Academic Journal of Surgery

Video-Assisted Thoracoscopy and Open Thoracotomy for the Treatment of Stage III Empyema: A Comparative Study

Fariborz Rousta — 2025-08-24

Background: Pleural empyema can be fatal and requires surgery if untreated. Stage III empyema, marked
by thickened pleura, necessitates surgical intervention. Both open thoracotomy (OT) and video-assisted
thoracoscopic surgery (VATS) are viable options, but there is insufficient clinical evidence to determine which
is superior.
Objective: This study evaluated the preoperative outcomes of VATS and OT in patients with stage III empyema
Methods: There were two groups of 30 patients with stage III empyema treated with OT or VATS. We measured
patients' preoperative characteristics and analyzed them using t-tests and chi-square tests
Results: No difference was seen between the mean (± SD) age of the OT (40.38 ± 19.71) and VATS group (43.56
± 19.82) (p-value = 0.796). The OT group's surgery and hospital stay (2.15 ± 0.58 hours) was about 1.5 times
the VATS procedure (1.44 ± 0.37 hours) (p-value = 0.018). Tachypnea duration (p-value = 0.174) and chest tube
duration (p-value = 0.417) were statistically similar between groups. OT patients experienced longer air leaks
than VATS patients (p-value = 0.019).
Conclusions: Both procedures are effective, but VATS may be preferable due to shorter operation times, hospital
stays, and its minimally invasive nature. Further clinical trials are needed for clearer guidance.

Impact of Body Mass Index on Mortality and Length of Stay in Postoperative Sepsis Patients Admitted to the Shariati Hospital Intensive Care Unit 2024

Nima Mohamadi Afrakoti — 2025-08-24

Background: Sepsis is one of the most challenging critical conditions in patients admitted to the Intensive Care
Unit (ICU), leading to increased mortality, prolonged hospital stays, and long-term complications. Body Mass
Index (BMI) is a significant factor affecting the prognosis of these patients. This study aimed to investigate the
relationship between BMI and mortality rate, ICU length of stay, symptoms three months post-discharge, SOFA
score, and CRP levels in patients with sepsis
Methods: This cross-sectional study was conducted on 162 sepsis patients admitted to Shariati Hospital's ICU in
1403. Patients were categorized into five groups based on BMI (underweight, normal weight, overweight, obese,
and morbidly obese). Data on clinical outcomes, including mortality rate, ICU length of stay, SOFA score, CRP
levels, and symptoms three months post-discharge, were collected and analyzed using statistical tests such as
ANOVA, chi-square, and logistic regression.
Results: The results showed that overweight patients had the lowest mortality rate (14.3%) and shortest ICU stay
(12 days), whereas underweight (20% mortality) and morbidly obese patients (22.2% mortality) had the highest
risk. The ANOVA test indicated that BMI significantly affected ICU length of stay (p = 0.00028). Additionally,
underweight and morbidly obese patients experienced the most long-term symptoms post-discharge, especially
severe fatigue (80% and 66.7%, respectively) (p = 0.0026). The mean SOFA score was also higher in underweight
and morbidly obese patients (9 and 8, respectively), indicating greater disease severity in these groups (p < 0.05).
Conclusions: The findings of this study suggest that BMI can significantly impact the clinical outcomes of
patients with sepsis. Overweight patients had better prognoses compared to other groups, while underweight
and morbidly obese patients were at higher risk in terms of mortality, longer hospital stays, and post-discharge
complications. These results could be used to optimize therapeutic and care strategies for ICU patients.

Evaluating the Reliability of Coagulation Tests in Guiding Surgical Decisions for Spinal Interventions in Post-COVID-19 Patients

Mahdi Mohsenzadeh — 2025-08-24

Background: The COVID-19 pandemic has introduced challenges in medical practices, impacting laboratory
testing and raising concerns about the reliability of specific tests. This study aimed to assess the reliability of
using hematology test results to delay surgeries, particularly in spinal interventions.
Methods: A retrospective analysis was conducted on the medical records of 220 patients who had undergone
spinal surgery between October 2021 and June 2023, and whose COVID-19 status was documented. Inclusion
criteria encompassed individuals without a history of blood disorders, pregnancy, drug or smoking addiction, or
recent surgical procedures. Data analysis utilized SPSS software, employing descriptive methods and statistical
tests such as the independent samples t-test and chi-square test, with statistical significance set at p < 0.05.
Results: Among the analyzed patients, 56.4% were male. Fusion surgery was performed on 82.7% of individuals,
while laminectomy surgery was performed on 17.3%. Approximately 65.9% had no underlying conditions,
and 67.3% had a history of prior COVID-19 infection. Postoperative thrombotic complications were observed
in 2.2%. Comparisons between patients with and without coagulation complications revealed no significant
differences in demographic information, history of COVID-19 infection, or coagulation test results. Furthermore,
a comparison of D-dimer test outcomes between individuals with normal D-dimer levels [54 people] and those
with levels exceeding 500 [55 people] demonstrated no significant distinction (p > 0.05).
Conclusions: Based on the findings, this study concludes that, for major and extensive spinal surgeries in
patients with a history of COVID-19, evaluating D-dimer test results does not offer significant assistance in
decision-making.

