Faculty of Medicine
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Item type:Publication, Amyand's hernia with gangrenous perforated appendicitis and diffuse peritonitis-case report(Oxford University Press (OUP), 2025-11); ; ; Manevska, Vesna JovanovskaAmyand's hernia, the presence of the vermiform appendix within an inguinal hernia sac, is a rare clinical entity (0.2%-1.7% of inguinal hernias). Acute appendicitis within the sac is rarer still, occurring in only 0.1% of cases. We describe a male patient presenting with an incarcerated right inguinal hernia, who developed diffuse peritonitis after manual reduction. Laparotomy revealed gangrenous perforated appendicitis with purulent peritonitis. Appendectomy, partial omentectomy, and peritoneal lavage were performed. The patient recovered uneventfully. Amyand's hernia complicated by perforated appendicitis is an exceptional surgical emergency. Early recognition and prompt surgical management are crucial for favorable outcomes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Variation of elective healthcare in West Africa: secondary analysis of an inguinal hernia international cohort study(Impact Health, 2024-07); NIHR Global Health Research Unit on Global SurgeryIntroduction: Access and quality of elective healthcare varies globally as shown in a previous study where inguinal hernia was used as a tracer condition. Inguinal hernia incidence increased from 1990 to 2019 but access to its repair is not fully characterised. The aim of this study was to evaluate access and quality of elective healthcare in West Africa comparing it with the other regions. Methods: We conducted a secondary analysis of a prospective, cohort, international study of hernia surgery. Data was collected from all consecutive patients undergoing primary inguinal hernia repair between 30 January and 21 May 2023. Inguinal hernia was chosen as the tracer condition to evaluate elective healthcare. In this analysis, we characterised the group of patients undergoing inguinal hernia repair in West Africa, comparing adults and children. We compared the access and quality metrics in West Africa with those measured and reported globally. Results: We included 18,058 patients undergoing inguinal hernia repair globally, from which 1,079 patients were from West Africa. Most included patients were adults (76.7%, 828/1,079) without comorbidities. Emergency surgery and bowel resection adjusted rates were higher in West Africa than globally (18,0% and 4.0% vs 7.9% and 1.5%, respectively). Waiting time for elective surgery was longer in West Africa (median 10.3 vs 8.0 months). Out-of-pocket payment was the most common financing method in West Africa patients (54.5%, 588/1079). Mesh adoption was less than half compared to the other regions globally (44.9% vs 94.8%). Postoperative complications were lower than other regions (adjusted rate 10.8% vs 13.3%). Discussion: This study identified that access to elective healthcare in West Africa still needs to be improved despite previous actions to tackle this. Adult, inguinal hernia patients would benefit if mesh was used to avoid recurrence in future. Reducing out-of-pocket payments might be essential to address both problems. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, AMYAND’S HERNIA–A RARE CASE OF RIGHT-SIDED INGUINAL HERNIA(Macedonian Association of Anatomists and Morphologists, 2023); Amyand’s hernia is the presence of the appendix in the inguinal hernia sac. The prevalence of this type of inguinal hernia is about 1%. Majority of cases of Amyand’s hernia are incidentally diagnosed during surgical treatment of inguinal hernia. Amyand’s hernia typically presents on the right side since right-sided inguinal hernia is more common and the appendix is located in the lower right quadrant of the abdomen. We present a case of a 23-year-old patient hospitalized at the University Clinic for Digestive Surgery in Skopje for elective surgical treatment of right-sided inguinal hernia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ЛАПАРОСКОПСКА ТАПП НАСПРОТИ ПОПРАВКА ПО LICHTENSTEIN; РАН КЛИНИЧКИ ИСХОД(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, EVALUATION OF POSTOPERATIVE PAIN IN PRESERVATION AND ELECTVE DISSECTION OF THE ILIOINGUINAL NERVE IN INGUINAL HERNIOPLASTY(Macedonian Association of Anatomists, 2023-05); ; The use of mesh techniques in the treatment of inguinal hernias significantly reduce recurrences. However the incidence of inguinodinia still present significant complication. The study was designed as a randomized, prospective, unilaterally blind clinical study. Forty male patients were included, to whom hernioplasty by Lichtenstein method with implantation of polypropylene mesh was performed. Patients were divided into 2 groups of twenty patients each. In first one the technique of the ilioinguinal preservation was used, and in the second one dissection of the ilioinguinal nerve was performed. At appropriate time points two types of scales were used to assessed the intensity of the pain: Numeric scale of pain (NSP) and Stanford pain scale (SPS).Data from 40 patients have been analyzed, of which 20 with preservation and 20 with dissection of the ilioinguinal nerve. Inguinodynia was present in two patients, one in each group, i.e. 5%, which indicates that there was no significant difference in the occurrence of inguinodynia in the group with preservation and dissection of the ilioingvinal nerve. No single direction can yet be given as to whether it is better to preserve or dissect the inguinal nerves, and there is also division over whether, if a neurectomy should be performed, it should be limited to the IIN or a triple neurectomy should be performed. