Palliative large bowel resections. Impact of the laparoscopic approach

INTRODUCTION: Nowadays colorectal cancer (CRC) incidence rate increases in the Western world. The lack of effective screening programs results in diagnosis of advanced cases in our country. Combination of hematogenic, peritoneal or systemic CRC dissemination with present or potential complications from local disease is not an exception. The decision for palliative resection is not easy and is a matter of balance be­tween potential risks of operative intervention and advances due to local tumour resection. Positive aspects of the laparoscopic approach are important in planning of these interventions. The aim of this study is to as­sess the indications for laparoscopic palliative large bowel resections in the literature available and to share our own experience.PATIENTS AND METHODS: During a two-year period, in the HPB and General Surgery Clinic, Acibadem City Clinic, Tokuda Hospital of Sofia, six laparoscopic palliative colon resections were performed. In the all cases, multiple liver metastases were diagnosed without possibility of liver resection. The early periopera­tive results were analyzed.RESULTS: Four left colon resections were performed with primary anastomosis due to high-level large bow­el obstruction and two right colectomies were done for primary tumour bleeding. Three patients were over 77 years old and presented with comorbidity. Average hospital stay was 5,6 days. No perioperative compli­cations were observed.CONCLUSION: Minimal surgical trauma, short recovery period and well-defined indications are important features in the process of planning of palliative large bowel resections in patients with disseminated CRC. The objective is to reduce risks of complications connected with primary tumour and to assure a good pa­tient`s quality of life. Scr Sci Med 2017; 49(3): 27-3

Surgical Treatment of Chronic Pilonidal Disease

Introduction: Pilonidal disease is a relatively common surgical disease affecting mainly young men aged 15–35 years (almost 4 times more than women) and with a tendency to increase its prevalence in the last two decades, including also among women. Although many surgical treatment methods have been described, the rate of recurrence and complications related to wound healing remain relatively high (17.5% and 11.6%, respectively, according to literature data) and worsen the quality of life of the patients for a long period of time.Material and Methods: For a 10-year period, from 2012 to 2022, 235 patients with an average age of 42.1 years were operated on for a pilonidal cyst in the Clinic for Hepatobiliary, Pancreatic and General Surgery of Acibadem City Clinic Hospital Tokuda. In 37.4% of them, surgical treatment was due to recurrence.Results: In all patients, after verification of the fistula course(s) with methylene blue and/or a ball probe, a sheet-like excision of the formation was performed. In 24 of the cases (10.2%), transposition with a Limberg flap followed; 118 patients (50.2%) were treated according to the so-called open method, and in 93 patients the resulting defect was closed primarily with imposed drainage.Conclusion: The ideal therapeutic approach should provide a short recovery period with the possibility of a quick return to normal daily life. Currently there is no consensus on the best operative technique

Acute appendicitis without appendicitis

Introduction: A clinical, imaging, and laboratory constellation for acute appendicitis requires operative treatment to avoid life-threatening complications such as perforation and peritonitis. The latter, in turn, are an absolute indication for surgical intervention. Although it does not change the operative approach, in rare cases, the cause of the condition is appendicular diverticulitis—usually an incidental, pathological diagnosis with a literature frequency of 0.004–2.1%. The differential diagnosis of diverticula of the appendix in patients with acute appendicitis is important because of the higher risk of developing the above complications, but also because of primary neoplasms of the appendix. The latter are rare Tu with a frequency of 0.2–0.5% of all GIT neoplasms. Among them, carcinoids are the most common and are characterized by slow growth and a long asymptomatic course. However, they often present with the picture of acute appendicitis with/without perforation, abscess or peritonitis.Materials, Methods and Results: The study was single-center, retrospective. Three patients with histologically verified appendicular diverticulitis with perforation and periappendicular abscess are presented, necessitating laparoscopic appendectomy (1 case), conventional appendectomy (1 case), right hemicolectomy (1 case). Adenocarcinoma of the appendix was proven in two patients with laparoscopic appendectomy.After verification of the permanent histological result and after discussion with the hospital Oncology Committee in the first case, the operation performed was determined to be sufficient in view of the oncological radicality. In the second case, reoperation with right hemicolectomy was recommended for histological evidence of T3 adenocarcinoma of the appendix. An appendicular mucocele was pathologically proven in one of the patients after laparoscopic appendectomy.Conclusion: The differential diagnosis of diverticulitis of the appendix in patients with acute appendicitis is important due to the higher risk of developing the above complications, but also because of primary neoplasms of the appendix. The latter are rare Tu with a frequency of 0.2-0.5% of all GIT neoplasms, which can also present with the picture of acute appendicitis with/without perforation, abscess or peritonitis

Underwater archaeological survey of Nesebar Aquatory

The underwater archaeological heritage of Nesebar, ancient Mesambria, was surveyed from 1960 to 1984. L. Ognenova discovered remains from the fortification system of the ancient town, dated to Pre-Greek, Classic, Hellenistic and Late Antique period (Preshlenov 2012). Most of the underwater monuments from the northern side of Nesebar peninsula were buried under coastal protection facilities built in 1980s. In 2017 the Center for Underwater Archaeology resumed the study. Most of the known and some unknown monuments were discovered and documented. These were walls of massive slabs (fig. 3, fig. 1. 2, 7) or well processed blocks (fig. 2, fig. 1. 4–6) associated with the Greek polis, Late Antique walls of stones with mortar (fig. 1. 1) as well as in opus mixtum (fig. 1. 3, 10). A wall dated to the Pre-Greek period was not found. The majority of these structures laybetween 2 and 3 m depth. Only one wall of blocks (fig. 1. 6) is at 5,5 m depth (Preshlenov 2012, 503, fig. 5, 509–512). A marine geophysical survey was conducted