Academic Journal of Surgery

Outcome of hemorrhoid artery ligation as a novel procedure for hemorrhoidal disease, case series in Shariati hospital of TUMS

2025-04-25T19:20:19+0430

Background: Hemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR) is a minimally invasive
procedure designed to treat grades III and IV hemorrhoidal disease by addressing both vascular supply and tissue prolapse.
Methods: This study retrospectively evaluated patients undergoing HAL-RAR between January 2024 and
January 2025. Data collected included demographics, disease severity, postoperative pain (Days 1 and 3),
hospital stay, and time to first non-problematic defecation.
Results: A total of 16 patients were included. Postoperative pain was low, with 62.5% reporting no pain on
Day 1 and 88% on Day 3. Median pain scores decreased over time and were not significantly affected by sex.
Defecation function recovered rapidly, with 100% achieving non-problematic defecation within two days
postoperatively. Age showed a non-significant trend toward delayed recovery and slightly increased pain. No
major complications were observed, and all patients were discharged after one night.
Conclusions: HAL-RAR appears to be a safe, well-tolerated, and effective short-term treatment for advanced
hemorrhoidal disease, offering minimal pain and rapid functional recovery. However, larger studies with control
groups and long-term follow-up are required to confirm these findings and evaluate durability.

Assessment of Chest CT Scan Findings in Multiple Trauma Patients Admitted to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in 2023

2025-04-25T19:20:20+0430

Background: This study investigates the clinical predictors of chest CT scan findings in patients with chest
trauma presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan in 2023.
Methods: A cross-sectional study was conducted on 460 patients with multiple traumas. Data were collected from CT scan reports and analyzed using SPSS 22 software, employing independent t-tests, correlation coefficients,and chi-square tests.
Results:The mean age of the patients was 40.2 ± 20.36 years (range: 16–97). Gender distribution included 28.7%
women and 71.3% men. Significant differences in CT scan findings were observed based on gender (P = 0.032),
trauma mechanism (P = 0.029), and clinical complaint type (P = 0.017). Patients under 20 years old exhibited
more normal findings, whereas those over 40 had a higher prevalence of rib and thoracic vertebra fractures.
Traffic accidents and collisions frequently resulted in rib and thoracic vertebra fractures, while altercations were
more commonly associated with pneumothorax. Clinical complaints of chest pain and deformity were frequently linked to pneumothorax and rib fractures.
Conclusions: These findings underscore the importance of age, trauma mechanism, and clinical complaints in
diagnosing chest trauma, facilitating more informed decision-making and diagnosis.

Modification in Brachytherapy Catheter Inset in the Keloid Bed

2025-04-25T19:20:20+0430

Background: Keloids are troublesome for both patients and surgeons who encounter recurrent lesions. Patients often seek newly developed treatments in hopes of alleviating the pain and manifestations associated with this condition. Surgery alone is generally ineffective and requires adjuvant therapies, one of which may be
brachytherapy.
Case presentation: We introduced a modification in catheter placement following surgical excision of keloids.
In the two presented cases, after lesion removal and closure of the deep cavity up to the subcutaneous tissue, the wound margins were closed while leaving a limited route for the catheter to prevent its displacement. The skin was then closed. The results of immediate post-surgical brachytherapy for keloids were highly encouraging.
Conclusions: Brachytherapy following surgical keloid excision yields significant results. This combination
needs more concise catheter inset especially in subcutaneous field.

Dexamethasone and Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2025-04-25T19:59:40+0430

Background: Laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder in patients experiencing gallstones or acute cholecystitis. Pain is a common side effect of surgery. Objective: This study evaluates the effectiveness of intraperitoneal dexamethasone injection from the umbilical port site in alleviating pain after laparoscopic cholecystectomy.
Methods: This research followed a triple-blind clinical trial that included 80 randomly selected patients who were hospitalized at Shahid Mohammadi Hospital in Bandar Abbas and deemed eligible for laparoscopic cholecystectomy. Patients were randomly divided into two groups, each containing 40 participants. In the test group, 8 mg of dexamethasone was injected into the intraperitoneal space through the umbilical port site during surgery, while no drug was administered in the control group. Pain scores were measured postoperatively using the VAS questionnaire at 6, 12, and 18 hours after surgery. The collected data were analyzed using SPSS version 21 statistical software, employing independent t-tests and chi-square tests. Results: The experimental group exhibited significantly lower levels of nausea, vomiting, analgesic consumption, and pain compared to the control group (p<0.000).
Conclusions: Study confirmed that intraperitoneal dexamethasone infusion from the port site significantly reduced postoperative pain, nausea, vomiting, and the consumption of painkillers.

