[Extensive right-sided hepatectomy for a metastatic process in patients operated on for colonic carcinoma]. / Desnostranna razshirena khepatektomiia zaradi metastatichen protses pri operirani za kartsinoim na kolona.

Proceeding from experience with a large number of liver resections performed for single or multiple metastases atypical in appearance, including left lobectomies, a description is presented of wide right-sided hemihepatectomy, done for the first time (13 May 1997) in the surgical clinic of the National Oncological Center. The intervention is undertaken because of two metastases in the liver subsequent to radical operation for carcinoma of the sigmoid colon. The single stages of the operation are likewise described. The effectiveness of application of Penchev's "Parenchymatome" (made in Bulgaria--Military Medical Academy) and "Tisomat" apparatus is evaluated. Using the latter the resection liver surface is sprayed with a bicomponent fibrin adhesive "Tisucol", obtained from the firm Immuno-AG.

[The tumor markers CEA and CA-19.9 in patients with colorectal carcinoma]. / Tumorni markeri CEA i CA-19.9 pri bolni s kolorektalen kartsinom.

The levels of two tumor markers--CEA and CA-19.9 were repeatedly determined in 146 patients with histologically verified colo-rectal cancer and in 58 healthy controls. The normal CA-19.9 values were up to 30 U/ml. The sensitivity of the two markers proved to be low: 48.8 per cent for CEA and 37 per cent for CA-19.9. In 26 of 35 patients with local recurrence or metastases marker increase preceded the appearance of clinical symptoms of progression of the pathologic process. The two markers appeared more informative than each of them when separately determined.

[A combined method for treating metastases of colorectal carcinoma to the liver]. / Kombiniran metod za lechenie na metastazi ot kolorektalen kartsinom v cherniia drob.

The method is a combination of operative treatment of metastases in the liver and regional intra-arterial chemotherapy. The indications for operative treatment of the underlying tumor, the metastases in the liver and the regional chemotherapy are pointed out. Two groups of patients with colorectal cancer and remote metastases in the liver are presented: one received surgical treatment alone, the other combined therapy. It is assumed that the combined treatment of the basic tumor, the metastases in the liver plus regional intra-arterial chemotherapy is a new trend in the treatment of advanced colorectal cancer metastasized in the liver.

[A method for placing and using an indwelling epidural catheter for analgesia in incurable cancer patients]. / Metod za postaviane i izpolzvane na traen epiduralen katetur za obezboliavane pri inkorabilni onkobolni.

Operative technique for implantation of indwelling epidural catheter produce of the firm "Braun" (Germany) is described. During the implantation the analgesics zone is checked with Lidocaine. The catheter pouch is fixed over a bone pad in a place well visible by the patient. For permanent pain relief Dipidolor is applied twice daily one quarter of the ampoule. This catheter is implanted for pains originating from the lower extremities, the pelvis and the abdomen. The method was applied on 2 patients with very good results obtained with minimal amount of opiates.

[Sexual disorders in men following radical operations on the rectum for carcinoma]. / Polovi narusheniia pri muzhe sled radikalni operatsii na rektuma zaradi kartsinom.

This is the first study in Bulgaria of postoperative sexual disorders following radical surgical operations for rectal cancer. The study group comprised 64 patients. Six months after the operation only 15 (24.4 per cent) were able to have erection. Fourty nine patients who complained of inability to have erection received long-term treatment with vitamins, tranquilizers, cholinomimetic drugs, beta-blockers and medicines increasing bladder tonus. Normal erection was re-established in 31 (63.3 per cent) of these patients. The 18 (36.7 per cent) patients unaffected by drug treatment reported of possible ejaculation. This is an indication that impairment of sympathetic innervation of the genitals after operations of the rectum is of transient nature, whereas parasympathetic damage may be definitive.

[The use of a new plastic method for consolidating a preternatural anus as prevention in paracolostomy hernias]. / Prilozhenie na nov plastichen metod za ukrepvane na protivoestestveniia anus praeter kato profilaktika na parakolostomichnite khernii.

Once the stage of extraperitoneal evasion of the sigmoid has been achieved for definitive preternatural anus, transsection is made of the aponeurosis of m. obliqu. ext. abdominis along its tendon fibers at a length of 5-6 cm. Then an aperture is made along the muscle fibers with the same length on m. obliqu. int. abdominis and m. transversus abdominis as well and finally f. transversalis is transsected. The peritoneum is intra-abdominally detached from the fascia beneath and alongside the aperture. An "Ampoxen" layer is placed around the internal aperture of the abdominal wall. The explant is sutured to the fascia and the evaded sigmoid. The latter is sutured to the aponeurosis of m. obliqu. ext. abdominis. Another Ampoxen layer is placed over this aponeurosis and sutured to the evaded intestine and in a chess-board way to the fascia. The method was applied in 22 patients with very good postoperative result.

[The results of using a new surgical method in carcinomas located in the proximal portion of the lower third of the rectum]. / Rezultati ot prilozhenieto na nov operativen metod pri kartsinomi, razpolozheni v proksimalnata chast na dolnata treta na rektuma.

