Prevalence of body dysmorphic disorder among Saudis seeking facial plastic surgery Zainab Salman Al Shuhayb Saudi Surgical Journal 2019 7(3):83-86 Importance: Nonpsychiatric physicians often encounter body dysmorphic disorder (BDD) which is a common psychiatric disorder. In the general population, BDD is estimated to affect 1%–2%. In esthetic specialties, however, rates are markedly higher. Objective: This study aims to quantify the prevalence of BDD among people seeking facial plastic surgeries in Saudi Arabia because the literature is sparse in this field. Design: This is a cross-sectional study, conducted in 2018 (October–December). Setting: A self-administered web-based questionnaire was administered on 453 individuals, aged 18 years and older, of Saudi residence. Participants: A total of 453 individuals, aged 18 years and older, of Saudi residence, were enrolled in the study. Main Outcome(s) and Measure(s): The study has three main measures which are: (1) sociodemographic data, (2) previous and future plastic surgeries, and (3) the Body Dysmorphic Disorder Questionnaire. Results: A total of 453 individuals were enrolled in this study. Of the total sample, 34.2% reported their desire to go for a facioplastic surgery in future, of which 14.19% fulfilled the criteria of BDD. Twenty-two individuals who fulfilled the criteria were all females (100%). All were relatively young, with 54.5% aging between 18 and 24 years of age, followed by 45.5% aging between 25 and 34 years of age. The majority were married 54.5%, with the rest being single. The majority of individuals (59.1%) live in cities, followed by 36.4% living in villages and 4.5% living in outskirts. Nearly 68.2% hold a college degree, followed by 27.3% holding a high school degree. The vast majority reported the desire to undergo a rhinoplasty (54.5%), followed by facial implants (9.1%), facelift (4.5%), eyebrow lift (4.5%), and cheek/jaw contouring (4.5%). Conclusion: We report a prevalence of 14.19% among people seeking facial plastic surgery. This prevalence is warring, requiring special attention by facioplastic surgeons, plastic surgeons, and dermatologists, when dealing with patients. We recommend the screening of all patients to be a standard practice to ensure the best outcome possible.

Predictors of career satisfaction among physicians: Observations from a tertiary care center Abdulmalik Altaf, Lujain Attar, Hani Z Marzouki, Ashraf A Maghrabi, Hanaa Tashkandi, Wisam Jamal, Murad Aljiffry Saudi Surgical Journal 2019 7(3):87-94 Introduction: Career satisfaction is vital to attain the superlative quality of work; dissatisfaction can consequently impact physicians' performance. This study was conducted to ascertain the level of physicians' satisfaction at work as well as identifying influencing factors. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants were clinicians serving in different specialties for 2 years or more after finishing their training. Job satisfaction was assessed through a self-administered questionnaire. Response to each question to each question was devised using 5-point Likert scale on a wide range of demographics, job characteristics, and five main domains of job satisfaction. Data analysis was executed using SPSS package (v. 24). Results: A total of 159 clinicians participated in our study. Majority of the participants were Saudi (145, 91.2%), with 113 male (71%). Age ranged between 30 and 40 years. 140 were married (88%). In general, more than one-third of the physicians were dissatisfied with their overall job condition 60 (38.0%). The most important prognosticators of career satisfaction were found to be age, years of experience, and type of practice (public vs. private or both). When a multivariate analysis, regression model was applied, “clinicians satisfaction with workload” and “time and energy spent on administrative tasks” were found to have a negative effect on job satisfaction. Conclusion: More than one-third of the clinicians were generally dissatisfied with their overall job condition. Goals should be directed to improve the elements that adversely affect career satisfaction. Necessary interventions are indicated to improve clinicians' performance in clinical practice, maximize the quality of care, and maintain stable workforce.

