[Management of gunshot injuries of the extraperitoneal rectum]

The aim of this study was to analyze and compare the different lines of surgical management and associated complications of extraperitoneal rectal injuries sustained in Aleppo through Syrian war to get the best one of them. This is a prospective study. Between July 2012 and July 2014, 31 patients with gunshot injuries to the extraperitoneal rectum were treated at the Aleppo University Hospital. Patients with only intraperitoneal rectal injuries were not included in the study. The surgical management of rectal injuries was evaluated, specifically looking at the utilization of proximal diversion, distal washout, and presacral drainage. Complications were compared between the different lines of surgical management. Thirty one patients who sustained penetrating rectal injuries were included in this study. Surgical management included diversion and presacral drainage in 17 patients [55%], diversion alone in 9 patients [29%], and diversion, distal washout and presacral drainage in 5 patients [16%]. Complications were identified in 8 patients [26%]. There were two deaths in the study group. In this cohort most cases have been successfully managed by proximal diversion and presacral drainage. We have not seen any additional benefit when distal washout was performed; and we have not closed any extraperitoneal rectal injury because it is unnecessary, very difficult, and may be impossible or cause additional injuries

Surgical management of achalasia

This study include 25 patients of achalasia in Aleppo university hospital and other hospitals during 4 years [2002-2006] and the results of our study are: The Percentage of female was 60% and male was 40% and The most frequent age group were second decade the female were most affected in our study and the commonest presentation was dysphagia 68%; vomiting 52%; respiratory problem 32%; weight loss 20% and the commonest preoperative investigation was upper Radiology 100% and non patient underwent treatment before surgery. The abdominal incision was a most commonly used 100% but The laparoscopic surgery was not use. Heller myotomy was the elective procedure in our study 92% and the esophagectomy was only 8%. The fundplication after Heller myotomy with dor fudplication was 36% toupete fundiplication was 32% nissen was 24%. The main complication at surgery was oesophageal perforation in 20% the injury of spleen was 8% and the most common complication after surgery was recurrence of dysphagia and regurgitation 8% for every one. The drain was put in 20% of patient. Drawing the drain was in first and second day. Discharge of patient at 2[nd] day 52% and 3rd was 40%

Benign gastric outlet obstruction

The number of cases which had surgery for benign gastric outlet obstruction is 24 cases. Affected male with benign gastric outlet obstruction were much more than female and the percentage of them is 75%. The average of age which were more affected is 60-70 years. Blood group O wase the commonest blood group in patients of benign gastric outlet obstruction. Benign gastric outlet obstruction were treated with gastrojejunostomy and truncal vagotomy in 57.8% of patients. 4.1% of patients with benign gastric outlet obstruction were treated with pyloroplasty and truncal vagotomy