Faculty of Medicine

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ЛАПАРОСКОПСКА ТАПП НАСПРОТИ ПОПРАВКА ПО LICHTENSTEIN; РАН КЛИНИЧКИ ИСХОД
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2020)
Mitevski, Aleksandar
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Markov, Petar
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Introduction. Laparoscopy as a minimally invasive technique has itsplace in inguinal hernia repair. Lower postoperative pain, earlier mobilization and earlier return to usual activities are comparable to an initially high cost of the hospital charge. Also, there is a lower percentage of postoperative complications especially related to the wound. Methods. The study was designed as a prospective randomized controlled study conductedin a three-year-period. Sixty-five patients were randomly assigned into two groups, examined-35 patients treated with TAPP technique and controlled-30 patients treated with Lichtenstein technique. Surgicaltime, preoperative pain, hospital stay, postoperative analgesia, functional status and convalescence were evaluated. The postoperative complications, hematoma, seroma, wound infection and urinary retention were also taken into consideration. Results. A significant diference was found in the surgicaltime favoring Lichtenstein over TAPP technique; postoperative hospitalization was significanlly longer in case of the Lichtenstein procedure. There wasa significant difference concerning postoperative pain and functional status between the groups, as well as in the same group regarding the postoperative days. The percentage of early postoperative complications wassignificantly lower in TAPP group (6.3% versus 16.7%); there wasa significant difference in convalescence (TAPP 4.6±1.2 / Lichtenstein 6.6±1.10). Conclusion. Patients treated with laparoscopic TAPP technique had better early clinical outcome compared to open Lichtenstein technique. It is a result of a lower intensity of the postoperative pain, less postoperative complications which leads to a shorter hospital stay, better functional status and short convalescence.
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LIGASURE HEMORRHOIDECTOMY (LH) WITH “NEAR BASE“ TECHNIQUE
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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Jovanovska, Frosina
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Limani, Nimetula
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Mustafova, Alma
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Cecum Volvulus, In Misdiagnosis of Acute Appendicitis: a case report
(2021-11-30)
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Jovanovska, Frosina
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Mustafova, Alma
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Dervisov, Kristijan
Cecum Volvulus, In Misdiagnosis of Acute Appendicitis: a case report Şenol Tahir, Martina Ambardjieva, Frosina Jovanovska, Alma Mustafova, Kristijan Dervisov, Nimetula Limani, Petar Markov, Berat Dalipi University Clinic for Surgical Diseases, General and Abdominal Departemen – St.Naum Ohridski, Skopje, N. Macedonia Background: As a type of intestinal malrotation, colon volvulus is most common in the sigmoid, followed by the caecum and then the transverse and splenic flexure. The cause of volvulus may be due to embryologically incomplete rotation of the intestine, Ledd’s bands, long mesocolon, or dolichocolon. Methods/Results: Preoperative diagnosis of cecal volvulus is usually accidental and can be confirmed by CT of the abdomen, and it is an incidental intraoperative finding in most cases. We present a patient with an operative diagnosis for acute appendicitis, with Alvarado score of 8 and positive ultrasonographic signs for acute appendicitis. On laparoscopic exploration for appendectomy, an enormously dilated colon (bigger cystic formation) affects the entire pelvis. The conversion was performed with lower median laparotomy, cecal volvulus found with 360-degree rotation in the direction of the clock’s hands with more significant deterioration of the caecum. Right hemicolectomy was performed with ileum- transverse colon double GIA stapler anastomosis. On the 6th postoperative day, the patient was discharged home. Conclusions: Cecal volvulus although a rare acute surgical condition should be recognized and properly surgically treated.
