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Abstract Background A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results. Methods The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0. Results There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802). Conclusions Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection. Trial registration (retrospectively registered) researchregistry3090.

Background: A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results., Methods: The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients' satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0., Results: There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients' satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802)., Conclusions: Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients' selection., Trial Registration: (retrospectively registered) researchregistry 3090 .

Unlabelled: Transanal hemorrhoidal dearterialization (THD) is a new surgical technique used for the treatment of hemorrhoidal disease. It is known for its easy performance and low perioperative risk. 44 patients have been operated by this method at the Clinic of General, Liver and Pancreatic Surgery for a period of 22 months. A comparative analysis was performed between the postoperative results with the use of transanal hemorrhoidal dearterialization, modified hemorrhoidectomy of Milligan-Morgan, and Whitehead's hemorrhoidectomy., Conclusions: When comparing transanal hemorrhoidal dearterialization with other methods, we found that it has an excellent aesthetic effect, requires shorter hospital stay and less analgesics, and causes less discomfort in the postoperative period.

The development of the medicine itself, meets the current question of the common, interdisciplinary method of approach in the treatment of a series of diseases, such as biliurolithiasis. The attempt to make a classification is basic for making an optimal method of treatment of the biliurolithiasis. The biliurolithiasis is a disease influencing some new strategies of treatment in the combined efforts of the urologist and the surgeons both.

Background: Inflammatory deseases of the billiary system are common in the hepato-billiary surgery. Most serious is the cholangitis. Treatment is based on individual approach of choice of moment of correct surgical intervention and corresponding adequate antibiotic therapy., Aim: Retrospective analysis of the experience of our clinic of the positive biliocultures and their antibiograms., Materials and Methods: 152 positive biliocultures taken intraoperativly, for 10 years period. 48 of them are from patients with cholangitis., Results: Analysis of count and species microbiological agents and their sensitivity to antibiogram antibiotics in table format. The data of the literature reviewed and discussed., Conclusions: Most common microbiological agents are E. coli 60%, Klebsiella 31%, Pseudomonas 24%. In 40% theres are more then one agent. Most common agents have big sensivity to Cefalosporines II-III generation, Amikacin, Ciprofloxacin and Carbapenems.

Background: Internal biliary fistula (IBF) is still a challenging condition. The preoperative diagnosis is established in less than 50% of cases. Treatment is based on individual approach but postoperative morbidity and mortality rates are high., Aim: To study the experince of our clinic in the diagnosis and treatment of IBF's and to make a review of the literature., Material and Methods: a retrospective analysis of the data of 7 patients with IBF (0,53% of all surgical interventions on the biliary system during a 4-years period). The preoperative diagnosis was correct in only 2 cases. All the 7 patients were treated surgically., Results: The early postoperative mortality and morbidity rates were 0% and 42,86% respectively. The data of literature are reviewed and discussed., Conclusion: IBS is a rare condition affecting more often women above 65 yrs suffering of gallstones. There are no typival clinical and laboratory data but US, CT-scan, ERCP and MRI might be a 100% informative. Open surgery remains the basic method of treatment.

Liver metastatic disease is the most common malignancy of the liver. The aim of our study was to elaborate criteria for selection of patients for surgical treatment based on definite preoperative characteristics. Results from the surgical treatment of 233 patients operated in the Liver-pancreas Surgery Clinic at the University Hospital "Aleksandrovska" for the period January 1990-December 2003 have been analyzed. On the bases of the results form the study we propose a modified clinically applicable risk score for patients' selection in lever metastatic disease surgery.

Cholangitis is a serious complication with high rate of incidence in hepato-billiary surgery. Inadequate treatment leads to worsening of the general condition of the patient, other comlications of the hepato-billiary system and other organs and systems. Cholangitis increases morbidityrate and often contributes to fatal outcome.