Faculty of Medicine

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    LAPAROSCOPIC VERSUS OPEN KASAI PORTOENTEROSTOMY FOR BILIARY ATRESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS BY THE PEDIATRIC SURGERY META-ANALYSIS STUDY GROUP (PESMA)
    (European Society of Paediatric Endoscopic Surgeons, 2025-10)
    Duygu Gurel
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    Mustafa Azizoglu
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    Carlos Delgado Miguel
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    Federica Pederiva
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    Mehmet Hanifi Okur
    Introduction: Biliary atresia (BA) is a rare but life-threatening neonatal liver disease requiring timely surgical intervention. The Kasai portoenterostomy (KPE) is the standard treatment, traditionally performed via laparotomy. Recently, laparoscopic approach has been introduced, but its efficacy remains debated. This systematic review and meta-analysis compared laparoscopic and open KPE in patients with BA. Methods: A comprehensive literature search of PubMed, Scopus, EMBASE, and Web of Science was conducted through April 2025. Primary outcomes were jaundice clearance, cholangitis, overall complications, 2-year native liver survival rate, and postoperative intestinal obstruction. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using Mantel–Haenszel methods under fixed- or random-effects models, based on heterogeneity (I²). We used RevMan 5.4 software meta-analysis statistic program. Results: A total of 26 studies were included. Jaundice clearance (17 studies; OR=1.10; 95%CI: 0.76–1.59; p=0.61; I²=42%) and cholangitis (15 studies; OR=1.17; 95%CI: 0.87– 1.59; p=0.30; I²=0%) rates showed no significant differences between laparoscopic and open groups. No significant differences were observed in overall complication rates (8 studies; OR=0.71; 95%CI: 0.24–2.09; p=0.54; I²=57%). Postoperative intestinal obstruction (7 studies) and 2-year native liver survival (8 studies) also showed comparable outcomes (OR=0.91; 95% CI: 0.36–2.27; p=0.83; I²=0% and OR=0.74; 95% CI: 0.49–1.10; p=0.13; I²=30% respectively). Conclusion: Laparoscopic KPE appears to be a safe and feasible alternative to the open approach, with comparable outcomes across major clinical parameters. While current evidence supports its feasibility, further high-quality prospective studies are needed to validate these findings and inform surgical practice.
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    GIANT LEFT HEPATIC CYST WITH GASTRIC OUTLET OBSTRUCTION
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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    Mihajloska Blazhevska, Pandora
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    Jovanovska, Frosina
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    The prevalence of cystic hepatic lesions in the United States is estimated to be 15%-18% and simple hepatic cyst is the most common, found in 2.5%-18% of the population. Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with GOO will often have recurrent vomiting of food that has accumulated in the stomach, but cannot pass into the small intestine due to the obstruction. A 74-year-old patient was admitted to the emergency department due to diffuse abdominal pain, bloating and tenderness in the upper abdomen. In the last month, he had malaise, bloating (especially after a large meal), loss of appetite, regurgitation and a metallic taste in the mouth. Laboratory tests (WBC 12.000, CRP 10) and a CT scan of the abdomen with contrast were performed. We detected a multiple cystic formations on the right liver lobe and larger one on the left liver lobe that compresses the antro-pyloric part of the stomach and D-1 of the duodenum. We performed gastric emptying with a nasogastric tube, serological tests to exclude possible echinococcosis and tumor markers to exclude possible malignancy. Then, we performed a diagnostic gastroscopy and the findings were normal. An indication for laparoscopic intervention has been made and laparoscopic evacuation and excision-reduction of the simplex cyst was performed. The histopathological analysis revealed a simplex cyst. The patient had a normal postoperative course and was discharged home on the third postoperative day. At the examinations after 1 and 3 months, the findings were normal. Large cysts within the liver parenchyma are in contact with the vascular, biliary and digestive systems. The resulting compression may lead to inferior vena cava obstruction, Budd Chiari syndrome, obstructive jaundice, portal hypertension and Gastric Outlet Obstruction.
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    LAPAROSCOPIC INCISIONAL HERNIA REPAIR IN OBESE PATIENT: A CASE REPORT
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2013)
    Mitevski, Aleksandar
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    Inoduction. Laparoscopic repair of ventral-incisional hernia is increasing compared to open technique. It has become a safe method, with low complications and cost comparable with open techniques. Shorter recovery and length of hospital stay are also associated with laparoscopic repair, especially among obese patients. Case report. We present a case of a 42-year-old patient with BMI (Body Mass Index) of 44. He has had three previous open operations for incisional hernia, the last one being two years ago. We performed a laparoscopic IPOM (Intraperitoneal Onlay Mesh) repair with composite mesh using transfascial (transabdominal) sutures and tacks (staples). Conclusions. Low rate of conversion, minimal perioperative morbidity and low recurrence indicate safety in obese and morbidly obese patients treated with laparoscopic approach.
