Recurrent varicose veins. Reflection of reflux pattern on the line of management

The aim of this study is to determine whether specific patterns of recurrent varicose veins are associated with the distribution of reflux sites detected clinically and proved by Doppler scanning; also to detect possible causes and evaluate different methods of management. Thirty nine patients with 64 affected limbs with recurrent varicose veins undergoing Doppler scanning and 3 methods of management [2 limbs for conservative therapy; 17 limbs for sclerotherapy; and 45 limbs for surgery]. The main outcome measures of this study is the type and time of previous surgery, sites and causes of reflux, type and sites of new interventions [conservative, sclerotherapy, and surgery], results-and complications. Recurrent varicose veins presented in both legs in 25 patients [64.1%], in left leg only in 9 patient [23.1%], and in right leg only in 5 patients. [12.8%]; ulceration was in 29 patients. [45.2%. Reflux was detected in 19 patients with residual problems in the groin of 28 / 64 affected limbs [43.8%]; 9 limbs [14.1%] with reflux came from epigastric and pudendal veins. Ulceration was associated with higher rates of deep reflux [45.2% versus 54.7% non-ulcerated limbs]. Groin re-dissection was done in 28 / 45 limbs [62.2%]; thigh communicators ligation in 1/64 limbs [2.2%]; and leg perforators sub-facial ligation in 16 / 64 limbs [35.6%]. Complications rate after surgery was encountered in 13 / 45 limbs [28.9%]. The saphenofemoral junction and long saphenous vein remains the key to varicose veins recurrence and Doppler scanning provides a valuable methodology not only to identify multiple sites of reflux hut also to evaluate the adequacy of previous surgery. Because of the efficacy of surgery in treating and preventing recurrence and ulceration, surgical procedures must be selected carefully and by appropriate expertise

Vertical bamded gastroplasty for morbid obesity

Vertical banded gastroplasty [VBG] involves creating a vertical pouch by stapling the front to the back wall of the stomach below the esophagogastric junction with newly created gastric pouch outlet. [VBG] is an effective operation for treatment of morbidly obese patients especially bulk eater. Twenty-one consecutive patients with morbid obesity of more than 5 years duration with mean body mass index [BMI] +/- 40.3 operated on between September 2001 to September 2004. They all were performed vertical banded gastroplasty [VBG] using re loaded linear notched TA90-B stapler, and the outlet of the gastric pouch banded with Prolene Mesh. Mean operative time was 89 minutes [range from 65 to 135 minutes]. Mean hospital stay was 5.5 days [range from 4 to 10 days].All patients were restored daily activities by the end of the first weak post operative and returned to their work by the end of the third week post operative. Operative and postoperative complications includes; One super obese female patient [4.8%]had iatrogenic injury of the spleen durin the procedure and spleenectomy was done, one case [4.8%] of immediate postoperative jaundice due to anesthetic Halothane inhalation, 3 cases [14.4%] developed vomiting after solid food ingestions, two cases of incisional hernia [9.6%]and one case[4.8%] developed stomal ulcer. There was no postoperative death [0%]. Follow up was for 2 +/- 0.5 years for 10 patients [48%], 1.5 +/- 0.3 year for 7 patients [33.6%] and 0.5 +/- 0.1 year for four patients [19.2%]. 18 patients [86.4%] showed good control of losing their extra body weight. Vertical banded gastroplasty [VBG] using re loaded linear notched TA90-B stapler is an effective modality of bariatric surgery for treating morbid obesity. It was left body anatomy intact with no dumping syndrome or nutritional deficiencies. It was financially economic compared to the original Mason VBG in which two staplers "linear and circular' used. Correctly, performed operation is a safe and easy to perform with considerable postoperative complications especially if done by an expert surgical team. It has the advantages of being a pure restrictive procedure with long run good weight loss results especially in bulk eaters patients

Morbidity of secondary thyroidectomy in patients with prior thyroid surgery for benign disease

The goal of this study was to evaluate the complication rate of secondary thyroidectomy in patients with prior thyroid surgery for benign disease Over more than 4-year period 80 thyroid reoperations were performed in Al-Hussain University Hospital. All information related to operative procedures, pathology, and complications were recorded prospectively. There Were 14 men and 66 women with a mean age of 48 years. Prior surgery was unilateralin48 patients [60%] and bilateral in 32 patients [40%], and 6 patients [7.5%] had more than one previous thyroid operation. For euthyroid recurrent nodular goiter, 73 reoperations [9l%] were performed and 7 reoperations were performed for recurrent thyrotoxicosis [9%], Six cancers were found [7.5%]. Completion : thyroidectomy was done in 50 patients [62.3%]. Postoperative complications occurred in 11 patients [14%] recurrent, laryngeal nerve palsy [3 patients], hypocalcemia [4 patients], hematoma requiring surgical evacuation [one patient], and wound infection [3 patients]. Complications remained permanent in 2 patients [2.5%] The permanent complication rate is slightly higher in thyroid reoperations than in primary thyroid operations. However, we believe that this 2.5% rate is low enough to allow reoperation whenever it is necessary, provided precise operative rules are respected