Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review.

OBJECTIVE: The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. METHODS: A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. RESULTS: Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening (p = 0.66; OR: 0.22; 95% of CI: 0.08-0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06-0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54-18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). CONCLUSION: Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

[Cryosclerosis. The forgotten endovenous cryoablation of the great saphenous vein. Mid-term results of a prospective comparative trial]. / Cryosclerosis. Az elfelejtett endovénás cryoablatio a vena saphena magna elégtelenségének kezelésében. Egy prospektív összehasonlító vizsgálat középtávú eredményei.

INTRODUCTION: Cryosclerosis was introduced by Milleret and Le Pivert in the 1980s. METHOD: A prospective non-randomized comparative study has been performed on initial 96 patients. 48 patients were treated by cryosclerosis and the others received conventional stripping. 52 cases were analyzed for 2-years. The primary end-point of the study was to determine the occlusion rate of cryosclerosis. The clinical failure, the improvement in the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores were analyzed as secondary outcome. RESULTS: Total recanalization of the great saphenous vein causing clinical failure was observed in one case (4%). The reopening of the great saphenous vein was observed in 4 limbs (15%) that did not cause the incompetence of the trunk. The occlusion rate was 81%. Recurrent varicosity was observed by 35% and 42% of the patients in the cryosclerosis and stripping groups respectively. There was no significant difference between the groups (log rank test, p = 0.391). There was significant improvement in both the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores in each group without remarkable differences observed between the groups either at baseline or on the mid-term. CONCLUSIONS: Cryosclerosis seems to be effective in the remodeling of the great saphenous vein. The method has no remarkable mid-term clinical advantages over classical stripping so far. Orv. Hetil., 2016, 157(50), 1994-2001.

[Successfully operated ruptured gastroduodenal artery pseudoaneurysm]. / Rupturált arteria gastroduodenalis pseudoaneurysma sikeresen operált esete.

INTRODUCTION: Visceral real and pseudoaneurysms are the rarest aneurysms of the arterial system. The aneurysms of the duodeno-pancreatic arcade constitute only 2-3% of all aneurysms. Their frequency after pancreatitis can reach 10%. AIM/PURPOSE: On the basis of an individual case the authors summarize their experiences with this rare, but varied disease, and they review the literature data. CASE REPORT: Their female patient of 62 with alcoholic antecedent was hospitalized with haematemesis, melaena, anaemia, icterus repeated several times, while abdominal CT scan verified the pseudoaneurysm of the gastroduodenal artery. The night before the elective operation a hypovolaemic shock arose with strong abdominal pain. Subsequent to the treatment of shock the authors performed the gastroduodenal artery ligation and Kehr-drainage. After an uneventful postoperative care she was discharged. CONCLUSION: Splanchnic aneurysms are rare, they are difficult to diagnose. Their importance lies in the fact that the risk of their rupture is 50% with a high mortality rate. Considering the patient's antecedent and concomitant diseases (alcoholism and pancreatitis) their occurrence shall be considered as a risk factor, so that the diagnosis could be established as soon as possible.

The role of cryosurgery in the treatment of the incompetent great saphenous vein.

Our aim was to determine the place of cryosurgery in the treatment of the incompetence of the great saphenous vein. Primary end-point of this study was to evaluate the clinical effectiveness of cryostripping and cryosclerosis. Complications frequently related to saphenous vein stripping were analyzed secondary. A literature search was conducted in the PubMed-database until September 2014. Randomized controlled trials with at least 6 months follow-up were eligible. Meta-analysis was performed by the IVhet-model. Forty-two unique publications were found- Five of them (3 trials), comparing cryostripping to stripping and endovenous LASER ablation, were eligible for meta-analysis. There were no significant differences between cryostripping and conventional stripping regarding the clinical effectiveness (P=0.06; RR:1.12; 95% of CI: 0.99-1.27) and saphenous neuralgia related to surgery (P=0.48; RR:0.94; 95% of CI: 0.89-0.99). The records of bruising were not uniform and comparable. No randomized controlled trials were found to perform a meta-analysis on cryosclerosis, therefore a short literature review is presented. The study has limitations and weak conclusions because of imprecision (small number of involved trials and limbs) and short term follow-up. Low quality evidences suggest that cryostripping is a reliable, efficient method with better cosmetic results than conventional stripping, however, long term comparisons are not available so far. Cryosclerosis could be an alternate to the known endovenous minimal invasive ablation procedures, but there are no exact strong evidences, especially on the long term.

Our experiences with saphenoperitoneal shunts in the treatment of intractable ascites.

Because of significant expenses and complication rates of traditional pumps (LeVeen, Denver, Agishi) used in the surgical treatment of refractory ascites a simple and cheap operative method has to be found. In saphenoperitoneal shunts the one-way flow is maintained by biologically given double saphenous valves. In our department 11 saphenoperitoneal shunts have been performed on 9 patients (2 female, 7 male) in the past one and a half years. Their ascites have been associated with cirrhosis of the liver (secondary to aethylism in 8, to HBV infection in 1). During the follow-up period significant reduction in body weight and abdominal girth, and increase in diuresis with standard diuretics were seen in 6 patients. The minor complications (3 seromas, 3 hematomas, 2 cellulitis) have been self-limiting in general. In the presence of major complications (1 peritoneal reflux, 1 severe hypoproteinaemia, 3 shunt occlusion) interventions were needed several times. In one of the occlusions contralateral fistula was created with PTFE prosthesis implantation, in another case desobliteration happened with a silicone drain left in the shunt. The saphenoperitoneal shunts could improve quality of life significantly in successful instances with minimal negative operative effects without the adverse effects of insertion of foreign material.

