Ligadura segregada de la arteria tiroidea superior. Minimizar la lesión posterior a la tiroidectomía en el rama externa del nervio laríngeo superior. Un nuevo enfoque práctico / Segregated ligation of the superior thyroid artery minimize post-thyroidectomy injury to the external branch of superior laryngeal nerve, a novel practical approach

External division of the superior laryngeal nerve supplies the crico-thyroid muscle to excite length and thickness of the vocal fold. Thus, increasing voice tone. The vicinity with the superior thyroid vessels sets the external branch of the superior laryngeal nerve in danger every time the superior end of the thyroid is dissected. Thus, the aim of present study is to assess the rate and complication of external branch of the superior laryngeal nerve injury post- thyroidectomy when segregated ligation of superior thyroid vessels closes to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuro-monitoring. The presented study is a prospective, non- randomized clinical study included 1450 patients who underwent thyroidectomy which either (total thyroidectomies, near total thyroidectomies or lobectomy and isthmectomy) in the Department of Surgery/AL-Diawania Teaching Hospital in Diawania City, Iraq, between January 2000 and February 2018. All patients underwent thyroidectomy through segregated ligation of superior thyroid artery very closely to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuromonitoring. Postoperative indirect laryngoscopy vocal cord examination with long term follow up through physical examination and clinical history to evaluate nerve integrity. In present study, the total cases with EBSLN injury were 38 (2.6%), in which the transient EBSLN injury occurred in 28 (1.9%) of patients and permanent injury occurred in 10 (0.7%) of patients and majority of cases with EBSLN injury were occur in patients with large size goiter 29 (2%) more than small size goiter 9 (0.6%) And these differences were statistically significant differences, (P<0.005). In addition to, the majority of cases with EBSLN injury were occur in male {25(1.7%)} more than female patients {13(0.9%)} And these differences were statistically significant differences, (P<0.005). Segregated ligation of superior thyroid artery is a safe technical option, cost effective, time preserved and need surgical skills to minimized risk of injury to the external laryngeal nerve

Prevalance of papillary thyroid carcinoma among patients underwent thyroidectomy and its relative relation to medical Z-Ray exposure

Background: The papillary thyroid carcinoma is the most common cancer among well-differentiated thyroid carcinoma. Exposure to environmental radiation adn edical X-Ray can be considered as an iportant risk factor. The aim of the study to evaluate the prevalence of papillary thyroid carcinoma among patients underwent thyroidetomy and the possible relation to X-Ray exposure. Patient and methods: A prospective clinically randomized trial was conducted in the department of surgery in Diwaniyah Teaching Hospital during the period from February 2016 to October 2018 on 432 patients with goiter from those 62 patients proved to be papillary thyroid carcinoma. Results: out of 432 patients with goiter underwent thyroidectomy 62 patients proved to be papillary carcinoma, female was 49 (79 %), and male was 13 (21%) with solitary thyroid nodule predominant (61.3%) the radiation exposure is higgly significant in patients proved to be papillary thyrid carcinoma about (85.48%), the FNAC sensitivity was low about 37%. There were 14 patients re-explored either for remnant thyroid tissue in 11 or neck disection in 3 patients. Only there patients presented with occult papillary thyroid carcinoma. Conclusion: Papillary thyroid carcinoma is the most common thyroid malignancy with salient increased incidence and female predominant in this region. X-ray exposure carries a significant risk factor for thyroid malignancy. However, further national clinical studies recommended confirming the results

Fibrin Glue Injection a Promising Option in the Treatment of Patients with Anal Fistula

Background: Fistula in ano is a public perianal illness and as a long-lasting inflammatory illness which does not cure naturally. There are several surgical procedures for treatment of fistula in ano, but these surgical interventions have little degrees of success, long time of wound healing after surgery and prolonged pain, especially in complex and difficult fistulas are observed. Novel sphincter-saving methods have been used in the management of perianal fistula in order to evade the risk of fecal incontinence. Among them, the fibrin adhesive method is popular because of its ease and repeatability. Objective: The objective of the present study is to evaluate the effect of fibrin-glue injection in the treatment of anal fistula (low/high as well as primary/secondary). Method: A prospective, planned experiment was conducted on 322 patients who were established to have fistulas in ano. They were assessed by sorting them into high fistula (172/322) and low anal fistula type (150/322). The fibrin glue was instilled in their anal tracts. The character of the anal tract, whether it was simple or complex and primary or secondary, was analyzed. The outcome in terms of a postoperative discharge (failure) was noted at 3 months, 6 months, 9 months, 1 year, and 2 years. Results: Total 322 patients were involved in this study. The general success rate was 275/322 (85.4%) after a mean follow-up of 1.5 years. All patients with a complex fistula (for low/high fistula, primary/secondary) had failure of healing (success rate 0%) either through first or second injection of fibrin-glue while all patients with simple fistula had successive rate of healing (for low/high fistula, primary/secondary) either through first or need the second injection of fibrin-glue. None of the patients had postoperative continence problems, and no other complications were noted. Conclusion: Fibrin glue is a novel attractive approach, easy, safe, minimally invasive, repeatable and cost effective for treatment of anal fistula simple (low/high and primary/secondary) and promising option for treatment of high fistula, and do not have a role for healing the complex anal fistula.