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Benefits of contralateral patent processus vaginalis closure during laparoscopic surgery for inguinal hernia in female children(Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences, 2022-06); After more than a decade, an accurate description of the current state of pediatric inguinal hernia repair still an issue of contention. Improvement of techniques together with patient-entered intervention that account for the experiences related to individual disease characteristics have become an important factor of which the surgeon must be aware. Therefore, the aim of this study is to analyze a potential treatment for metachronous contralateral inguinal hernia (MCIH) in children during laparoscopic assisted percutaneous internal inguinal ring suturing (PIRS). In a prospective clinical study, carried out at the University Clinic for Pediatric Surgery in Skopje, Republic of North Macedonia, we analyzed the data from 49 female children, aged 1-14 years old, with clinically diagnosed congenital inguinal hernia treated via PIRS. The position of hernias on the right side was 29 (59.2%) on the left side was 19 (38.8%) and on both sides was 1 (2.0%). With intraoperative assessment, it was determined that in 33 (67.3%) participants there was no presence of a hidden hernia, while in 16 (32.7%), there was indeed the presence of a hidden hernia. Of the hidden hernias determined laparoscopically [16 (100%)], 8 (50%) were left and right hidden hernias, all treated laparoscopically. The PIRS technique is a procedure where the basic advanced treatment is exploration. This also included the adequate treatment of other pathologies, such as the prophylactic closure of a contralateral patent processus vaginalis with simultaneous treatment as there is the potential for hernia in future, therefore reducing the number of metachronous inguinal hernias. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparative Study for Application of Polypropylene Monofilament Light Mesh, Polypropylene Monofilament Heavy Mesh and Self Gripping Polypropylene Mesh in Patients with Inguinal Hernia Surgically Treated with Lichtenstein Technique(Vilnius University Press, 2020-12-29); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FIRST EXPERIENCES WITH LAPAROSCOPIC HERNIOPLASTY IN THE TREATMENT OF INDIRECT INGUINAL HERNIAS IN FEMALE CHILDREN(2018); ; Introduction: Inguinal hernia is one of the most performed operations in pediatric surgery, and it is the most common reason for consulting a pediatric surgeon. The incidence of indirect inguinal hernia in children is 0.8-4.4%. There are more operative methods of open surgical and minimally invasive laparoscopic techniques. Aim: The aim of this study is to identify the descriptive characteristics of the initial cases of applying a laparoscopic hernia repair technique for the treatment of female children diagnosed with congenital indirect inguinal hernia. Materials and method: This is a descriptive study with collected clinical data from the University Clinic of Pediatric Surgery in Skopje. The sample, collected in the period 2015-16, covers a total of ten girls aged 0-14 years, who were clinically diagnosed with indirect inguinal hernia.The patients underwent PIRS(percutaneous internal ring suturing) techique.Results: The average age of the patients was 68,3 ± 34,2 months with a minimum of 24 and maximum of 168 months. According to the location of the inguinal hernia, in 7 (70%) patients it was right-sided, in 2 (20%) it was left-sided, and in 1 (10%) it was bilateral. During the laparoscopic exploration of the inguinal hernia repair there was an incidental finding of two contralateral occult inguinal hernias that were sutured with the same technique in a single act. In 50% of the patients the intervention lasted less than 25 (23-31) minutes. The length of the hospital stay was 10,8 ± 3,1 hours. The shortest hospital stay was 8 hours and the longest 16 hours. Fifty percent of the children took up a sitting position in bed in less than 4 hours. The average time for taking up a sitting position was 4,1 ± 0,9 hours with a minimum of 3 and maximum of 6 hours. Post-operative analgesia single dose was given to only 2 (20%) of the children. The length of the surgical scar in 50% of the children is less than 2mm. During the 6 month post-operative follow-up period, there were no recurrent findings of hernia in any of the cases. Conclusion:The laparoscopic technique of percutaneous closure of the internal inguinal ring in the treatment of inguinal hernia in female children is a minimally invasive procedure with preferable advantages in terms of reduced post-operative pain, reduced hospital stay, rapid return to normal activities as well as an excellent cosmetic effect. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Topical treatment of minor facial burns in pediatric patients(2017); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE ANALGESIC EFFECT OF ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK FOR LAPAROSCOPIC BILATERAL INGUINAL HERNIA REPAIR(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University, Skopje, Macedonia, 2017-04); ; ; Background: Transversus abdominis plane (TAP) block is a (new) regional anesthetic technique that provides analgesia to the parietal peritoneum, as well as the skin and muscles of the anterior abdominal wall, by introducing local anesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscles. Pain after laparoscopic bilateral inguinal hernia surgery can be moderate to severe and can result in prolonged hospital stay, unanticipated hospital admission and delayed return to normal daily activities. We evaluated the efficacy of TAP block in patients undergoing laparoscopic bilateral inguinal hernia repair in a randomized controlled clinical trial. Material and methods: Sixty patients undergoing laparoscopic bilateral inguinal hernia repair were randomized to undergo standard care (n=30) or to undergo a bilateral TAP block with bupivacaine (n=30). All patients received standard anesthetic, and after induction of anesthesia, the TAP group received an ultrasound-guided bilateral TAP block. Each patient was assessed after operation at 2, 6, 12 and 24 hours after surgery. Results: Bilateral ultrasound-guided TAP block significantly reduced postoperative visual analogue scale (VAS) pain scores at rest and on moving, reduced ketonal and tramadol postoperative consumption and reduced incidence of PONV in the TAP block group after surgery compared to control group. Conclusion: Bilateral ultrasound-guided TAP block provides effective postoperative analgesia during the 24 postoperative hours after laparoscopic bilateral inguinal hernia repair.