass was more efficient than sleeve gastrectomy in controlling and remission of DM type 2 without the need for medications. A long-term study should be performed to reveal their effect and benefits to the patients.

BACKGROUND: Fistula in ano is a chronic problem for the patients. It causes distressing because of foul odor and soiling with recurrent infection and discharge. Recurrence and anal sphincter injury were the most critical complications following surgery. Loose, thick seton placement was the most promising surgical operation. AIM: To reduce the time of seton placement, therefore, decreasing the suffering of patients from soiling and multiple dressing. PATIENTS AND METHODS: A retrospective study, one hundred patients with high type fistula in ano treated surgically in Al-Sader Medical city and Al-Najaf daily private clinic, Najaf city, Iraq, from February 2018 to March 2019. Fistulography and magnetic resonance imaging have taken from all patients. After that, fistulectomy with loose, thick seton suture placed for 3 months. Patients with the persistence of high fistula tract underwent a second surgery and third operation until complete healing. RESULTS: One hundred patients with high type fistula in ano with male 96 (96%) and female patients were 4 (4%). The rate of complete healing among male patients after the first operation was 90 (93%), while female patients showed a 4 (100%) rate of complete healing after the first operation. Three of the remaining male patients with persistently high fistula tract showed complete healing after the second operation, whereas 3 (3%) the rate of complete healing was 100% after the third operation. CONCLUSION: A loose, thick seton placed in high type fistula tract for 3 months provides excellent protection to the external anal sphincter with less recurrence rate and rapid healing.

Despite the availability of laparoscopy, open surgery remains the most common practice for primary inguinal hernia repair in general surgery. This study aimed to evaluate the combined mesh and darn (CMD) repair compared to mesh alone (MA) repair in treating adult inguinal hernias regarding recurrence and postoperative complications. We conducted a prospective randomized study, including 330 patients with primary inguinal hernias who underwent primary inguinal hernia repair at our facilities between February 2015 and January 2018. Time spent in the hospital, time to resume regular activities, postoperative sequelae, and recurrence rates were assessed. Patients were randomly assigned to 2 groups: CMD repair was performed on 165 patients (Group 1), and MA repair was done on 165 patients (Group 2). Patients were monitored for three years. The average operation time for MA was 62.2 minutes, compared to 72.9 minutes for CMD. The average time to return to normal work was comparable for both groups at around 3 weeks. In Group 2, 12 (7.1%) patients experienced postoperative complications and 3 (1.7%) recurrences. In the CMD repair group, 13 (8.1%) patients had postoperative complications, but no recurrences were observed. Hospitalization duration and postoperative pain were similar between the two groups. At the three-year follow-up, the CMD repair demonstrated a lower recurrence rate than MA, while both groups had similar postoperative complications, hospital stays, and return to normal activities. The operative time was slightly longer for CMD repair compared to MA repair.