Management of nonvascular postlaparoscopic bile duct injury Bilal O Al-Jiffry, Mohamed Al Saeed, Majed Al-Mourgi, Samir Badr, Tamer Abdel-Rahman, Abdel-Hafez Shweel, Alaa E Younes, Abdullah Al-Sawat, Aseel Abu-Duruk, Owaid Al-Malki, Mohamed Hatem, Mahmoud El-Meteini Saudi Surgical Journal 2019 7(3):95-99 Background and Aim of the Work: Early management of postlaparoscopic nonvascular biliary injuries by an expert team is essential to achieve a good outcome. In this article, we would evaluate the results of this prospective multicentric study in the management of postlaparoscopic nonvascular biliary injuries. Patients and Methods: This prospective multicentric study enrolled 168 patients with iatrogenic nonvascular bile duct injury (BDI). In all cases, endoscopic retrograde cholangiopancreatography (ERCP) was performed, and further management was done according to Strasberg type of injury. Results: Intra-abdominal biliary collection was managed by ultrasound-guided drainage. Type A (19%) was diagnosed and treated by ERCP. Types B and C (20.2%) were treated by duct reconstruction of the isolated segment and Roux-en-Y hepaticojejunostomy (RYHJ), respectively. Strasberg type D nondevascularized partial injury (7.1%) was treated by primary repair around stent. In complete type D patients and E (10.7% and 43%, respectively), Roux en-Y hepaticojejunostomy with lowering the hilar plate was performed. After ERCP, 78% of patients developed hyperamylasemia and only 4.8% developed pancreatitis. After HJ, 9.7% of patients developed stricture and were treated by percutaneous transhepatic cholangial dilatation. Conclusion: This study proved the safety and efficacy of the management of iatrogenic BDI by an expert team implementing different diagnostic and treatment modalities such as ultrasound, computed tomography scan, and ERCP in addition to different surgical options, particularly the use of right end-to-side and left side-to-side RYHJ, with lowering the hilar plate and anterior anastomosis.

Gastrointestinal stromal tumors: Do we follow the current guidelines? A self-critique Mohammad Ezzedien Rabie, Abdelelah Hummadi, Mohammad Bazeed, Ismail El Hakeem, Abdulla Saad Al Qahtani, Hesham Haroon, Abbas Al Zain Saudi Surgical Journal 2019 7(3):100-107 Background: Despite its rarity, gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Several guidelines are currently present where, among other recommendations, mutational analysis and referral to specialized centers have been mentioned. However, this might be difficult to apply at times. Aim: The aim of the study is to explore our experience in the management of GIST. Patients and Methods: Histopathologically-proven GISTs, encountered in our hospital in the period from June 2012 to November 2018, were included in the study. Results: We identified 14 patients, 8 males and 6 females, with a mean age of 58.6 years. Thirteen patients were sporadic GIST, while one was syndromic (associated with neurofibromatosis, multifocal, and arose from the small gut). Twelve patients presented in an emergency situation, while two presented in an elective setting. Thirteen cases were primary localized GISTs and one was metastatic. The organs involved were the stomach in five cases, ileum in four cases, jejunum in two cases, duodenum in two cases, and rectum in one case. In 13 cases, the patient's complaint led to the diagnosis, while in one case, it was discovered incidentally on investigations for another illness. The main clinical features were abdominal pain in five cases, melena and anemia in four cases, hematemesis and melena in one case, rectal bleeding in one case, abdominal pain and mass in one case, intestinal obstruction in one case, and urinary retention and constipation in one case. The mean diameter of the cyst on computed tomography was 8.7 cm. An endoscopic biopsy was performed in six occasions and missed the diagnosis in four of them, whereas percutaneous biopsy was performed in five occasions and was suggestive in two cases and diagnostic in the remaining three. According to a combination of stage, (primary, metastatic, or recurrent) size, risk stratification, mode of presentation, performance status, and comorbidities, treatment was planned. Five patients received surgery only, three patients received surgery followed by imatinib, one patient left to be treated elsewhere, and three patients received surgery to be followed by imatinib but did not show up, one patient received imatinib only, and one patient is still under evaluation. The mean duration of follow-up was 65.7 months, where the disease showed no recurrence in four cases, metastasized to the liver in two cases, and death occurred in two cases, while five cases were lost to follow-up. In this series, no mutational analysis was performed as imatinib was the only drug used, and no referral to specialized centers was done. Conclusion: Surgical resection and kit inhibitors, either alone or in sequence, are the main pillars of treatment of GIST. Risk stratification, in addition to the mode of presentation, the presence or absence of metastasis and comorbidities, dictates which plan to follow. Except for mutational analysis, and referral to specialized centers, our practices are in line with the current guidelines to a reasonable extent.