Effects of Different Techniques ("Surgical Versus Laser") on Impairment of Lymphatic Drainage and Scar Formation in Humans

2025-04-25T19:20:20+0430

Scars are abnormal changes in skin tissue caused by injuries, infections, and various factors. They commonly
result from fibroblasts in affected skin synthesizing collagen, leading to irregular growth and excessive collagen
accumulation within the extracellular matrix.
This study aims to investigate the effects of surgical and laser methods on scar formation mechanisms and
lymphatic drainage, as well as their outcomes. The objective is to assess skin scars created by laser and surgical
incisions and their impact on pathophysiology and lymphatic flow in humans.
A total of 20 patients with skin lesions were included in this study. The migration of methylene blue dye through
the lymphatic vessels of the lower limbs was evaluated, with the administered dose limited to under 2 mg/kg.
Transverse incisions were then performed distally using either a surgical blade or laser. The wounds were allowed to heal by secondary intention. The results indicated that laser-treated wounds did not heal completely, retaining a noticeable area of granulation tissue along with hair loss. In contrast, wounds created through surgical incisions healed entirely. Additionally, significantly lower dye migration levels were observed in the limbs after laser treatment compared to surgical incisions (p = 0.007). The findings suggest that scar size may be influenced by the type of incision used. However, further research is required to validate these results.

Successful Term Pregnancy After Cesarean Scar Molar Pregnancy

2025-04-25T19:20:20+0430

Background: Cesarean scar molar pregnancy (CSMP) is an exceptionally rare clinical entity, combining two
uncommon obstetric conditions: cesarean scar pregnancy and molar gestation. The diagnosis is often delayed due to nonspecific symptoms and misinterpretation of imaging findings, and there is limited data regarding fertility outcomes following such cases
Case Presentation: We report the case of a 32-year-old woman, gravida 2 para 1, who presented with vaginal bleeding and a diagnosis of missed abortion at 12 weeks gestation. Despite medical management with misoprostol, she experienced severe hemorrhage requiring surgical intervention. Intraoperative findings revealed thinning of the previous cesarean section scar and abnormal tissue suspicious for ectopic gestation. Pathologic examination confirmed a partial molar pregnancy implanted at the cesarean scar site. Following surgical repair and appropriate follow-up, including serial β-hCG monitoring until undetectable levels were reached, the patient conceived spontaneously two years later. The subsequent pregnancy progressed uneventfully to term and was delivered via cesarean section.
Conclusions: This case highlights the importance of considering CSMP in the differential diagnosis of atypical
pregnancies in patients with a history of cesarean section, especially when imaging shows abnormal sac location or persistent bleeding. Early diagnosis and prompt management are crucial for patient safety and preserving fertility. To our knowledge, this is one of the rare reports of a successful term pregnancy following CSMP

Apixaban-Associated Spontaneous Rectus Sheath Hematoma: A Geriatric Anticoagulation Dilemma in an 87-Year-Old Woman

2025-04-25T19:20:20+0430

Spontaneous rectus sheath hematoma (RSH), a rare complication of anticoagulation therapy, can pose significant diagnostic and management challenges. We present the case of an 87-year-old woman with atrial fibrillation, hypertension, and chronic kidney disease (CKD) who developed spontaneous RSH while on apixaban. She presented with acute abdominal pain and a palpable mass, accompanied by anemia and coagulopathy. Non-contrast computed tomography (CT) confirmed a large rectus sheath hematoma. Conservative management, including discontinuation of apixaban, administration of tranexamic acid, and close monitoring, led to clinical improvement without requiring invasive intervention. This case underscores the importance of recognizing RSH in anticoagulated patients, particularly elderly individuals with renal impairment. Clinicians must maintain a high index of suspicion for atypical bleeding sites in patients on direct oral anticoagulants (DOACs) and consider conservative strategies when managing hemodynamically stable cases. The report highlights the need for individualized risk-benefit assessments when resuming anticoagulation and emphasizes patient education on bleeding risks.

Case Report of a Recurrent Sarcoma in a 57-Year-Old Female

2025-04-25T19:20:20+0430

This case report describes the recurrence of sarcoma in a 57-year-old female with no significant medical history.
Following initial surgical excision two years prior, a large mass reappeared in the left flank and was subsequently
removed completely. This case highlights the challenges associated with managing recurrent sarcomas and
underscores the importance of ongoing surveillance.