[Large-intestine perforations caused by primary colorectal cancer]. / Debelochrevni perforatsii, predizvikani pri purvichen kolo-rektalen rak.

Twenty-seven cases of perforation, produced by primary colorectal carcinoma over the period 1993-1998, are described. The underlying causes of colorectal carcinoma complication and types of perforations observed are discussed. This is a report on personal experience with the therapeutic approach and operative management of this severest complication of colorectal carcinoma.

[Combined and extended radical operations in colorectal carcinoma patients]. / Kombinirani i razshireni radikalni operativni interventsii pri bolni s kolo-rektalen rak.

This is a report on radical operative interventions performed in 273/385 patients presenting complicated colorectal carcinoma, covering the period 1993 through 1998. Fifty-four patients are subjected to combined and extended operations, distributed as follows: 31 combined and 23 extended. In fifteen patients with abdomino-perineal extirpation the combined interventions include: hysterectomy (6), ovariectomy (8), resection of vagina (7), prostate gland resection (3) and bladder resection (2). In case of resection of rectum after Hartmann, combined intervention is done in five patients--small intestine resection, ovariectomy, appendectomy and cyst extirpation from pelvis minor, respectively. Postoperative lethality amounts to 12.9 per cent, or 7/54 patients with complicated colorectal carcinoma undergoing combined and extended surgical interventions.

[Primary colorectal carcinoma as an underlying cause of obturation of the ileum]. / Obturatsionen debelochreven ileus, predizvikan ot p'rvichen kolo-rektalen rak.

This is a report on 169 patients presenting colorectal carcinoma with complication assuming the form of occlusive ileus, observed over the period 1993 through 1998. Obturation is the commonest complication of colonic carcinoma (48.9%) with the left colon being more often involved (58.3%), recorded in a total of 108 patients. During the same period of time, occlusive ileus against the background of carcinoma of the rectum is diagnosed in 61 cases, representing 37 per cent of complicated forms of this malignant neoplasm. The scope of operative management and the procedure used are largely determined by the location of primary malignancy. The timing of undertaking one or another operative intervention depends on the efficacy of preoperative preparation, degree of occlusive ileus progress, patient's age, concomitant diseases and the like. Failing to comply with or overlooking some of the aforementioned factors invariably exerts an unfavourable effect on the final outcome of treatment. In each patient presenting colorectal-carcinoma-induced occlusive ileus it is mandatory to precisely specify the scope of surgery, consistent with the patient's general condition, and eliminate the underlying cause jeopardizing his life.

[Minicholecystectomy--the technical aspects]. / Minikholetsistektomiia--tekhnicheski aspekti.

In current interventional medicine operations on the gallbladder and biliary tracts, performed by "mini" access are ever more widely used in practice. Cholecystectomy done through minilaparotomy is an attractive procedure with well established superiorities, irrespective of the enthusiasm for laparoscopic accomplishment of the interventions in this particular field of surgery. Approbation of the method initiates in the early 80-ies, and ever since then it marks a ceaseless improvement in technical respect. In this report reference is made to a number of technical hints, rendering the procedure safer and readily accessible in the routine surgical practice, as well as successfully competing with laparoscopic cholecystectomy.

[Relaparotomy after an appendectomy]. / Relaparotomiia sled apendektomiia.

The analysis covers 2555 appendectomies, performed on an emergency and scheduled surgery basis in the clinic of emergency surgery.--State University Hospital "Queen Giovanna", Sofia, over the period 1985-1997. Relaparotomy is necessitated in 28 cases (1.09 per cent) because of various postoperative complications. Data are presented on the number of relaparotomies, done under conditions of emergency and scheduled surgery, and with a special reference to the pathoanatomical character of appendicitis. The underlying causes of undertaking relaparotomy and postoperative lethality are analyzed. As shown by the obtained results post-relaparotomy mortality rate is the highest after primary operation for destructive form of appendicitis and advanced form of peritonitis.

[Minimally invasive laparoscopic cholecystectomy - analgesia and pulmonary function]. / Minilaparokholetsistektomiia - analgeziia i pulmonalna funktsiia.

