بعد جراحی

Benign tumors of the gastrointestinal tract with a muscular origin are typically found in the esophagus, stomach, or small intestine, and rarely in the large intestine. Approximately 3% of all gastrointestinal leiomyomas occur in the large intestine, primarily in the descending colon and sigmoid colon. These lesions are usually asymptomatic and are often discovered during endoscopic procedures.

A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.

Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.

Common methods used in thyroidectomy include total thyroidectomy, subtotal thyroidectomy, and lobectomy. Due to higher treatment costs and lower quality of life of the patients suffering from complications of thyroidectomy, development of new surgical methods is nesessary.

In this cohort study, 64 patients underwent thyroid surgery. The clinical information of the patients including pathology report, thyroid volume, TSH level, duration of operation, amount of bleeding during and after operation, duration of hospitalization, hematoma, wound infection, hypocalcemia and recurrent laryngeal nerve damage and Horner syndrome, were collected based on the review of the medical records, follow- up of the patients, the type of surgery (lobectomy and ismectomy, subtotal thyroidectomy and total thyroidectomy) and the complications and factors related to them, after one month of follow-up were investigated.

The results showed that the mean age of the patients was 42.17 year and 54 (84.4%) of them were women. The average intraoperative and postoperative bleeding were 31.09 and 12.81cc respectively. Intraoperative bleeding in the patients with subtotal thyroidectomy surgery was higher than those in the other two methods and showed a significant relationship (P=0.008) but there was no statistically significant difference in the postoperative bleeding among the three surgical methods (P=0.552). The operation time was slightly higher in the total thyroidectomy method but did not show a significant difference (P=0.058) among the three methods.

The results of this study showed that intraoperative bleeding in the patients with subtotal thyroidectomy was higher than those in the other two methods, and no difference was observed in the amount of postoperative bleeding in the three surgical methods. The operation time was slightly higher in the total thyroidectomy method. In this study, surgical procedures were performed by the final year surgical residents with full supervision and the help of experienced specialists. The incidence of complications was closely related to these factors.

Considering the emergence of new diseases, increased prevalence of nosocomial infections, and microbial resistance in recent years, it is necessary to disinfect the hands with a suitable hand sanitizer, as instructed by the Center for Disease Control (CDC). This is because hand hygiene is the most important way to control infections. Surgical hand antisepsis protocols emphasize the importance of both mechanical cleaning and antimicrobial action to effectively eliminate microbial contamination. Recommendations from organizations such as the Association of Perioperative Registered Nurses (AORN), the World Health Organization (WHO), and the Association for Professionals in Infection Control and Epidemiology (APIC) underscore this principle. While routine handwashing removes visible debris and transient microbes, surgical hand antisepsis requires additional steps and the use of antimicrobial agents. This may involve a surgical scrub with an antimicrobial soap or the application of an alcohol-based hand rub (ABHR). The latter approach has demonstrated greater efficacy in reducing microbial contamination compared to soap and water alone. Since a few compressive studies in Iran have dealt with global standards for disinfectants, this study investigated the effects of surgical scrub based on the European standards with TGSept AL Plus, produced by the research team of Tajhiz Gostar Sharif , on normal flora of hands in a group of the operating room medical staff in Hazrat Fatemeh Plastic Surgery and Repair Hospital of Tehran, in 2023.

This study evaluated the short-term durability and effectiveness of this solution according to the EN12791 standard on microorganisms and microbial contamination reduction. To this end, 30 members of the surgical team were randomly selected. The bacterial sampling was performed three times: after washing the hands with common detergents, after hand scrubbing with the studied disinfectant (about 90 seconds), and three hours after surgery. The samples were immediately transferred to a laboratory for swap culture and pour plate test.

Then bacterial colonies were counted, contamination reduction was measured, and the shelf life of the solution was determined according to the standards.  Results showed that a 60-to-90-second scrub with an alcohol-based disinfectant is the best way to reduce hand contamination and, thereby, nosocomial infections.

Based on the study findings, alcohol-based solutions can be recommended for surgical scrubs, according to WHO guidelines.

Creating sustainable income, enhancing economic perspectives, optimizing and managing costs, and generating revenue in the health system—especially in hospitals, which are primary providers of medical services—are critically important. These have become priority, vital policies. This study was conducted to compare the recorded costs in patient files with the approved global tariffs for surgeries at Imam Khomeini Hospital in Kermanshah.

