Does cryostripping add anything to the treatment of the ascending thrombophlebitis of the great saphenous vein?

OBJECTIVE: To analyse the differences of outcome between cryostripping and conservative therapy in the treatment of superficial vein thrombosis. PATIENTS AND METHODS: A retrospective analysis was performed between the October of 2001 and the October of 2014. In all, 246 cases were eligible for the study. High ligation, cryostripping and local thrombectomy was carried out on 94 patients with thrombophlebitis of the proximal part of the great saphenous vein. Thromboembolic events, the presence of residual varices and time for recovery were compared to 152 cases treated conservatively because of superficial vein thrombosis. RESULTS: Thromboembolic events were found without significant difference (mean ± SD for surgery: 1.11 ± 0.60 and conservative therapy: 1.11 ± 0.55; p = 0.988) in each group. The presence of residual varices (mean ± SD for surgery: 1.03 ± 0.52 and conservative therapy: 1.42 ± 0.99; p = 0.001) and the time for recovery (mean ± SD for surgery: 15 ± 10.50 and conservative therapy: 26 ± 12.32; p < 0.001) were more favourable in the cryostripping group. CONCLUSION: Our analysis confirmed that cryostripping does not result in a lower risk for thromboembolic complications due to superficial vein thrombosis but can be an alternative method to treat the ascending thrombophlebitis of the great saphenous vein because it has some advantages over conservative treatment on the short term.

Cryosclerosis. A forgotten endovenous procedure for treating the incompetence of the great saphenous vein. Short term results.

AIM: The aim of the present study was to prove the effectiveness, reliability and minimal invasiveness of cryosclerosis. METHODS: A prospective non-randomized study had been performed. The study enrolled 96 patients; 48 patients were treated by cryosclerosis and the other 48 by conventional stripping. Every time high ligation and phlebectomy of varices were done, in 1 patient the incompentence of the small saphenous vein was treated also by cryosclerosis. During the follow-up visits the obliteration of the great saphenous saphenous vein (GSV) was investigated; as primary objective of the study, secondary outcome measures were the most frequent complications of the conventional surgery, postoperative pain and recovery. Color-Duplex scan of the operated lower extremity was performed into 30 patients of the study group. Additionally, the vein wall (unhandled and frozen) was analyzed by transmission electron microscope in one case. All of the involved patients were examined at a follow-up visit (7 days after surgery) and sent back a questionnaire (6-8 weeks after surgery). RESULTS: Recanalization was observed only in 2 patients (success rate after 6 weeks: 93.3%). Thromboembolic events occurred only in the control group (1 patient, minor pulmonary embolism). Regarding mild wound healing disorder and lymphorrhea there were no significant differences between the groups. Concerning postoperative pain, bruising and recovery the cryosclerosis was found significantly favorable. The incidence of limb swelling after surgery was the same in each group. Temporary sensory abnormalities seem to be frequent in the study group, but the results show that the rate of permanent saphenous nerve injury is higher in the patients operated with the conventional method. The histological examination showed changes in the frozen vein wall. CONCLUSION: Lacking long-term results, we can only consider that cryosclerosis allows the occlusion of the great saphenous vein, is minimal invasive and should be considered among endovenous procedures for treating GSV incompetence.

The blood supporting of nipple-areolar (NAC) complex performing for mammaplasties.

In case of mammaplasties the blood support of the nipple-areolar complex is one of the most important. The authors give a comprehensive clinical summary of the operating technics which are suitable to correct mastoptosis and breast hypertrophy (or macromastia). After mentioning the anatomy, blood and nerve supply of breast, following the classifying of mastoptosis and breast hypertrophy. Summarizing of the historical development of operating methods, which resulting in modern solutions, and adding Hungarian-related data. The widely used mastopexies and reduction mammaplasties will be analyzed, with demonstration of transposition of NAC using different kind of dermo-glandular flaps, e.g.: Skoog-, Pitanguy-, McKissock-, Strömbeck-, Robbins-, Regnault- and other's method. After discussing the possible postoperative complications, authors underline the necessity of detailed analysis and exact planning in varied clinical cases for achieving wanted functional and aesthetic result. Attaching importance to have more perfect operating techniques.

The cryovaricectomy (demonstration of a new method).

The operating technique of the primary varicosity has changed recently. The subcutaneous methods have been used nowdays. We give account of making 416 cases by cryovaricectomy, which is a quite new method. Using this technic we can remove the dilated venous branches during a 3-4 millimeters wide incision of skin and preserve the sufficient main vein. Summarizing of our advantageous experience: the cryovaricectomy is suitable for principles of minimally invasive surgery, and the operating time is much more briefer, the aesthetic results are best, the attendance far shorter and the postoperative complaints of patients much more fewer.

Transabdominal preperitoneal herniorraphy: technique and results.

As enthusiasm for laparoscopic surgery has grown, laparoscopic approaches to the groin hernia have evolved. The most widely accepted laparoscopic repair employs the placement of a large sheet of mesh in a preperitoneal position to cover potential hernia spaces. Between March 1994 and February 1997 160 inguinal and 3 femoral hernia were operated of an transabdominal preperitoneal (TAPP) polipropylen mesh. 131 patients were operated (128 males and 3 females, ranging in age from 19 to 82 years), 31 (23%) of them had bilateral hernias. Recurrent hernia was the indication in 52 (32%) cases. Average operating time for unilateral repair was 80 minutes and for bilateral repairs was 108 minutes. Postoperative complications included 7 (4.3%) cases of transient neuralgias, 20 (12%) cord/scrotal transient seromas-hematomas and 2 (1.2%) hydrocele. The 5 (3.1%) early recurrences were considered to be caused by technical inexperience and/or too small prosthetic patch. The laparoscopic hernioplasty has definitive advantage: minimal postoperative pain, short hospital stay (average postoperative time of hospitalization 3.1 days) and early restoration of full physical activity (in 1 to 2 weeks). The method should be considered as a potential "best option" in patients with recurrences and bilateral inguinofemoral hernias.