Awareness of first-aid management of epistaxis among school students in Jeddah, Saudi Arabia Khalid A Alshehri, Waleed M Alqulayti, Omar Mohammed Saggaf, Maryam Z Enani, Abdulrahman K Bahatheq, Lujain K Abdalwassie, Hani Z Marzouki Saudi Surgical Journal 2019 7(3):108-112 Objective: The objective of this study was to assess the level of awareness regarding primary home management of epistaxis among high- and middle-school students and their teachers. Materials and Methods: This cross-sectional study was conducted in December 2018 by distributing a paper-based questionnaire to high-and middle-school students and teachers in Jeddah, Saudi Arabia. Results: The study included 706 individuals (53.4% males and 46.6% females) with a mean age of 16.58 ± 5.57 years. Based on the correlation between our variables, 57.5% of the participants had a good knowledge score, while only 3.5% had an excellent score. Male high-school students were significantly more knowledgeable than female middle-school students. Conclusion: Awareness of first-aid management of epistaxis was fair. However, more integrated educational resources should be made available for the general population and school students and teachers.

The prevalence of sharp injuries in the operative room among surgical residents and their behavior to them in the southern region of Saudi Arabia Saad Mohammed Abdullah Alqahtani, Shaker Hassan Al-Shehri, Turki Khalid Alshehri, Salah Saad Al-Zahrani, Sameer Marei Alqahtani Saudi Surgical Journal 2019 7(3):113-118 Background: Residents of surgical specialties have a high risk of sharp injuries. The reporting behaviors have a critical step in prophylaxis and early treatment. Aim: The aim of this study is to assess the prevalence of sharp injuries in the operative room among surgical residents and their behavior. Methodology: A descriptive cross-sectional study was conducted including 166 surgical specialty residents who involved in operating procedures from seven hospitals in the southern region of Saudi Arabia. A self-administrating questionnaire about sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures was used for data collection. The study questionnaire was developed by the researchers after intensive literature review and another research tool from a previous similar study which was conducted in King Abdul-Aziz University Hospital in Jeddah city of Saudi Arabia. Results: About 64% of the residents have had at least one sharp injury in the last year. Most of these injuries (53.3%) occurred while suturing and 76.6% claimed the reason was due to fatigue. Most of the recent injuries (86%) were self-induced injuries caused with a solid needle (65.4%). The most common action post the injury was replacing the gloves and the needle (36.7%). Only 9% of them have reported all of their injuries to the concerned authorities, and 56% claimed the reason that they were not bothered. About 75.3% of them were aware of their local policies. Conclusion: Sharp injuries and needlestick are common among surgical residents, but they have weak reporting behavior. More educational training program about the sharp-related safety program may improve their attitude and behavior regarding sharp injuries.

Predictors of postoperative complications in retroperitoneal sarcoma surgery Mohammed O Nassif Saudi Surgical Journal 2019 7(3):119-127 Introduction: Retroperitoneal sarcomas (RPSs) are large in size and often involve adjacent organs or vital structures. Completeness of resection is critical for long-term survival; however, this often involves extensive surgeries. This study aimed to identify predictors of early severe postoperative complications after RPS surgery. Methodology: In patients who underwent surgery for RPS, intraoperative variables and patient characteristics were assessed to determine predictors for severe postoperative complications. Results: Two hundred and thirty-three patients were included. In comparison to patients who had no comorbidity, those with one or more comorbidities were more likely to have postoperative complications (odds ratio [OR]: 2.38; confidence interval [CI]: 1.03–5.48). Patients who avoided admission to the intensive care unit (ICU) within 24 h of surgery had less complications postoperatively (OR: 0.08; CI: 0.02–0.30). Multiple organ resection during surgery and patients' age had no impact on the occurrence of severe complications. Conclusion: This study showed that a high patient comorbidity index, male gender, and early admission to the ICU were independently associated with an increased risk of postoperative severe complications. However, the age of the patient and degree of surgical resection had no impact on this occurrence. These findings suggest that age and extent of resection should not be used as a sole determinant of patient's eligibility for curative surgery.

Laparoscopic versus open repair of posttraumatic diaphragmatic hernia (Saudi experience) Abdulrahman Ashy, Hamed Hussien Abousteit, Yasser Ahmed Salem, Essam Badr, Mosab Ibrahim Hassan Saudi Surgical Journal 2019 7(3):128-132 The aim behind this study is to evaluate the feasibility and efficacy of laparoscopic versus open repair of acute and chronic posttraumatic diaphragmatic hernia in three patients treated in our institute in Jeddah, Saudi Arabia.