A new type of abdomino-transanal resection of the rectum instead of its extirpation is being applied in tumors localized in the proximal part of the lower one third of rectum (5-6 cm from the anorectal line). For removing the whole lymph collector of the lower one third of the rectum the authors remove the levator tunnel as well. What remains intact is only the anal mucosa and the external anal sphincters. The anastomosis is realized by preliminary placing all catgut. Prophylactic transversostoma is also an obligatory procedure, so that the anal sphincters may remain at rest for 2-3 months after the operation. During this time the anal sphincters and the neorectum are fixed to the adjacent tissues and the anal tonus is fully restored. This operation was applied in 15 patients with very good result, as regards anal continence, without any case of relapse of the tumor so far.

[The use of a new method for the restoration of duodenal passage following the partial extirpation of its wall in treating locally advanced tumors of the right half of the colon]. / Prilozhenie na nov metod za vuzstanoviavane na duodenalniia pasazh sled partsialna ekstsiziia na stenata mu pri lechenie na lokalno avansirali tumori na diasnata polovina na kolona.

When excision of the tumor infiltration of the duodenum is followed by formation of a small defect, the authors apply a personal modification of two-story suture. Then the duodenal suture is fully covered with the serosa of the small-intestinal loop. Thus the suture is hermetically sealed and remains in a relative rest. When a large defect remains after excision of the tumor infiltration of the duodenum, a short jejunal loop is taken and a longitudinal section is made on it of equal length with that of the duodenal defect. Laterolateral anastomosis is made between the duodenal defect and the jejunum. Brown's anastomosis is made somewhat distally from the duodenojejunostomy. In this way the duodenum is not narrowed, the tissues are sutured without any tension and postoperative duodenal stasis is minimal. The first variant of the method was applied in 3 patients and the second in 3 patients with very good postoperative result.

[The results of the formation of a new anal sphincter by using the mm. graciles in acquired anal incontinence]. / Rezultati ot oformianeto na nov analen sfinkter chrez izpolzvane na mm. graciles pri pridobita analna inkontinentsiia.

The operative method of Pickrell for shaping a new anal sphincter from mm.graciles is described, emphasizing the refinements which the authors have introduced in it. In mobilizing the muscle, fascial fibers are left on both sides of the vascular-nervous bundle. They prevent the latter from overdistension when the muscle turns around the anal canal. Two arcuate lateral sections are made in the perianal area; this is followed by driving a subcutaneous tunnel, but under the perineal raphe and the anococcygeal ligaments. The two muscles are perianally wound each on 360 degrees, whereby m.gracilis dex. is fixed to tub. ossis ischii sin. and m.gracilis sin. is fixed to tub. ossis ischii dex. Before being fixed, the tendon end is inserted in the subperiosteal bone tunnel. When the tendon of the muscle is shorter, it may successfully be elongated by the explantoplast Ampoxen (applied in 3 patients). A total of 16 patients were treated. The result was good in 15 (93.8 per cent) and unsatisfactory in 1 (6.2 per cent).

[The use of a transabdominal method in treating inguinofemoral hernia simultaneously with surgery of the rectum or sigmoid in carcinoma]. / Prilozhenie na transabdominalen metod za lechenie na ingvinofemoralni khernii ednovremenno s operatsii na rektuma ili sigmata zaradi kartsinom.

Detailed description is given of inguinofemoral herniotomy with subsequent plastic repair through transabdominal approach simultaneously with radical oncologic operation of sigmoid and rectum. The plastic repair is a two-stage procedure: The first stage consists of suturing the musculo-aponeurotic part of m. transversalis and m. obliq. internus abdominis to lig. inguinalis or lig. inguinalis to lig. Cooperi in femoral hernias. The second stage is the "ampoxen" explant, which is sutured cranially to f. transversalis, medially to the fascia behind m. rectus abdominis, downward to the public or obturator fascia and laterally to the fascia over m. iliopsoas. The explant serves as a firm "umbrella" from the internal part of the entire inguinofemoral area. The method was applied on 7 patients with very good postoperative result.

[The results of using necessarily low anterior resections for carcinoma of the lower half of the middle third of the rectum]. / Rezultati ot prilozhenieto na prinuditelno niski predni rezektsii po povod kartsinom v dolnata polovina na srednata treta na rektuma.

Compulsively low anterior resection of rectum was performed in patients with tumor localized in the lower half of the middle one third of the rectum (7-10 cm from the anorectal line) and vague vascular arcades in the left half of the colon or having very fat meso. The following technique was applied: The left half of the colon was mobilized, releasing it from the gastrocolic junction, and the rectum--to the anal sphincters; One-stage anastomosis with step-like course of the catgut was performed, threading it previously to the posterior and lateral parts of the anastomosis and on the anterior wall--to the rectal stump only; when the anastomosis was performed, the catgut was passed through the upper pelvic diaphragmatic fascia as well. The method was applied on 19 patients; the first six of them had prophylactic transversostomy performed. In none of the patients was insufficiency of the anastomosis or recurrence of the tumor observed.