This descriptive cross-sectional study was conducted at Imam Khomeini Educational and Therapeutic Hospital in Kermanshah in 2022. The research population included financial records for surgeries under the global tariff, covering the last six months of 2020 and the first six months of 2021. Data were collected from the Hospital Information System (HIS) and analyzed using SPSS-22 software.

Among 357 cases involving 13 types of surgeries reviewed in this study, tonsillectomy, pterygium, and appendectomy surgeries resulted in losses, while other surgeries were profitable. Considering the average actual cost of each surgery, in 14% of the surgeries, the global tariff was lower than the average actual cost, while in 86% of cases, the global tariff proved beneficial to the hospital.

Although most centers that apply the global surgery tariff are financially unprofitable, implementing operational plans based on essential resources and designing corrective actions to reduce global costs—particularly by managing patient length of stay—can improve efficiency and productivity.

Rhinoplasty is one of the most common surgeries performed worldwide. This study aimed to explore the experiences of individuals undergoing rhinoplasty.

This study follows a qualitative descriptive phenomenology design. Participants included individuals who underwent rhinoplasty surgery, selected based on purposive sampling. Data collection continued until data saturation was achieved, resulting in 24 participants. Data analysis was conducted using Colaizzi's seven-step method. Lincoln and Guba's criteria were applied to ensure data validity.

The qualitative analysis identified five main themes, each containing several conceptual categories describing the experiences of patients undergoing rhinoplasty. The main themes included feelings of self-loathing, competition, beauty obsession, psychological disorders, and doubts and regret.

Based on the findings of this study, psychological counseling should be considered in developing guidelines and protocols for cosmetic surgeries by the Ministry of Health or the Association of Cosmetic Surgeons, along with the involvement of a psychologist for approval.

Teamwork is crucial in the operating room to ensure quality patient care and good outcomes. However, various factors affect the effectiveness of teamwork in the operating room. Therefore, the purpose of our study was to investigate the attitude and perception of operating room staff toward teamwork and associated factors.

In this cross-sectional study 267 people were recruited by convenience sampling technique from 5 teaching hospitals in Ahvaz, Iran in 2023. The "T-TPQ and T-TAQ" were used to evaluate teamwork in the operating room. Data were analyzed by SPSS v26 using descriptive and analytical tests.

The mean scores of perceptions and attitude towards teamwork were reported as 3.86 ± 0.4 and 3.78 ± 0.5, respectively. Also, there was no significant relationship between the variables of age, sex, education level, and type of operating room, dominant shift, role, work experience and the amount of monthly activity hours to perception teamwork. But the attitude towards teamwork was a predictor variable for the perception of teamwork in operating room.

The present study showed a positive attitude towards teamwork among operating room personnel, but none of the demographic variables had any effect on the nurses' perception and attitude towards teamwork. In addition, the findings showed that the attitude towards teamwork is effective on the perception of the teamwork of the personnel. Therefore, it is suggested to increase the staff's perception of teamwork in the operating room by providing the necessary training and improving the attitude towards teamwork.

Work-related injuries in surgical technologists cause burnout and poor quality of nursing care. Applying ergonomics can prevent musculoskeletal disorders (MSDs) and reduce work-related stress. Considering the high prevalence of MSDs and job stress in surgical technologists, the present study will aim to determine the effectiveness of ergonomic training interventions based on the PRECEDE-PROCEED model on musculoskeletal disorders and stress in surgical technologists.

This study will be conducted as a randomized controlled trial among surgical technologists working in two hospitals in Yazd in 2024-2025. The surgical technologists of one hospital will be assigned as the intervention group (34 people) and the other hospital as the control group (34 people). The intervention program will be implemented based on the framework of the 8-phase PRECEDE-PROCEED model and the use of ergonomic principles and stress-coping techniques based on the Lazarus interactive model. Data will be collected using the Rapid Entire Body Assessment (REBA), the Nordic Musculoskeletal Questionnaire, the Perceived Stress Scale (PSS-10), and the Behavioral Risk Factors Questionnaire at three stages: baseline, three months, and six months after the intervention. In the control group, data collection will take place in three stages simultaneously with the intervention group, without any intervention. Data were analyzed using independent two-sample t-test and non-parametric Mann-Whitney U test.

Ethical considerations: 

The study protocol has been approved by the Medical Ethics Research Center of Yazd University of Medical Sciences (IR.SSU.SPH.REC.1402.033) and the Iranian Clinical Trial Center (IRCT20230422057974N1).