[Experience with saphenous-peritoneal shunts in the treatment of intractable ascites]. / Saphenoperitonealis shunt képzésével szerzett tapasztalataink a refrakter ascites kezelésében.

INTRODUCTION: The price and complication rates of pump models applied in the treatment of intractable ascites are significantly high. The development of a more simple, cheaper technique--using the biologically given venous valves--the saphenoperitoneal shunts became essential. TECHNIQUE AND RESULTS: In authors' department 11 saphenoperitoneal shunts have been performed on 9 patients from 01.01.2001. to 01.04.2002. After operation significant reduction in abdominal girth and increase in diuresis with diuretics in unchanged doses were observed in 6 patients decreasing their dyscomfort. In one of the patients the ligation of fistula have been needed due to peritoneal reflux, in another one severe hypoproteinaemia have developed. In 3 cases shunt occlusions have appeared: one of them have got Denver-shunt, in other case contralateral saphenoperitoneal shunt have been created with PTFE prosthesis implantation, in the third patient desobliteration have been performed with silicone drain. CONCLUSIONS: Significant improvement of quality of life would be caused by saphenoperitoneal shunts with minimal negative operative effects in successful cases. Besides this method is cost-effective, and has moderate and well corrigable hemodynamic effects.

[The simultaneous occurrence of inguinal hernia and colorectal cancer--case reports]. / A lágyéksérv és a colorectalis daganat együttes megjelenésérol néhány eset kapcsán.

INTRODUCTION: The simultaneous occurrence of inguinal hernia and colorectal cancer is rare, but it is well known by surgeons. We call attention to the synchronous diseases with the help of cases accumulating in our department and with the support of literature. CASE REPORTS: A 76-year-old male hernioplasty by Lichtenstein was performed on, and during the exploration because of ileus having developed in the postoperative period a stenosing rectum carcinoma was discovered. 87-year-old inguinal hernial male patient's sigmoid tumor was justified as a result of complex examination completed before surgery. The resection of sigmoid and simultaneously left-sided hernioplasty were carried out transabdominally with implantation of polypropylene mesh. With a 81-year-old male presenting bilateral inguinal hernia a carcinoma of rectum was found with digital examination. A rectum resection by Dixon was made, and in second stage inguinal herniorrhaphies are planned after cytostatic treatment. With a 94-year-old male patient arriving with incarcerated hernia a stenosing carcinoma of rectum was palpated with rectal digital examination, but the patient refused all intervention. After reposition of abdominal wall hernia of an 81-year-old female patient a tumor was found--through colonoscopic examination--30 cm from anal opening, but the patient rejected any kind of operation. CONCLUSION: With the contemporaneous appearance of two diseases should be taken into consideration, when long existing hernia rapidly becomes larger, and complaints emerge with the hernial patients. At this point the complex examination of colon is inevitable during the operative preparation.

[Cryosurgery and endoscopy in the treatment of varicose veins]. / Kryo és endoszkópia a visszérsebészetben.

Multiplex wide incisions and often deforming scars following varicose surgery are out of date. Nowadays cryoprobes are used to remove epifascial varicose veins, while endoscopy is used to treat transfascial (perforating) venous insufficiency. We analyse the results of 1000 cryovaricectomies performed in the last 8 years. Complications developed in 5.8%, mostly were self-limiting. It is a fast operation, offering good aesthetic result, and hospital stay is short. Subfascial endoscopic perforating veins surgery (SEPS) have been carried out in 2 years in 28 patients, 8 had active ulcers, combined operation have been performed in 20 patients. There were 3 wound complications, which was a very good result compared with high complication rate of earlier used open divisions. The biggest advantage of the procedure is, that it can be performed even if the ulcer is active, since the operation is performed on intact area. Both methods meet the requirements of minimal invasive surgery, with excellent cosmetic and functional results.

The Histological Changes of the Great Saphenous Vein at 2 Years after Cryosclerosis.

Cryosclerosis was developed at the end of the last decade. It is the endovenous cryoablation of the great saphenous vein and has been forgotten before the era of the endovenous ablation techniques began. The caused histomorphological changes of the vein weren't described before, especially, years after the procedure. A 31-year-old female patient underwent cryosclerosis 2 years ago. Because of the recanalization of the great saphenous vein and recurrent varicosity, high ligation, cryostripping and phlebectomy of varices were performed. During surgery, a saphenous vein piece was harvested to investigate the histomorphological effect of cryosclerosis. Histological findings verified that recanalization had occurred, the vein wall had undergone remodeling, and the picro-sirius red stain showed collagen deposition in the whole vein wall. Cryosclerosis seems to result in the remodeling of the vein wall.

Giant appendix or an appendiceal mucocele? Case report of an 11-year-old child.

We present an 11-year-old male child with an enormous appendix that was regarded as an appendiceal mucocele. The disorder is very rare and usually appears in middle aged patients. It is a clinical diagnosis. It could cause a variety of symptoms, especially, acute appendicitis and unidentified lesion in the right iliac fossa. According to the reasons, it could be just a curiosity without any relevancy or the sign of a malignant lesion with bad prognostic factors. The histopathological findings prove the origin.