Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.

Background: Retroperitoneal heamorrahge is an acute surgical condition that is associated with difficulty of diagnosis, organ injuries and mortality. Materials and Methods: One hundred and two patients with traumatic retroperitoneal hematoma treated in Al Yarmuk teaching hospital from May 2012 to January 2013 were reviewed retrospectively. The data include patient's age, type of injury, presenting symptoms, associated injuries and common site of hematoma. Results: In 102 patients, 69 were males (67.6%) and 33 were females (32.3%), mean age of 22 years. The comments presenting symptoms was pain (85.2%), followed by tenderness (73.5%) and shock (58.8%). Around 38.2% were injured by blunt trauma and 61.8% by penetrating trauma. The large bowel was the most common affected organ 26.4%, spleen and kidneys were the second affected organ (23.5%) while the jejunum and ileum were the third associated organs to be affected (14.7%). The commonest complication was septicemia, followed by wound infection. The least reported complications were Pulmonary embolism, Fistula, and Intestinal Obstruction. Conclusion: Traumatic retroperitoneal hematoma is life-threatening condition, early diagnosis and correct treatment is of upmost importance.

Background: Stone disease is a wide health problem; certain drugs have been used as supplement with ESWL for the treatment of symptomatic uncomplicated lower ureteric stone like Nefidipine, Alfuzosin and Tamsulosin. The purpose of this study is to evaluate the efficacy of Tamsulosin for the treatment of lower ureteric stone of 5-10 mm diameter after ESWL. Methods: A total of 105 patients with lower ureteric stone of less than 10 mm diameters were divided into two groups. Group 1 including 48 patients received 0.4 mg Tamsulosin and diclofenac sodium analgesia as needed immediately after ESWL and continued until stone expulsion was confirmed up to maximum of 30 days. Group 2 including 47 patients was given diclofenac sodium only as needed after ESWL. Result: 46 of 49 patients in group 1 and 44 of 48 patients in group 2 ultimately passed stones. The number of ESWL sessions was 1.4 ± 0.6 in group 1 & 1.42 ± 0.75 in group 2. There were 10 patients who needed analgesia after ESWL in group 1 and 17 patients in group 2. Visual analogue scale pain severity score was 5.32 ± 1.23 and 6.41 ± 1.26 in group 1 and 2, respectively. The time to stone expulsion in group 1 and 2 was 8 ± 5.4 days and 12 ± 10.3 days, respectively. No significant complications or side effects occurred. Conclusion: The use of Tamsulosin in combination with ESWL in patients with lower ureteric stone of 5-10 mm was effective for reducing the time to stone expulsion, decreasing need for analgesia, and facilitating stone passage without significant improvement in stone free rate.

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone; 2) Group 2: including 60 patients with distal ureteric stone. Pre-operatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.