Maxillary central incisors are very important in regard to function and aesthetics. Early treatment of the impaction of these teeth will lead to higher chance of success and lower rate of complications.

Case report:

 This case report shows the clinical features and periodontal findings of a horizontally impacted maxillary central incisor which is located near the floor of the nasal cavity. The surgical and orthodontic method used for this patient was ultimately very successful in terms of aesthetics and tooth function.

Our results showed that careful monitoring and interdisciplinary collaboration during the treatment phase led to good periodontal health and successful aesthetic results with suitable functional occlusion.

To achieve the least reasonably achievable’ dose of radiation, we have herein introduced a new technique for performing Percutaneous nephrolithotomy (PCNL) under fluoroscopic guidance, named “Low-Fluoro PCNL” (LFPCNL).

PCNL was performed using a standard technique. Modifications in LFPCNL were as follows: Alken guide was replaced on the guidewire and passed into the selected without fluoroscopy.Thereafter, the 30F Amplatz sheath was passed over the dilator without fluoroscopy. To ensure the correct position of the Amplatz sheath, intrarenal saline fluid injection was performed through the ureteral catheter.

LFPCNL was performed in 13 patients (8 males, 5 females) with a mean age of 47.2±15.4 years. The mean fluoroscopy time and mean radiation dose scores were 66.3±40.0 seconds and 24±20 mGy, respectively. No complications occurred in this series of patients.

The present study has introduced the LFPCNL technique as a new, feasible, and safe fluoroscopic-guided PCNL that reduces radiation time. This study had a case series setting and was performed as a feasibility study. This issue is the main limitation of our research; therefore, it is highly recommended to assess the efficacy of our technique in a prospective comparative study with a large sample size

Benign prostate hyperplasia is the most common benign tumor in males. An open prostatectomy procedure can be performed to treat this problem. This procedure can be performed using Pfannenstiel or lower midline incisions. The purpose of this study was to investigate the effect of each of these incisions on the operation time, postoperative pain, intraoperative bleeding, and postoperative scar.

This study was conducted using a randomized clinical trial method on 62 patients who had been referred to Shahid Beheshti Hospital in Hamadan, Iran in 2022 for prostatectomy. Patients were randomly divided into two groups of L (lower midline incision) and P (Pfannenstiel incision). The required data was collected through relevant tools, and the collected data were analyzed using an independent t-test in SPSS software (version 23).

The results showed that there was no significant difference between the L and P groups before studying individual characteristics and the two groups were homogeneous. Based on statistical tests, there was a significant difference between group P and group L regarding the amount of bleeding in the enucleating stage, the amount of pain 24 h after the operation, and the scar score (P<0.05).

The Pfannenstiel incision was considered preferable during the open simple prostatectomy and had less bleeding during the operation, less postoperative pain, and better aesthetic results than the lower midline incision.

Breast cancer is one of the most common types of cancer in women. Locoregional treatment of this disease includes surgery and radiotherapy. Placement of surgical clips to determine the tumor bed is very helpful in radiotherapy planning. It seems that in southwest of Iran, surgeons are less familiar with this issue or have not realized its importance, leading to their insufficient use of this technique. Therefore, our study was conducted to determine the frequency of clips placement in breast cancer patients in this region.

This retrospective study was performed on all women with breast cancer referring to the department of clinical oncology at Golestan Hospital from April 2016 to March 2017. The frequency of clips placement was determined among patients who had undergone breast conserving surgery in this 2-year period. The demographic and clinicopathological data of these patients were reviewed and analyzed.

Out of a total of 1059 patients with breast cancer, 944 (89.14%) underwent breast-conserving surgery, of whom 89 (8.40%) had undergone surgical clips placement. The mean number of clips was 3, and in 58 patients (65.17%) more than 3 clips were placed.

Considering the small number of clipped cases in this region (and probably throughout Iran), it is recommended that training workshops be held for surgeons so that they become more familiar with the importance and necessity of surgical clips placement and its technique.

The clinical skills of surgical technologists, in the role of scrubs and circulars, play an essential role in the success of surgery; Therefore, this study was conducted to examine the clinical skills of orthopedic surgical technologists in the operating room of selected hospitals of Isfahan University of Medical Sciences.

Methods and Materials:

 This study was conducted as a cross-sectional analysis. 26 surgical technologists working in the orthopedic operating room, who met the inclusion criteria, were selected and included in the study through convenient sampling method. Data collection tool was a researcher-made checklist of clinical skills that included 85 items with a 4-point Likert scale (50 questions related to the circular person and 35 questions related to the scrub person).

