نشریه جراحی ایران
سال هجدهم شماره 4 (زمستان 1389)

Introduction & Annually, a lot of patients experience motor problems due to nerve lesions. Reviving the muscle activity is essential to bodily function. There are a variety of methods which can be adopted to repair motor difficulties. The aim of this study was to compare and contrast the three methods of invasive transplantation surgery, namely: end-to-end alone, end-to-end coverage with vein tube and coverage with amniotic membrane. 36 male rats weighing 250-350 grams, and of the same breed were randomly divided into three equal groups. After being treated with anesthesia, the sciatic nerve in all three examined rat groups was cut. Surgery was performed on the three groups of rats, using the three mentioned invasive methods. The first group of rats were operated upon using two suture ends, the second group was operated upon using the amniotic membrane, and for the third group, the venous conduit was used. Twelfth weeks after surgery, EMG was used to determine the restoration of nerve function. For each rat axon counted. Furthermore, the Foot Print test was used in the first and the Twelfth weeks to determine nerve function. Paired sample t-test was used to compare the results of the first and twelfth weeks, and one way Anova test used to compare the results of the three groups. The results of this research indicate that the foot print gradually improved in all three groups. There were significant statistical differences between end to end anastomosis with amniotic membrane coverage (-53.75+/-19.75) and simple end to end anastomosis (-79.68/+-11.79) groups in the 12th week (P=0.017). The best electrophysiological result was in the end to end anastomosis with amniotic coverage group. The electrophysiological results indicate that there are significant statistical differences between end to end anastomosis with amniotic membrane coverage and end to end anastomosis with vein conduit coverage groups (P=0.044). The histological results showed that the most axonal count were in the end to end anastomosis with amniotic membrane coverage group. The axonal count indicate that there were significant statistical differences between end to end anastomosis with amniotic membrane coverage and end to end anastomosis with vein conduit coverage groups (P=0.041). The result of this research, in line with results from similar studies, confirms a significant and beneficially effective Amniotic membrane on nerve grafts as compared with other grafts.

Introduction & The high incidence of postoperative delirium (POD) after elective, non-cardiac surgery (4–54%), provides a useful clinical venue to study its relationship to postoperative cognitive and functional impairments Present study was done to assess the prevalence of cognitive disorder in older patients before and after surgery in Hamadan educational Hospitals. In this descriptive-analytic study, 160 old person who referred to surgery wards of teaching hospitals of Hamedan city were assessed during a one-year period (2009-2010). A questionnaire included age, sex, type of surgical operation, type of anesthesia, and duration of anesthesia was fulfilled for each patient. For the assessment of cognitive function, patients were evaluated with MMSE (Mini Mental State Examination) questionnaire before operation (day of admission) and three days after it. In mentioned questionnaire the ideal score is 30, score below 25 indicates probable cognitive impairment and a score below 20 indicates definite cognitive impairment. The mean age of the studied patients was 75.40 ± 5.80. Most of these patients were males in an age of range 71 to 75 years (67.5%). Pre-operative MMSE score was higher than 25 in 75.6% of patients; 20 – 25 in 16.9% of patients and below 20 in 7.5% of patients. After operation this score was higher than 25 in 52.5% of patients; 20 t0 25 in 28.8% of patients; and below 20 in 18.7% of patients. There is a significant difference between the percentage of patients who had pre-operative score below 20 and the patients who had score below 20 after operation (P