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Giant Retroperitoneal Liposarcomas with Involving Adjacent Abdominal Organs: Two case reports
(2022-09-15)
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Jovanovska, Frosina
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Mustafova, Alma
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Bundovska, Marija
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Panic, K
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Ligasure hemorrhoidectomy (LH) with „near base“ technique
(Springer Science and Business Media LLC, 2021-10)
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Jovanovska, Frosina
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Mustafova, Alma
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Dervisov, Kristijan
Ligasure hemorrhoidectomy (LH) with „near base“ technique Şenol Tahir*, Martina Ambardjieva, Frosina Jovanovska, Alma Mustafova, Kristijan Dervisov, Nimetula Limani, Berat Dalipi, Petar Markov University Clinic for Surgical Diseases, General and Abdominal departemen – St. Naum Ohridski, Skopje, N. Macedonia Background: In this study we evaluate the use of MilliganMorgan hemorrhoidectomy with Ligasure vessel sealing. Methods: Grades 3 and 4 hemorrhoids are operated with Ligasure by coagulation and cutting of the hemorrhoids at positions 5, 7 and 11 hour. Te patients received premedication, analgesia and intravenous 500 mg metronidazole preoperatively. Under anesthesia, placed in a lithotripsy position, the anoscope is placed with a easy retraction, than a 5 mm V shape incision is made with the scalpel at the anocutaneous border. Te nodule was lifted with an instrument and the LigaSure was placed on the base of the nodule (leaving 2 mm enough mucosa above the sphincter), coagulated and incised. Te control check, 24 hours later and sent home with oral analgesic and metronidazole therapy. Follow-up 7, 14 and 28th day Results: 52 patients undergoing LH surgery, with an average age of 42.5 years. 59 % are women and 56 % are grades III. Average operative intervention 17.0+4.1 minutes, hospital stay 1.2 days, Postoperative pain (VAS1-6) 3. Urinary retention 0.4 %. Minor bleeding 5.6 %. Pruritus in 5.6 %, gas incontinence 7.6 %. No stenosis or incontinence. Conclusions: LH is an efective and safe surgical method and it should be used as a routine.
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CORRELATION OF SCORING SYSTEMS WITH HISTOPATHOLOGICAL FINDINGS AND THEIR IMPORTANCE IN REDUCING THE PERCENTAGE OF UNNECESSARY APPENDECTOMIES
(Македонско лекарско друштво = Macedonian medical association, 2019)
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Markov, Petar
Introduction. Acute appendicitis (AA) is one of the most common emergency surgical conditions, where emergency laparotomy is necessary. However, perforation rates and negative laparotomies during this procedure have not been reduced. The purpose of this paper was to evaluate the importance of the scoring systems in the differenttial diagnosis for setting an indication for appendectomy. Method. Prospective comparisons of the values of 4 scoring systems were performed among 60 patients: Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis. Values for the scores were determined in all patients treated with lower right quadrant (LRQ) abdominal pain, under a differential diagnosis of AA. After the appendectomy (open surgery or laparoscopic), a correlation was obtained between the histopathologic findings (HP) and the corresponding latent values. Results. In the study 63.33% of the patients were male. Distribution of patients according to the values of the three different systems (Alvarado, RIPASA and Tzanakis) showed that the largest number of patients had values higher than 8 and AIR values of 7- 8. In the study, 95% of the operated patients were positive for appendicitis compared to the histopathological finding. 80% of the surgeries included on-time appendectomy, 15% delayed diagnosis, and 5% were found to be with an unnecessary appendectomy. According to the HP findings of those with positive findings, 77.2% of the cases had appropriate preoperative ultrasonographic (US) diagnosis. A statistically significant association of the scores with HP findings (promptly phlegmonous, promptly gangrenous, late perforated and unnecessary) was found only for the Alvarado, AIR, Tzanakis, and no statistically significant association was found for the RIPASA score. Conclusion. Scoring systems are useful diagnostic tools for appendectomy indication. Using one or a combination of two or more scoring systems reduces the percentage of unnecessary appendectomies.
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Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis
(Vilnius University Press, 2020-12-29)
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Markov, Petar
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Mladenovik, Dragoslav
<jats:p>Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.</jats:p>
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CORRELATION OF SCORING SYSTEMS WITH HISTOPATHOLOGICAL FINDINGS AND THEIR IMPORTANCE IN REDUCING THE PERCENTAGE OF UNNECESSARY APPENDECTOMIES
(Macedonian Medical Association, 2019-02)
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Markov, Petar

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