BackgroundAccording to the literature, defects in para-umbilical hernias up to 2 cm in diameter could be sutured primarily. For defects larger than 2 cm in dimeters, mesh repair is recommended. The aim of this study is to evaluate the outcome of para-umbilical hernia repair with proline mesh regardless of its size.MethodsIn this retrospective study, patients with para-umbilical hernia, who were managed by onlay mesh placement were presented, and followed for 1–6 years. Several variables were studied including patients' socio-demographic data, post-operative complications, morbidity and mortality.ResultsThe series includes 58 patients, the age ranged from 18 to 85 years with median age of 44 years and inter-quartile range of 13.5 years. Mean body mass index was (30.9 ± 4.2). From 49 female patients; 43 (87.8%) were multipara. Forty seven cases (81%) presented for the first time, and 11 cases (19%) had recurrent hernias. Twenty patients (34.5%) had hernia defect ≤2 cm, while 38 patients (65.5%) had hernia size >2 cm. Superficial surgical site infection was found in 6 patients (10.34%). Seroma was found in one female patient (1.72%). One patient (1.72%) had recurrent hernia after 19 months.ConclusionMesh onlay repair by open surgery can be applied to all sizes of para umbilical hernias, it has low recurrence rate and the rates of morbidity and recurrence are comparable with international standard.

Background  Laparoscopic cholecystectomy is a one of main surgical procedures that used widely for the treatment of symptomatic gallstones throughout the world. Although laparoscopic cholecystectomy has its own advantages, but bile duct injuries occur more frequently compared to the open cholecystectomy. In this study, critical view of safety (CVS) technique is compared to conventional infundibular technique (IT). Objectives  The aim is to compare critical view of safety with infundibular technique in laparoscopic cholecystectomy, in term of duration of the surgery and bile duct injuries (BDI). Methods Laparoscopic cholecystectomy was performed for 245 patients at Sulaimani city within a period from April 13th 2015 to April 13th 2016. The patients were divided into two groups; critical view of safety was used for the first group and infundibular technique for the second. Comparison performed between the both groups for operation time and bile duct injury. Results The operative time was significantly reduced in CVS technique as the mean time of the operations was (33.04 min) for CVS, and (38.58 min) for IT, with significant P-value (0.013). Seventeen cases (6.93%) converted to open cholecystectomy; the conversion found more in IT group, with significant P-value (< 0.001). Conclusion The “critical view of safety” although needs more patience in dissections with comparison to infundibular technique, but it is found to be faster and regard as a safe technique in laparoscopic cholecystectomy.

Background: Sacrococcygeal Pilonidal sinus (SPNS) isa common problem has a variable presentation and many surgical techniques for treatment. Still, there is controversy about the best method of surgery, because of notable rates of recurrence. Objective: The aim is to clarify the better, cost-effective and less painful method for treating patients having SPNS. Methods: This is a retrospective study of 119 patients with SPNS, treated by two different surgical methods: group A (69 patients) treated with open surgery and group B (50 patients) treated by primary midline closure. The patients followed for 2 years. Comparison between the two groups was done, for post-operative complications and recurrence. The data were analyzed using of Statistical Package for Social Science (SPSS) version 21. Chi square used to determine association between variables. P value < 0.05 is regarded statistically significant. Results: From 119 patients: Group A (69 cases) underwent open surgery and group B (50 cases) had primary closure. Postoperative infection was (5.9%), bleeding (2.5%), scar fissuring (5.9%) and chronic pain (3.4%). Recurrence found in 6 patients (5%); 2(2.9%) in Group A and 4(8%) in Group B.Conclusions: The open method needs multiple dressings which are coasty and painful, longer healing time and may be complicated by scar fissuring, but of lower recurrent and infection. The closed method is preferablefor patient's comfort, and it is costeffectiveness.

Laparoscopic cholecystectomy has been found to be associated with the development of traumatic neuromas on rare occasions. The present study reports a rare case of post-cholecystectomy biliary tree traumatic neuroma. Herein, a 47-year-old female with a history of laparoscopic cholecystectomy presented with upper abdominal pain and anorexia. Upon an examination, a yellow discoloration of the sclera was observed. Magnetic resonance cholangiopancreatography revealed a dilated proximal bile duct and mild dilatation of the intrahepatic biliary tree due to a stricture. Intraoperatively, a hard bile duct mass was observed with multiple enlarged lymph nodes in the peri-hepatic region. The patient was initially suspected to have bile duct cancer; however, a histopathological analysis of the resected mass revealed a bile duct traumatic neuroma. Biliary traumatic neuromas may be underestimated since they often remain asymptomatic. It is unfortunate that, as traumatic neuromas often lack distinguishing characteristics, no particular radiological findings for traumatic neuromas of the bile duct have been described to date, at least to the best of our knowledge. The rarity of this condition, combined with the absence of a standardized diagnostic modality, renders its diagnosis difficult and can even lead to misdiagnosis as biliary cancer.

Background  Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy, mainly because of technical difficulty.  Objectives  To identify the prediction of difficult laparoscopic cholecystectomy. Materials and Methods Preoperative clinical, laboratory, and radiologic parameters of 249 patients, who underwent laparoscopic cholecystectomy, were analyzed for their technical difficulty. Parameters (male sex, abdominal tenderness, previous upper abdominal operation, sonographically thickened gallbladder wall, age over 65 years, preoperative diagnosis of acute cholecystitis, history of ERCP) were found to have significant effect in multivariate analysis. Results Overall 54 operations (21.7%) were difficult; 36 operations (14.5%) took long time and 18 patients (7.2%) required conversion to open cholecystectomy.  Conclusions Conversion risk can be predicted to some extent. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.