Introduction & Carpal tunnel syndrome is the most prevalent peripheral neuropathy. Surgery through a less invasive method has not been studied in Iran and there is no reliable data about the effectiveness, safety, success and side effects of this method. This study is performed in order to assess the outcome of carpal Tunnel Release treatment with less invasive method by DASH (Disability of Arm, Shoulder and Hand) questionnaire and visual analogue scale (VAS) in patients attending the orthopedic clinic of Sina hospital, during 2007-2009. In the present cross sectional study, patients who had attended orthopaedic clinic of Sina hospital from 2007 to 2009 and who were candidates for decompression surgery with less invasive method for carpal tunnel syndrome and who had signed for inclusion in this study were included. After performing limited open surgical approach, patients were assessed by DASH score on days 21, 42 and 84 days after their operation. Post operative pain was assessed by visual analogue scale (VAS). All gathered data was analysed using SPSS 15. Sixty two patients (43 female, 19 male, with mean age of 49.76±9.65 years) were entered in this study. The mean duration of symptoms before surgery was 21.2±3.4 months. The mean operation time was 39.33±6.9 minutes. No major complication occurred during the operation. The mean DASH and VAS score declined significantly during the follow up period (P=0.00). There was no statistically significant relationship between DASH and VAS scores, operation period, patient's age and sex, but there was significant relationship between all score of pre and post operation with pre-operative symptom's duration (P=0.00). There was no statistically significant relationship between post operative pain and parasthesia, operation period, patient's age and sex and duration of symptoms before surgery. Based on DASH and VAS scores after surgery, this method is effective in decreasing symptoms.

Introduction & Epidural anesthesia (EA) is known as a prophylaxis of postoperative thromboembolism, but the mechanisms are poorly understood. Reviewing the literature, we found no reports about the ability of epidural anesthesia to reduce the risk of venous thromboembolism in abdominal contouring surgery and liposuction. The majority of medical publications in this field are derived from orthopedic cases. From June 1992 to August 1995, 27 cases of abdominoplasty and 12 cases of liposuction of lower extremities and abdomen were done under GA (Group1) and from September 1995-August 2009 about 379 cases of abdominoplasty-liposuctioning and 204 lipoaspiration of lower extremities and abdomen were done under EA (Group2) by the 1st author (FH). Thirty two cases (5.5%) of the group 2 transferred to the group 1 due to unsuccessful epidural anesthesia. To have an analysis of the data of this study descriptive statistical methods were used and to compare thromboembolic events and similar distribution of gender in the two groups, fisher test was used. Two cases (5.5%) of thromboembolic events happened in the group1 (1 case of lower leg venous thrombosis and 1 case of pulmonary embolism). Excluding the patients with medical problems who needed chemical prophylaxis and cases of epidural anesthesia failure from this study, no cases of deep venous thrombosis or pulmonary embolism were detected in the group2 patients. Employing the differential epidural nerve block mechanism and moving lower limb muscles during the operation is the most effective way to prevent deep venous thrombosis and resultant pulmonary embolism.

Introduction & Splenectomy is among the operations that are performed laparoscopically nowadays. One of the challengaes in this surgery is hilar vessels ligation. It is especially critical about the spleen which is prone to hemorrhage and its resection is based on hilar vessels ligation. Ligasure which ligates the vessels with bipolar electrical activity seems simple, effective and safe. The purpose of the current study was to evaluate the function and safety of ligasure in performing laparoscopic splenectomy and its possible complications. This was a descriptive study to assess safety and weakness of Ligasure in laparoscopic splenectomy. The study carried out on patients with idiopathic thrombocytopenic purpura (ITP) who needed splenectomy in Shariati hospital. During the study period, 35 patients with ITP underwent laparoscopic splenectomy with Ligasure vessel sealing system. We assessed surgery duration, intraoperative and postoperative bleeding, decrease in hemoglobin due to surgery, need to blood transfusion during or after surgery, and need to conversion to open surgery as well as post operative complications and hospital stay. 35 patients were included in this study, with the mean age of 31.5±9.2 years. 25 patients were male and 10 were female. Mean operative time was 132±40 minutes. Intraoperative bleeding volume was 145±103 ml. Decrease of hemoglobin level due to surgery was 1.8±1.1dL. Postoperative hospital stay was 3.8±1.4 days. None of the cases converted to open surgery. Intraoperative or postoperative blood transfusion was required for three patients. The amount of bleeding from abdominal drain was 104±90 cc. According to the result of our study, ligating hilar vessels of spleen with ligasure in patients with ITP is safe in laparoscopic surgery which results in appropriate hemostasis without major bleeding during or after operation. Thus, this method is recommended in the case of laparoscopic splenectomy of patients without splenomegaly, such as idiopathic thrombocytopenic purpura.