This is a report on 27 patients subjected to cholecystectomy for calculous cholecystitis through minilaparotomy. In 21 of them minicholecystectomy is performed under conditions of intubation inhalatory anesthesia. In the remainder (6 cases) intraoperative epidural analgesia is approbated, proceed-in during the short postoperative period. The laboratory and functional parameters, having an essential practical bearing on analgesia and pulmonary function, are monitored both intra- and postoperatively.

[Our experience with treating acute noncalculous cholecystitis]. / Nashiiat opit pri lechenieto na ostriia nekalkulozen kholetsistit.

Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases. Diagnosis is made on the ground of active echographic and clinical observation. Conservative therapy is effective in 28 cases. The remainder (61) are operated at 1 to 4-day intervals after the onset of the disease because of persisting symptomatology and/or deterioration of the patient's condition. During laparotomy the gallbladder presents marked enlargement with thickened, exudate-imbibed wall. Cholecystectomy is done in all 61 cases. In twelve of them, owing to dilatation of the common bile duct and minimal serum bilirubin increase, stenosing papillitis is diagnosed by intraoperative cholangiography, treated by external biliary drainage and endoscopic sphincterotomy, undertaken after improvement of the general condition. Acute inflammation, free of fibrosis, with isolated foci of gangrene and necrosis of the bladder wall are histologically documented. In four senile patients presenting serious concomitant diseases, with exceptionally high operative risk, echographic percutaneous transhepatic cholecystectomy is resorted to, followed by antibiotic bladder instillations with a very good outcome. The summed up results of acute noncalculous cholecystitis treatment are estimated as very good.

[The treatment of acute cholecystitis complicated by mechanical jaundice]. / Lechenie na ostriia kholetsistit, uslozhnen s mekhanichna zhultenitsa.

After analyzing the summed up treatment results in 368 patients with acute cholecystitis, complicated by obstructive jaundice, the inference is reached that it is a matter of a complication, unfavourable in terms of prognosis, with a definite impact on both immediate and long-term therapeutic results. Early operative intervention following intensive preoperative preparation (including ERHPG with endoscopic papillosphincterotomy and ensuing biliary decompression, or echographic percutaneous cholecystectomy) contribute to control the acute inflammatory process in the gallbladder, and preclude the development of liver (or hepato-renal) failure against the background of obstructive jaundice. Proceeding from the severe, irreversible changes in liver and kidney, hardly responding to treatment, and persisting deterioration of the general condition, acute cholecystitis complicated by obstructive jaundice is defined as an emergency life-endangering condition, requiring a priority operative approach.

[Necretomy and prolonged local postoperative lavage in the surgery of necrotic pancreatitis]. / Nekrektomiia i prolongiran lokalen sledoperativen lavazh v khirurgiiata na nekrotichniia pankreatit.

Over an 8-year period, sixty-one patients with mean age 52.5 years are operated on for necrotic pancreatitis in the clinic of emergency surgery at the Faculty Hospital "Queen Giovanna"--Sofia. The initial prognosis of the severity of disease scores 4.5 points average according to Ronson's rating system. The indications for operative treatment are clinically determined and further specified by ultrasonographic echo-ranging and computerized axial tomography. Necrectomy associated with prolonged local postoperative lavage are used as a method considered the most adequate from tactical viewpoint. The criteria for this particular therapeutic approach are substantiated. At 19.6 per cent lethality the postoperative results are estimated as satisfactory, and fully consistent with worldwide experience along this line.

[The results of the long-term follow-up of an expanded variant of selective proximal vagotomy]. / Rezultati ot dalechnoto proslediavane na razshiren variant na proksimalna selektivna vagotomiia.

This is a report on a long-term follow-up study of the results of an extended variant of proximal selective vagotomy in patients undergoing clinical approbation over periods ranging from 7 to 9 years. The details of technical implementation of the variant are described. At zero lethality and complete recovery of the patients followed up, the late results are estimated as excellent.

[Echinococcosis--the current surgical aspects]. / Ekhinokokoza--suvremenni khirurgichni aspekti.

Over the period 1985 through 1992, forty-four patients presenting echinococcosis (echinococcus of the liver--33 cases, lung--nine, and spleen--two), aged 12 to 79 years, are operated in the emergency surgery clinic of the State Faculty Hospital "Queen Giovanna". The up-to-date methods of diagnosing are comprehensively described, followed by illustration and discussion of the operative procedures used in the treatment of echinococcosis. The early and long-term results are estimated as satisfactory.