Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids - early and long-term postoperative results.

BACKGROUND: A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results. METHODS: The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients' satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0. RESULTS: There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients' satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802). CONCLUSIONS: Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients' selection. TRIAL REGISTRATION: (retrospectively registered) researchregistry 3090 .

Clinical case of neuroendocrine malignant tumor with unusual localization in the adrenal cortex.

The authors present unusual clinical case with atypical diagnostic work-up and histological result of adrenal neuroendocrine carcinoma.

Advantages of transanal hemorrhoidal dearterialization as compared to other surgical techniques for the treatment of hemorrhoidal disease.

UNLABELLED: Transanal hemorrhoidal dearterialization (THD) is a new surgical technique used for the treatment of hemorrhoidal disease. It is known for its easy performance and low perioperative risk. 44 patients have been operated by this method at the Clinic of General, Liver and Pancreatic Surgery for a period of 22 months. A comparative analysis was performed between the postoperative results with the use of transanal hemorrhoidal dearterialization, modified hemorrhoidectomy of Milligan-Morgan, and Whitehead's hemorrhoidectomy. CONCLUSIONS: When comparing transanal hemorrhoidal dearterialization with other methods, we found that it has an excellent aesthetic effect, requires shorter hospital stay and less analgesics, and causes less discomfort in the postoperative period.

[Carcinoma of the stomach - our experience with surgical treatment]. / Kartsinom na stomakha - nashiiat opit v khirurgichnoto lechenie.

Carcinoma of the stomach is among the commonest malignancies of the gastrointestinal tract regardless of the permanent tendency of its diffusion to decrease, observed in the last 25-30 years. The readily accessible methods of diagnosing the disease contribute greatly to its early detection. However, owing to diverse causes, in over 70 per cent of cases the diagnosis is usually made as late as in the advanced III-IV stages. The latter circumstance preordains largely the unfavourable long-term results of the treatment undertaken where surgery plays a major role. It is the purpose of this study to analyze the surgical strategy and tactics currently used in the management of gastric carcinoma. Over a 5-year period (Jan 1995 through Dec 1999), in the Chair of General and Operative Surgery of the Medical University--Sofia a total of 184 gastric carcinoma patients, including 116 men (63.1%) and 68 women (36.9%) with age ranging from 23 to 80 years, undergo operation. Diagnosing is based on past history, physical, laboratory and x-ray data, but first and foremost on evidence from FGS and histological assessment of biopsy material (carried out in all patients). With a view to precise preoperative staging of the lesion, roentgenoscopy + roentgenography of lungs, USD and CAT of the abdominal organs are also done. The following intervention are performed: gastrectomy 18 (9.8%), upper pole resection 43 (23.4%), subtotal resection of stomach 4 (2.2%), prosthetic replacement of cardia 8 (4.3%), derivations 22 (11.9%), and explorative laparotomies. Combined subtotal gastric resections of gastrectomies are necessitated in 73 patients (39.7%) because of carcinomatous infiltration of contiguous organs and/or presence of liver metastases. Morbidity involves 29 patients (15.7%) with lethality amounting to 16 (8.7%). The long-term postoperative results are discussed under a separate heading. Operative treatment of gastric carcinoma patients is the only chance of survival. The scope of indication for more aggressive surgical interventions, including combined resections and gastrectomies, are broadened leading in turn to a considerable reduction of the proportion of explorative laparotomies.

[Surgical treatment of insulinomas with observations on six cases in one year]. / Operativno lechenie na insulinomite s nablyudenie v'rkhu shest klinichnim sluchaya za edina godina.

Insulinomas are among the endocrine pancreatic tumors most commonly met with. Regardless of their small proportion compared to other tumors of the digestive system, they give rise to pressing surgical problems on account of a number of reasons, namely: 1) early clinical diagnosis and undertaking opportune operative management in those presenting benign neoplasms, even in oligosymptomatic cases, 2) exact topical preoperative diagnosis using echography, CAT, MRI, angiography and the like; 3) intraoperative identification of the tumor/tumors in the event of multiple involvement, and choice of the most adequate operative approach, 4) intra- and postoperative monitoring of the blood sugar levels and appropriate insulin therapy prescription. Over the period Jan/Oct 1997, six patients presenting clinical, laboratory and instrumental evidence of insulinomas are subjected to operation in Department of General and Operative Surgery of the Medical University-Sofia. The basic principles with a reference to preoperative topical diagnosis and surgical tactics adopted, as well as postoperative care and monitoring of hyperglycemia developing as the result of surgery, are thoroughly discussed. Good immediate and long-term postoperative results are recorded in all six patients.