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1. Deroofing - a Method of Choice in the Treatment of Suppurative Perineal Hidradenitis

Author

Filipov, E., Ristovski, I., Nedyalkov, K., Mirochnik, P., Stoykov, D., Karastoyanov, E., Presolski, I., Nguen, D., Iliev, S., Tonchev, P., and Grozev, V.

Subjects
following-up, deroofing, perineal suppurative hidradenitis, bacterial flora, surgical methods
Abstract

Purpose: Suppurative hidradenitis is a chronic relapsing inflammatory disease that affects the apocrine sweat glands. Therefore, it is most often located in the axilla, groin and perianal area. Usually, people of working age affected. Perineal and perianal locations cover about 37% of the total morbidity rate and are more common in males. The objective of this study was to share our experience with the application of deroofing for the treatment of purulent perineal hidradenitis. Material and methods: This prospective interventional study covered 13 patients with suppurative fistulasing hidradenitis of perineum treated in Division of Coloproctology and Septic Surgery, Georgi Stranski University Hospital of Pleven for the period from 2008 till 2013. Results: The interval between the occurrence of disease and its surgical treatment was very long - from two to 36 years (average of 9,2 years). It resulted from the progression of the disease with enlarged soft tissue involvement. Sometimes, the disease was complicated by chroniosepsis. The average hospital stay was 13,5-day long. Operative wounds healed secondarily at an average of about 30 days. The patients were followedup for six months, one year and two years. Two patients with relapses on the sixth postoperative month were hospitalized again. The surgical intervention warranted good results. Conclusion: Treatment of suppurative hidradenitis of the perineum is complex, both in terms of local status and systematic violations resulting in chronic infection. There are numerous surgical techniques for treating this pathology. The advantages of deroofing are the following: minimal trauma to the patient, application by using local anesthesia at the early stage in order to minimize hospital stay, no need of special equipment, a lower recurrence rate than the other methods and formation of aesthetically acceptable scar.

Published
2013

2. Changes in the Function of the Anal Sphincter Complex and Generated anal Pressure at Different Anatomical Levels After Elastic Ligature Application in Patients with Anal Fistula

Author

Iliev, S., Tonchev, P., Presolski, I., Grozev, V., Stoykov, D., Ekrem, I., Valcheva, A., and Nguen, D.

Subjects
postoperative anal incontinence, anal fistula, fecal incontinence severity index, elastic ligature, anal canal pressure, anal sphincter tonometry
Abstract

Purpose: The purpose of the present study was to measure by means of especially developed apparatus the anal and intrarectal pressure before and after different operations for perianal fistulas as well as to correlate the degree of incontinence evaluated by Fecal Incontinence Severity Index (FISI) with changes in the measured pressures and type of operation used. Material and methods: The study covered 311 patients with perianal fistulas who were operated with several methods. Anal canal pressures at 5 different levels were measured by the especially developed apparatus at rest, squeezing and cough, before and after 6 months of operation. FISI form was used for incontinence detection. Results: Resting, squeezing and cough pressures were higher in men before and after operations. Average reduction of anal rest pressure by 10-15%, at contraction by 20-25% and at cough by 5-10% resulted in mild incontinence according to FISI score. Average reduction of anal rest pressure by 20-25%, at contraction by 30-40% and at cough by 20-25% correlated with postoperative moderate degree of incontinence according to FISI score. No severe incontinence was registered by FISI examination. Usage of the method of elastic ligation of perianal fistulas, i.e. the method of Hippocrates-Thoma Junescu caused the highest percentage of postoperative mild degree incontinence (15,9%) and moderate one (4,3%) by FISI. No patients presented with severe degree of incontinence. Conclusion: The method of anal sphincter tonometry demonstrated a significant reduction of anal pressure after surgery for anal fistulas. This objective decrease of anal sphincter tone correlated with the higher FISI score arguing of postoperative incontinence. The method of Hippocrates-Thoma-Junescu resulted in the highest rate of incontinence (around 20%) and anal pressure reduction.

