Background: thyroid carcinoma is the most common endocrine carcinoma as it accounts for almost 90% of all endocrine malignancies. The term incidental denoted malignant tumors of the thyroid gland detected by post-operative biopsy results of the resected specimens resected from benign thyroid diseases. Among the incidental thyroid malignancies, papillary carcinoma is the commonest pathological type.Objectives : To determine the incidence of incidental thyroid carcinoma and to insist on accurate preoperative diagnostic work up of patients with thyroid diseases.Patients & Methods: A prospective study, which was conducted during the period from March 2013 to April 2014 at Baghdad teaching hospital first surgical unit by the same team of surgeons. Ninety nine patients were referred for surgical treatment of goiters, 4 patients who had a known malignant diagnosis by FNAC were excluded from the study, the remaining 95 patients were evaluated for the presence of the cancer by post-operative pathological exam. The surgical operations performed were total lobectomy with isthmusectomy, subtotal, near total or total thyroidectomy.Results: incidental thyroid carcinoma was found in 18 patients (18.9%), 15 patients with non-toxic MNG (15.7%), 2 patients with solitary thyroid nodule (2.1%) and one patient (1.1%) with toxic MNG. Out of 18 patients with incidental thyroid carcinoma, 15(83.3%) aged >45 and the remaining 3 (16.7%) aged≥45, only one male had ITC and the remaining patients were females.Conclusions: It can be concluded that the incidence of incidental thyroid carcinoma in our study is relatively high so a more radical surgical treatment in the management of patients with presumably benign thyroid disease is recommended.

Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients included in this study had insufficient weight loss after Sleeve Gastrectomy and converted to Roux-en-Y gastric bypass.Results: Fifteen patients (71.4%) had LSG as their single bariatric operation before conversion to roux en Y gastric bypass, 2 patients (9.5%) had Intragastric balloon and 4 (19.1%) patients had the laparoscopic adjustable gastric band before to their sleeve gastrectomy. Fourteen patients (66.6%) were female and 7 (33.4%) were males, At 6, 12, 18 months after bypass ,mean BMI was 37.2 (32.7-44.3),32.5(28.7-39.1) and 30.2 kg/m2 (24.3-37.9 kg/m2) respectively , reflecting a %EWL (percentage weight loss) at 18 month of 61.7%.Conclusion: insufficient weight loss after Sleeve Gastrectomy can be safely and effectively treated by conversion to Roux-en-Y gastric bypass to control weight loss failure or weight regain.Keywords: weight loss failure, weight regain, failed Sleeve Gastrectomy.

Background: thyroid carcinoma is the most common endocrine carcinoma as it accounts for almost 90% of all endocrine malignancies. The term incidental denoted malignant tumors of the thyroid gland detected by post-operative biopsy results of the resected specimens resected from benign thyroid diseases. Among the incidental thyroid malignancies, papillary carcinoma is the commonest pathological type. Objectives : To determine the incidence of incidental thyroid carcinoma and to insist on accurate preoperative diagnostic work up of patients with thyroid diseases. Patients & Methods: A prospective study, which was conducted during the period from March 2013 to April 2014 at Baghdad teaching hospital first surgical unit by the same team of surgeons. Ninety nine patients were referred for surgical treatment of goiters, 4 patients who had a known malignant diagnosis by FNAC were excluded from the study, the remaining 95 patients were evaluated for the presence of the cancer by postoperative pathological exam. The surgical operations performed were total lobectomy with isthmusectomy, subtotal, near total or total thyroidectomy. Results: incidental thyroid carcinoma was found in 18 patients (18.9%), 15 patients with non-toxic MNG (15.7%), 2 patients with solitary thyroid nodule (2.1%) and one patient (1.1%) with toxic MNG. Out of 18 patients with incidental thyroid carcinoma, 15(83.3%) aged >45 and the remaining 3 (16.7%) aged≥45, only one male had ITC and the remaining patients were females. Conclusions: It can be concluded that the incidence of incidental thyroid carcinoma in our study is relatively high so a more radical surgical treatment in the management of patients with presumably benign thyroid disease is recommended.