The average age and work experience of the participants in this study were 29.38 ± 4.95 and 6.42 ± 5.72, respectively. Most of the participants were female (73.1%), most of them had a bachelor’s degree (92.3%) and they were in the workforce (50%). The average clinical skill scores of operating room technologists in the role of circular (in the range of 0-150) and scrub (in the range of 0-105) were 137.27 ±11.24 and 99.69 ± 5.06, respectively. Moreover, they were at the optimal level. The results showed that th average clinical skill scores are more in women than men; however, the t-test did not show a significant difference between the two groups (P=0.56). There is also a significant negative relationship between age and work experience with circular and scrub skills(P<0.001).

The results of this study showed that the orthopedic surgical technologists of selected hospitals in Isfahan have optimal clinical skills in both circular and scrub roles. In addition, there is a significant correlation between factors such as age, gender, and work history and education level with the clinical skills of the personnel. Therefore, it is suggested to plan and implement specialized training courses by respected hospital officials to improve the clinical skills of orthopedic surgical technologists in both circular and scrub roles and achieve an ideal level of skills.

Diabetes is a significant risk factor for postoperative complications and mortality. However, there are different opinions about the relationship between the increase in glycosylated hemoglobin (HbA1c) level and the incidence of surgical complications.

In this retrospective study, 189 diabetic patients referred to Sabalan Hospital in Ardabil who were admitted for surgery were examined in 2021. The data related to demographic information, HbA1c test, postoperative complications, and the outcome of patients’ hospitalization were extracted from the records and entered into the researcher-made checklist. Patients were divided into two groups of uncontrolled diabetes with HbA1c of 7 and above and the controlled diabetes group with HbA1c below 7.

Out of 189 patients included in the study, 97 patients were in the uncontrolled diabetes group, and 92 patients were in the controlled diabetes group. The average age of diabetic patients in uncontrolled and controlled diabetes groups was 58.18±8.91 and 61.84±5.52, respectively. According to the results, surgical site infection and the need for re-surgery during hospitalization showed a significant relationship with an HbA1c level (p≤0.05). Other postoperative complications were not significantly different between the two groups.

It seems logical that elective surgeries should be postponed in HbA1c levels higher than 7% because the presence of high HbA1c levels indicates that the patient’s diabetes is not under control, and as a result, there is a higher probability of chronic complications of diabetes as well as a higher risk for post-operative complications.

In order to provide timely and competitive services that satisfy their customers, managers need to make correct and appropriate decisions, timely and effective decision-making requires having correct cost information, this study aims to calculate and compare the total price. Day bed and day patient surgery department was performed with national tariff in 2022.

The current study was a descriptive study based on available data and applied in terms of purpose, which was conducted cross-sectionally and survey in the second quarter of 2022 in the Amin Teaching-Therapeutic Hospital of Isfahan by census method, and all the files of hospitalized patients The surgical department included 497 cases in the study. Information about patients was extracted from the hospital's health information management system and accounting unit. Excell and Spss software were used for data analysis.

The total cost of one patient day based on the daily bed with the calculation of depreciation is 30,050,190 Rials and without considering depreciation 20,433,338 Rials, and the total cost of one patient day based on the occupied day bed with depreciation is 46,912,477 Rials and Without depreciation, it was 31,899,249 Rials, while the national tariff was only 5,112,000 Rials. The income of the surgery department during the study period was 7,545,993,000 Rials, which compared to the total cost of the department, including depreciation equal to 4,194,667,122 Rials and excluding depreciation, the amount of 2,610,771,543 Rials was negative. .

The large difference between the notified tariffs and the actual costs of the inpatient departments has caused a lot of damage to the treatment complexes, and this allocation of credit and budgeting reduces the motivation of managers in line with financial discipline and efforts to improve productivity.

Diabetes is a set of metabolic disorders that manifest with increased blood sugar. This is a large pandemic disease that has several hundred million sufferers and a similar number of people at risk, and some people also show a pathophysiology similar to diabetes during injury and severe stress. Diabetic patients require hospitalization and surgery more than other people, and the mutual effects of surgery and diabetes can affect the course of surgery or its complications. Knowing the effects of surgery on diabetes, diabetes and its drugs on surgery and how to manage blood sugar during surgery can be a basis for timely and correct decision making.