Published
2013

3. Proceedings of XII-th National conference of Coloproctology with nternational participation

Author

Blagov, I.; Clinic of Abdominal Surgery, University Hospital "St. Ann", Sofia, Sechanov, I.; Clinic of Abdominal Surgery, University Hospital "St. Ann", Sofia, Katev, N.; Medical University Sofia, Goranov, N.; Medical University Sofia, Jaramov, N.; Medical University Sofia, Radionov, M.; General and endoscopic surgery clinic, University hospital "Saint Anna" Sofia, Shirouzu, K.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Kinugasa, T.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Akagi, Y.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Damianov, N.; Military medical academy -Sofia, Ward of coloproctology, Iliev, S.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Tonchev, P.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Presolski, I.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Grozev, V.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Filipov, F.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Mirochnik, P.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Raycheva, W.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Ristovski, I.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Hristova, V.; Military medical academy -Sofia, Ward of coloproctology, Yaramov, N.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Sokolov, M.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Petrov, B.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Pavlov, V.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Grozdev, K.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Melnikov, V.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Presolski, I.; I-st Surgical Clinic, Department of septic surgery - University Hospital "Dr. George Stransky" - Pleven, Kyosev, V.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Vasilev, K.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Ivanov, P.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Kotashev, G.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Grigorov, G.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Hristov, D.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Barsukov, Y.A.; Department of Colorectal Cancer, Tkachev, S.I.; Department of Radiation Oncology, Mammadli, Z.Z.; Department of Colorectal Cancer, Kuzmichev, D.V.; Department of Colorectal Cancer, Aliev, V.A.; Russian Cancer Research Center, Moscow, Gordeev, S.S.; Department of Colorectal Cancer, Blagov, I.; Clinic of Abdominal Surgery, University Hospital "St. Ann", Sofia, Sechanov, I.; Clinic of Abdominal Surgery, University Hospital "St. Ann", Sofia, Katev, N.; Medical University Sofia, Goranov, N.; Medical University Sofia, Jaramov, N.; Medical University Sofia, Radionov, M.; General and endoscopic surgery clinic, University hospital "Saint Anna" Sofia, Shirouzu, K.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Kinugasa, T.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Akagi, Y.; Kurume University Faculty of Medicine, Kurume-City, Fukuoka, Japan, Damianov, N.; Military medical academy -Sofia, Ward of coloproctology, Iliev, S.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Tonchev, P.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Presolski, I.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Grozev, V.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Filipov, F.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Mirochnik, P.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Raycheva, W.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Ristovski, I.; I-st Surgical Clinic, Department septic surgery - University Hospital "Dr. George Stransky" - Pleven, Hristova, V.; Military medical academy -Sofia, Ward of coloproctology, Yaramov, N.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Sokolov, M.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Petrov, B.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Pavlov, V.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Grozdev, K.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Melnikov, V.; Medical University of Sofia, University Hospital" Alexandrovska", Sofia, Presolski, I.; I-st Surgical Clinic, Department of septic surgery - University Hospital "Dr. George Stransky" - Pleven, Kyosev, V.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Vasilev, K.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Ivanov, P.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Kotashev, G.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Grigorov, G.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Hristov, D.; Military Medical Academy, Clinic of Endoscopic surgery, Sofia, Bulgaria, Barsukov, Y.A.; Department of Colorectal Cancer, Tkachev, S.I.; Department of Radiation Oncology, Mammadli, Z.Z.; Department of Colorectal Cancer, Kuzmichev, D.V.; Department of Colorectal Cancer, Aliev, V.A.; Russian Cancer Research Center, Moscow, and Gordeev, S.S.; Department of Colorectal Cancer

4. [Emergency reoperations in surgery of the gastrointestinal tract].

Author

Kovachev L, Grozev V, and Iliev S

Subjects
Bulgaria epidemiology, Emergencies, Female, Gastrointestinal Diseases complications, Gastrointestinal Diseases mortality, Gastrointestinal Diseases surgery, Humans, Male, Middle Aged, Multiple Organ Failure mortality, Multiple Organ Failure surgery, Reoperation statistics & numerical data, Retrospective Studies, Digestive System Surgical Procedures
Abstract

Data concerning the therapeutic approach in a series of 28 patients, representing 1.3 per cent of the total number of abdominal operations performed in the Chair of Propedeutics of Surgical Diseases over the period 1990-1995, are retrospectively analyzed. In 19 of them primary operative interventions are done on an emergency basis. In further 19 cases the complications have inflammatory character. A total of 31 operations are done with lethality amounting to 36 per cent (10 patients). Multiorganic insufficiency develops in five of them (mean age 39 years). The remainder, dying of septic complications, are with mean age 76 years. The successful treatment of intraabdominal postoperative complications is largely dependent on the surgeon's experience and skills, material equipment and facilities available and on the algorithm of the therapeutic approach adopted.

Published
1997

5. [A laparoscopic cholecystostoma in advanced mechanical jaundice].

Author

Tsvetkov I, Kovachev L, Filipov P, and Grozev V

Subjects
Adenocarcinoma complications, Adult, Cholestasis diagnosis, Cholestasis etiology, Emergencies, Humans, Male, Minimally Invasive Surgical Procedures, Pancreatic Neoplasms complications, Cholecystostomy, Cholestasis surgery, Laparoscopy
Published
1996

6. [Our experience with the surgical treatment of cholelithiasis].

Author

Kovachev L, Kolev R, Filipov P, Presolski I, Grozev V, Tsvetkov I, Deliĭski T, Baĭchev G, Mikhaĭlov M, and Panaĭotova R

Subjects
Acute Disease, Aged, Bulgaria epidemiology, Cholangiography, Cholecystectomy, Cholecystostomy, Cholelithiasis complications, Cholelithiasis diagnostic imaging, Cholelithiasis mortality, Chronic Disease, Humans, Intraoperative Care, Middle Aged, Retrospective Studies, Cholelithiasis surgery
Abstract

The treatment results in 312 patients with cholelithiasis, covering the period 1989 to 1993, are retrospectively analyzed. Overall postoperative lethality amounts to 4.4 per cent. The obtained results are fully comparable in terms of both missed concrements left behind within the extrahepatic bile ducts, and in terms of postoperative complications, associated with the indications for choledochotomy. This is attributed to the therapeutic approach algorithm adopted with respect to the indications for intraoperative cholangiography and choledochotomy.

Published
1994

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