Background: Laparoscopic colectomy is performed in an increasing number of institutions as a minimally invasive treatment for benign and malignant large bowel disease. Laparoscopic rectal surgery enables more accurate visualization of the anatomical structure in the pelvic cavity for selected patients with tumors in the middle and low rectum.Objectives: To determine the early outcome of patient who underwent laparoscopic low anterior resection using radial reload stapler.Patients and methods: This is a prospective study of 8 patients with low or mid rectal cancer who underwent a laparoscopic low anterior resection between January 2017 till June 2017 at Saint Raphael hospital.Results: Eight patients underwent elective laparoscopic low anterior resection, 5 (62.5%) of them were male and 3(37.5%) were female. In 6 (75%) patients complete rectal transaction done only radial reload stapler, while the other 2 (25%) patients complete transaction couldn’t be done only by the radial reload stapler and they need one Endo GIATM (Covidien) medium thick purple stapler. There was no anastomotic leakage, no wound infection and no mortality.Conclusion: The primary results and early outcome of this study showed that laparoscopic low anterior resection using radial reload is a safe procedure without increasing the risk of anastomotic leak. Further analysis in a large series is needed to draw definitive conclusions.

Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients included in this study had insufficient weight loss after Sleeve Gastrectomy and converted to Roux-en-Y gastric bypass.Results: Fifteen patients (71.4%) had LSG as their single bariatric operation before conversion to roux en Y gastric bypass, 2 patients (9.5%) had Intragastric balloon and 4 (19.1%) patients had the laparoscopic adjustable gastric band before to their sleeve gastrectomy. Fourteen patients (66.6%) were female and 7 (33.4%) were males, At 6, 12, 18 months after bypass ,mean BMI was 37.2 (32.7-44.3),32.5(28.7-39.1) and 30.2 kg/m2 (24.3-37.9 kg/m2) respectively , reflecting a %EWL (percentage weight loss) at 18 month of 61.7%.Conclusion: insufficient weight loss after Sleeve Gastrectomy can be safely and effectively treated by conversion to Roux-en-Y gastric bypass to control weight loss failure or weight regain.Keywords: weight loss failure, weight regain, failed Sleeve Gastrectomy تحويل عملية قص المعدة الى عملية تحويل مسار المعدة للمرضى الذين فشلوا في فقدان الوزن  د. محمد قاسم عبدالجبار د. رامز سامي مختار د. مصطفى عادل عباس  الخلاصة: خلفية: البدانة لا تزال تمثل مصدر قلق كبير في جميع أنحاء العالم. وقد اكتسبت استئصال و تكميم المعدة بالمنظار شعبية كبيرة بين المجتمع الجراحي باعتباره إجراء جراحي مستقل. ومن المرجح أن يتبع العدد المتزايد في اجراء قَص وتكميم المعدة بوجود إعداد  متزايدة من المرضى الذين يعانون من فشل في  فقدان الوزن ، وتعرف بأن فقدان الوزن غير كافي أو اكتساب الوزن من جديد. الهدف من الدراسة: لتقييم فعالية تحويل قَص وتكميم المعدة الى عملية تحويل مسار المعدة في موضوع فشل فقدان الوزن المرضى والطرق: استعراض بأثر رجعي للمرضى الذين خضعوا لقص وتكميم المعدة بالمنظار من تشرين الاول ٢٠٠٩ حتى كانون الاول ٢٠١٦في مستشفى القديس رافائيل(الراهبات)، خضع ٢١ مريضا يعانون من فشل في فقدان الوزن بعد عملية قَص وتكميم المعدة الى عملية تحويل مسار المعدة بالناظور وتمت متابعة فقدان الوزن لدى المرضى لمدة ١٨ شهر أو اكثر.  النتائج: خضع سبعة عشر مريضا (٨٠.٩٪) لعملية قَص وتكميم المعدة كإجراء وحيد ، وخضع ٤ (١٩.١٪) من المرضى لعملية قرص المعدة قبل اجراء قَص وتكميم المعدة. وكان ١٤ مريضا (٦٦.٦٪) من الإناث و ٧ (٣٣.٤٪) من الذكور، في الشهر السادس و والاثنا عشر والثامن عشر شهرا بعد بعد تحويل مسار المعدة، كان متوسط ​​مؤشر كتلة الجسم ٣٧.٢ (٣٢.٧-٤٤.٣)، ٣٢.٥ (٢٨.٧-٣٩.١) و ٣٠.٢ كجم / م ٢ (٢٤.٣ -٣٧.٩ كغ / م ٢) على التوالي، مما يعكس (نسبة فقدان الوزن) في الشهر الثامن عشر ٦١.٧٪. الاستنتاج: عملية تحويل مسار المعدة بالناظور بعد فشل فقدان الوزن بعد عملية قَص وتكميم المعدة هو اجراء أمن وفعال. كلمات البحث: فشل في  فقدان الوزن ،استعادة الوزن، فشل قَص وتكميم المعدة