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    EFFECT OF BILATERAL ERECTOR SPINAE PLANE (ESP) BLOCK ON PAIN AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR: A CASE SERIES
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
    Toleska, Marija
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    Dimitrovski, Aleksandar
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    Trposka, Angela
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    Panoska Avramovska, Aleksandra
    Laparoscopic ventral hernia repair (LVHR) operations are followed by moderate postoperative pain, shorter recovery periods and less surgical complications such as seroma, hemorrhage, intestinal injury, mesh infection and recurrence. Pain after LVHR sometimes can be severe and last more than one week up to one month. Erector spinae plane (ESP) block is inter-fascial plane block and performed bilaterally can provide a good visceral and somatic analgesia for various abdominal surgeries. We describe five cases of laparoscopic ventral hernia repair who received bilateral ESP block prior to induction to general anesthesia and its effective analgesic effect was seen in the intra- and postoperative period. Our results showed that bilateral ESP block performed before the induction to general anesthesia provided a good analgesia and low opioid consumption in the intraoperative period, low pain scores in the first 48 hours and no need of rescue analgesia after laparoscopic ventral hernia repair surgery.
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    Laparoskopna radikalna cistektomija sa ekstrakorporalnom derivacijom urina - početno iskustvo i preliminarni rezultati
    (Okruzna podružnica SLD Leskovac, 2020)
    Shabani, Bashkim
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    Gurmeshevski, Slobodan
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    SUMMARY Introduction and objectives: To report our experience with laparoscopic radical cystectomy (LRC) and extracorporeal urinary diversion for muscleinvasive bladder cancer. We have evaluated and summarized the surgical outcomes and complications of this procedure. Patients and methods: We have evaluated retrospectively all patients who underwent LRC at our clinic over a one year period. In all patients, ureteroileocutaneostomy (Bricker technique) was performed for urinary derivation. We have analyzed the following parameters: patient demographic data, laboratory data, intraoperative fluid volume, estimated blood loss and transfusion requirements. Respiratory parameters including arterial blood gas data, anesthesia time, surgical time, time of oral intake, admission to ICU (intensive care unit), hospital stay and any adverse events during the whole period of hospitalization were also analyzed. Results: Patients had similar demographic characteristics. Estimated intraoperative blood loss was 392 ml. Due to prolonged surgical time and CO2 pneumoperitoneum, hypercapnia was observed in 3 patients. Patients had a short period of bowel dysfunction and rapid shift from parenteral to oral nutrition, short hospital stay and low rate of surgical compilations. Conclusion: The results of our study have shown that laparoscopic radical cystectomy is a safe, feasible, and effective alternative to open radical cystectomy. Ex tra cor - po real urinary diversion through a small incision decreases the operating time, while maintaining the benefits of laparoscopic surgery. However, some larger prospective evaluation is to be made for summarizing the overall conclusions.
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    Androgen Secreting Steroid Cell Tumor of the Ovary Represented with Postmenopasal Bleeding and Extensive Hirsutism
    (Scientific Foundation SPIROSKI, 2013-12-15)
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    Introduction: Steroid cell tumors of the ovary present less than 0.1% of all ovarian tumors and belong in the group of sex cord-stromal tumors. Case description: We present a case of 69-year-old woman investigated because of postmenopausal bleeding, a 5-year history of excessive hirsutism, baldness and acne. The evaluation revealed elevated serum testosterone, but ultrasound detected a 2 cm mass of the left ovary. The patient underwent hysterectomy and bilateral adnexectomy. The histopathology diagnosis was steroid cell tumor, not otherwise specified. Postoperative chemotherapy was administered at the discretion of the radio-oncologist. At the last follow-up 48 months after surgery, the hirsutism was completely resolved, the serum testosterone was within the normal range and there was no evidence of recurrence. Conclusion: In adult patients with hirsutism and elevated serum testosterone a possibility of a presence of an ovarian steroid cell tumor should be considered. Surgery is the main treatment of such patients.
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    OUR INITIAL EXPERIENCE WITH LAPAROSCOPIC RADICAL CYSTECTOMY
    (Department of Anesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia, 2020-04)
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    Mojsova-Mijovska M
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    Petrusheva-Panovska A
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    Shabani B
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    Background and objectives: In this era of minimally invasive surgeries, at the University Clinic for Urologic Surgery in Skopje, the laparoscopic radical cystectomy (LRS) was performed in 11 patients for the first time. In this paper, we have evaluated and summarized the anesthesia management, features and complications of LRC. Material and method: In a retrospective manner, we evaluated all patents who underwent LRC at our Clinic over a one-year period. We noted and analyzed the following parameters: patients’ demographic data, preoperatively and postoperatively, laboratory data, intraoperative fluid volume, estimated blood loss, allogeneic transfusion requirements. Respiratory parameters including arterial blood gas data, anesthesia time, surgical time, time of oral intake, admission to ICU, hospital stay and any adverse events during the whole period of hospitalization were also analyzed. Results: This evaluation included 11 patients who were successfully operated and their data were analyzed. Patients had similar demographic characteristics. Estimated intraoperative blood loss was 472 ml and decreased transfusion requirement was noticed. Due to prolonged surgical time and CO2 pneumoperitoneum, hypercarbia was observed in few patients. Patients had shorter period of bowel dysfunction and rapid oral intake, shorter hospital stay and fewer complications. Conclusion: We believe that these data from our initial experience with newly performed minimally invasive radical cystectomy will reflect to our daily routine practice in radical cystectomy surgery towards laparoscopy. However, some larger prospective evaluation is to be made for summarizing the overall conclusions