The Effects of Fetal Head Circumference on The Duration of Labor and Cesarean Section in Term Pregnancy

Masomeh Sabzevary — 2025-08-24

Background: To investigate whether fetal head circumference (FHC), independent of estimated fetal weight
(EFW), is a risk factor for prolonged second stage of labor and cesarean delivery in term pregnancy.
Methods: A single-center, non-randomized cross-sectional study including 580 cases was conducted. Cases
included singleton primigravida term pregnancies.
Results: In the vaginal delivery and cesarean groups, the FHC was 35.01 ± 1.18 cm and 35.02 ± 1.32 cm,
respectively (P = 0.95); biparietal diameter (BPD) was 94.99 ± 0.65 mm and 94.96 ± 0.65 mm, respectively (P =
0.66); EFW was 3366.18 ± 207.04 g and 3363.03 ± 251.54 g, respectively (P = 0.34). The lengths of the first and
second stages of labor were not associated with the type of delivery (P₁ = 0.92; P₂ = 0.79). BMI was significantly
associated with the duration of the first stage of labor (P₁ = 0.04), but not the second stage (P₂ = 0.87). BPD was
significantly associated with the duration of the first stage (P₁ = 0.007), but not the second stage (P₂ = 0.57). EFW
was not associated with either stage (P₁ = 0.68; P₂ = 0.73). FHC was significantly correlated with the duration of
the second stage of labor (P < 0.01).
Conclusions: Among various maternal and fetal parameters, FHC was correlated with prolonged second stage
of labor without increasing the risk of cesarean delivery. The decision regarding planned cesarean should not be
based on FHC in uncomplicated pregnancies.

Investigation of Biocompatible Wound Dressing and Skin Graft Treatment Methods in the Healing of Skin Wounds of 3rd Degree Burn Trauma in Motahari Hospital: A Clinical Trial

Kourosh Mohammadi Mazleghani — 2025-08-24

Background: One of the primary concerns among burn patients with third-degree skin injuries is the healing
process and the severity of resulting skin lesions—an issue that has attracted considerable research attention.
Accordingly, the present study aimed to evaluate the therapeutic effects of biocompatible wound dressings and
skin grafting on the healing of third-degree traumatic burn wounds in patients admitted to Motahari Hospital.
Methods: This semi-experimental randomized clinical trial was conducted in 2024. The study population
included 18 patients with third-degree traumatic burns covering less than 5 cm², referred to the Motahari Burn
Center in Tehran. Data were collected using a researcher-designed form. Statistical analyses were performed
using SPSS software, employing the Mann–Whitney and Spearman tests.
Results: The mean age of participants was 36.25 years, and most were male (77.77%). The leading cause of burns was gas exposure (44.43%), and 66.68% of patients had burns covering 25% to 45% of total body surface area.
Patients treated with biocompatible wound dressings experienced significantly less scar formation, improved
follicle and dermal appendage restoration, and more aesthetically favorable skin regeneration.
Conclusions: Addressing patients' concerns about wound healing is essential, and effective therapeutic
approaches should be employed. Based on the study's findings, the use of biocompatible wound dressings is
recommended in skin and burn recovery services.

Intact Parathyroid Hormone (iPTH) as a Predictor of Symptomatic Hypocalcemia after Total Thyroidectomy; A Cross Sectional Study

Amin Yaghoubzadeh — 2025-08-24

Background: This study aimed to measure levels of intact parathyroid hormone (iPTH) following total or
completion thyroidectomy, to evaluate its role in diagnosing symptomatic hypocalcemia in affected patients.
Methods: This cross-sectional study was conducted on patients who underwent total or completion thyroidectomy
during 2014–2015. Serum iPTH and calcium levels were measured immediately after surgical wound closure.
Hypocalcemia symptoms were assessed every 8 hours postoperatively. The relationship between serum calcium
and iPTH levels was analyzed. Statistical tests included repeated measures ANOVA, t-test, Chi-square, Mann–
Whitney U, and ANOVA. The optimal iPTH cut-off value was determined using receiver operating characteristic
(ROC) curve analysis.
Results: Of 112 surgical patients, iPTH was measured in 100 cases. Twenty patients developed symptomatic
hypocalcemia. There were no statistically significant differences among normocalcemic, asymptomatic
hypocalcemic, and symptomatic hypocalcemic groups in terms of age, preoperative calcium levels, or length of
hospitalization (P = 0.48, P = 0.46, and P = 0.6, respectively). iPTH levels differed across the groups, notably
between asymptomatic and symptomatic hypocalcemic patients (P = 0.029). ROC analysis identified an optimal
iPTH cut-off value of 18.9 pg/mL, with sensitivity and specificity of 90% and 56.52%, respectively.
Conclusions: iPTH measurement immediately following thyroidectomy shows utility in predicting symptomatic
hypocalcemia and may play an important role in identifying patients at risk postoperatively.

A Rare Case of Twice Perforated Appendix

Turgavarathan Letchumanan — 2025-08-24

Stump appendicitis is a rare complication of appendectomy. It was first described in 1945 by Rose [1]. To date,
it remains both a diagnostic dilemma and a management challenge for clinicians.
We present a case of a 58-year-old gentleman with a past history of appendectomy, who presented with cardinal
symptoms and signs of intestinal obstruction. Assessment with CT abdomen revealed pericecal inflammation,
pneumoperitoneum, and multiple intra-abdominal collections; however, stump appendicitis was not identified.
He underwent surgery, during which stump appendicitis was diagnosed intraoperatively, and a completion
appendectomy was performed. We review the literature regarding the diagnostic challenges and treatment
strategies for stump appendicitis.