One of the constant questions of hospitals and insurance organizations is the actual tariff of global surgeries. This study aims to compare the actual costs of surgeries in the hospitals affiliated to Birjand University of Medical Sciences (BUMS) with the approved global tariffs.

This is a retrospective study that was conducted in 11 hospitals affiliated to BUMS. The study population includes all global surgery bills in 2021. The criterion for entering the study was the presence of sufficient samples (at least 10 bills) from each of the performed global surgeries. Out of 91 collected global surgical procedures, 57 surgical procedures (equivalent to 63% of all global surgical procedures) met the inclusion criteria. The actual costs of surgeries were extracted from the hospital information system and compared with the government-approved tariffs. Data were analyzed using descriptive statistics in Excel 2016 software.

Based on the results, 52% of examined global surgery procedures, the global income was less than the average actual cost, while in 48% of the cases, the hospitals benefited from the costs of surgery. In 56 surgery cases, the billing cost was 12-139% higher than the approved global tariff, and in 23 cases, the difference was more than 50%.

There is a considerable difference between the actual cost of global surgeries in hospitals affiliated to BUMS and the approved tariffs. Due to the higher actual cost of surgeries, these tariffs have resulted in losses in hospitals.

Surgical correction of hypospadias is one of the most common pediatric surgeries. Due to the several methods of hypospadias operations, the evaluation of results has always been challenging. Several questionnaires have been designed to reduce the discrepancy in the reports of hypospadias surgery, and the HOPE questionnaire is one of the most common. Based on our search, the reliability and validity of the Persian version of the HOPE (Hypospadias Objective Penile Evaluation) questionnaire have not been assessed yet.

In this cross-sectional study, firstly, the questionnaire "Objective evaluation of penis in hypospadias" was translated by two urologists and an English language expert familiar with medical concepts according to the Backward-Forward translation method into Persian and then again into English, and finally, the questionnaire was sent to experts and compared with the original questionnaire. The quality of translation and content were finalized and corrected. Thereafter, in order to check the form and content validity, the questionnaire was sent to eight experts, and the content validity indices and its content validity ratio were calculated. In order to check the reliability-stability of the re-test, two questionnaires, including images after hypospadias surgery of 42 patients, were delivered to eight specialists in pediatrics, urology, and pediatric surgery to determine the score at a time interval of one week, and finally, the data were analyzed in SPSS software (version 23) using the test-retest method. The Intraclass Correlation Coefficient (ICC) index and its confidence interval were calculated by the scores obtained from twice answering the instrument for each factor and the entire questionnaire. In order to determine internal consistency and reliability, Cronbach's alpha coefficient was calculated for each factor and the entire questionnaire.

In our study, intraclass correlation coefficient values for inter-rater reliability in the HOPE score were calculated at 0.89, indicating the high reliability of this questionnaire in Persian. The internal consistency of the Persian version of the HOPE scale was confirmed, rendering a Cronbach's alpha coefficient of 0.98.

The good validity and reliability of the HOPE scoring system in Persian support its use as a standard objective outcome measure of the cosmetic result after hypospadias surgery.

Patients who have nephrolithiasis and are candidates for operation may have symptomatic or asymptomatic bacteriuria, which should be treated before any surgical intervention. We evaluated our patients for the prevalence of bacteriuria before surgical intervention.

Between March 2020 and March 2022, a total of 832 patients (489 men and 343 women) with a mean age of 38.4 years, who were candidates for renal stone surgery, were evaluated by tests, including complete blood count, urine analysis, and preoperative culture. In this study, we recorded the bacteriuria (symptomatic or asymptomatic).

Of 832 patients, 594 had the first episode of stone formation and 238 had recurrent diseases. Of these, 784 patients were scheduled for percutaneous nephrolithotomy and 48 patients for open nephrolithotomy. Overall, in the preoperative urine analysis test, 56 cases of bacteriuria were reported, of which 22 cases had positive urine cultures. Of the positive culture cases, 14 were recurrent and 8 were patients who had kidney stones for the first time. The most common microorganism was Escherichia coli (n=15), followed by Klebsiella (n=4), Proteus (n=2), and Pseudomonas (n=1). Only 8 of these patients had symptoms and the rest were asymptomatic. All of these patients received a course of oral antibiotics before the operation.

Bacteriuria is a common finding in patients with nephrolithiasis that seems to be more common in recurrent diseases; therefore, urine culture and appropriate treatment are mandatory before any intervention to prevent serious complications, such as infection, sepsis, and mortality.

Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.

A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.

The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period.

Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.