Introduction & Soft tissue sarcomas constitute 1% of all cancers. But they have high overall mortality. More than 50% of such patients in America die from soft tissue sarcoma. Pathogenesis of the soft tissue sarcomas like other neoplasms is unknown. Environmental and genetic factors are effective in this incidence. The aim of this study is an epidemiologic evaluation of soft tissue sarcoma in Yazd. In this descriptive and retrospective study the case of soft tissue sarcomas in 93 patients, who had referred to the hospitals of Shahid Sadoughi University of Yazd, Iran, from 1994-2005, is studied. Questionnaires containing sex, age, job, residency, type of sarcoma, anatomical site and recurrence, were filled out and the data was analyzed by SPSS 13. Of these 93 patients 54 (58.1%) were male and 39 (41.9%) were female. The age range was 1 to 89 years old and median age was 42.99 ± 22 year old. The most frequent sarcomas were fibrohistiocytic sarcoma (20.4%), synovial sarcoma (15%), rhabdomiosarcoma (10.8%) and liposarcoma (9.7%). The most frequent sarcoma in males was fibrohistiocytic and in female was synovial sarcoma (25.6%). Limbs are the most common locations for sarcoma (33.3%). We conclude that frequency distribution of soft tissue sarcoma in Yazd is similar to that of Western countries. More studies are necessary to evaluate the role of environmental carcinogens, as the cause of the sarcomas.

Introduction & The aim of this study was to compare the results of pilonidal sinus surgery with primary closure versus open method. In a randomized clinical trial, all the patients with the diagnosis of chronic natal cleft pilonidal sinus, referring to the surgical clinic of Shariati Hospital during 2007 - 2008 were included. They underwent either excision with midline closure (primary closure, n=40), or excision without closure (open wound management, n=40). Patients who came with an acute pilonidal abscess were excluded from the study. The recorded outcomes were hospital stay, healing time, off work period, postoperative pain, patient’s satisfaction and the recurrence rate. The majority of patients were male in both groups (87.50%). There was no significant difference in the hospital stay. Off work period (8.65±1.73 vs. 11.53±2.33 days, P=0.001) and healing time (3.43±0.92 vs. 5.3±0.79 days, P=0.001) were shorter in the primary closure group; but, there were no significant differences in their hospital stay and number of visits. The intensity of postoperative pain in the 1st (37.75±6.5 vs. 43.63±5.06, P=0.001), 2nd (26.75±6.66 vs. 34.63±5.48, P=0.001), 3rd (18.25±6.05 vs. 27.88±6.88, P=0.001), and 7th (8.45±3.85 vs. 17.88±6.19, P=0.001) days were lower in the primary closure group. Statistically there was no significant difference in the complication and recurrence rate between the two groups. Patients’ satisfaction was higher in the primary closure group (4.15±0.53 vs. 3.6±0.5, P=0.001). According to the results of this study, excision and primary closure is the preferred procedure in the management of patients with pilonidal sinus. It has the advantages of shorter time off work, earlier wound healing, lesser postoperative pain, higher patients’ satisfaction, while complication and recurrence rates are comparable with open method.

Traumatic descending thoracic aorta pseudoaneurysm has been treated traditionally with open surgery in the past, which had noticeable rates of mortality and morbidity. A safer less invasive method of treatment for this disease is made possible with recent progress in endovascular treatment techniques. We present three cases of traumatic descending thoracic aorta pseudo aneurysm that were treated with Thoracic endovascular aortic repair (TEVAR) and were discharged from our clinic without any complication.