Search

Background and aims. Patient safety culture (PSC) is an essential component of the quality of healthcare. Improving PSC is considered a priority in many developed countries. A specialized software platform for registration and evaluation of hospital patient safety culture has been developed with the support of the Medical University Plovdiv Project №11/2017. The aim of the study is to assess the status of PSC in Bulgarian hospitals and to compare it to that in USA and Croatian hospitals. Methods. The study was conducted from June 01 to July 31, 2018 using the web-based Bulgarian Version of the Hospital Survey on Patient Safety Culture Questionnaire (B-HSOPSC). Two hundred and forty-eight medical professionals from different hospitals in Bulgaria participated in the study. In order to quantify the differences of positive scores distributions for each of the 42 HSOPSC items between Bulgarian, Croatian and USA samples, the χ2-test was applied. The research hypothesis assumed that there were no significant differences between the Bulgarian, Croatian and US PSCs. Results. The results revealed 14 significant differences in the positive scores between the Bulgarian and Croatian PSCs and 15 between the Bulgarian and the USA PSC, respectively. Bulgarian medical professionals provided less positive responses to 12 items compared with Croatian and USA respondents. The Bulgarian respondents were more positive compared to Croatians on the feedback and communication of medical errors (Items - C1, C4, C5) as well as on the employment of locum staff (A7) and the frequency of reported mistakes (D1). Bulgarian medical professionals were more positive compared with their USA colleagues on the communication of information at shift handover and across hospital units (F5, F7). The distribution of positive scores on items: “Staff worry that their mistakes are kept in their personnel file” (RA16), “Things ‘fall between the cracks’ when transferring patients from one unit to another” (RF3) and “Shift handovers are problematic for patients in this hospital” (RF11) were significantly higher among Bulgarian respondents compared with Croatian and US respondents. Conclusions. Significant differences of positive scores distribution were found between Bulgarian and USA PSC on one hand and between Bulgarian and Croatian on the other. The study reveals that distribution of positive responses could be explained by the cultural, organizational and healthcare system differences.

INTRODUCTION : Laparoscopic abdominoperineal resection (LAPR) as a minimally invasive approach for the treatment of large rectal cancer is widely used. It has been proven to be technically feasible and safe with fewer complications and faster postoperative recovery than the open procedure. Our aim was to evaluate LAPR safety and feasibility as compared to the open procedure in large low rectal cancer. PATIENTS AND METHODS : A total of 34 low rectal cancer patients who underwent open APR (OAPR) were matched with 42 patients who underwent LAPR in a one-to-one fashion between 2011 and 2014 in the Divi­sion of General Surgery, Kaspela University Hospital of Plovdiv. RESULTS : Intraoperative parameters of LAPR were better than those of OAPR as followed: mean operation time (121.8±47.8 min versus 152.1±49.2 min), mean operative blood loss (82±30.0 mL versus 120±35.0 mL), mean total number of retrieved lymph nodes (12±1 versus 12±1.4), and percentage of surgical complications (12.3% versus 15.1%). Laparoscopically treated patients showed significantly shorter postoperative analge­sia (2.1±0.7 days versus 3.7±0.6 days), earlier first flatus (36.3±7.9 hours versus 48.5±9.2 hours), shorter uri­nary drainage (3.8±3.4 days versus 5.8±1.3 days), and shorter hospital stay (6.2±1 days versus 8±2.0 days). Local recurrence rate during a three-year period (in 3 versus 4 patients) and metachronous liver metastasis (in 5 versus 6 patients) were less common after LAPR than after OAPR. CONCLUSION : The risks of APR-specific surgical complications such as perineal wound infection and para­stomal hernia were comparable between the laparoscopic and open surgery groups. There were no signifi­cant differences regarding local recurrence and metachronous liver metastasis between these groups. Com­plication and locoregional recurrence rates in low large rectal cancer patients after laparoscopic and open were quite similar. Scr Sci Med 2017; 49(3): 22-26

Laparoscopic resections of the pancreas have gained in popularity in the last few years. Those preserving the integrity of the spleen are performed very rarely and are a challenge for every surgeon. We hereby report a case of laparoscopic resection of the pancreatic tail with preservation of the spleen and the integrity and the blood supply to the spleen in a 26 year-old patient with a large pseudopapillary tumor of the pancreas. Postoperative recovery was quick and without complications. The functional and aesthetic result was satisfactory. Laparoscopic resection of the pancreas is a safe and effective therapeutic procedure in selected patients

INTRODUCTION: In the last few years there has been a resurgence of laparoscopic exploration of the common bile duct as an alternative to endoscopic retrograde cholangiopancreatography (ERCP), the primary method for diagnosis and treatment of biliary tract calculosis. AIM: The aim of this study was to clarify the indications and methods for performing laparoscopic bile duct exploration, based on our experience in the field and data from the literature. PATIENTS AND METHODS: We recruited 12 patients who underwent laparoscopic exploration and stone extraction from the common bile duct (CBD) in the surgical ward of Kaspela Hospital, Plovdiv over the period January 2011 to January 2012. The diagnostic and therapeutic modalities used in the study included laboratory tests, ultrasound study, CT, ERCP, digital cholangiography, clamp and balloon stone extraction, primary suture and choledochoduodenostomy. RESULTS: Stone extraction was successfully performed in 8 patients using the transcystic approach through an incision used in the cholangiography. The procedure failed in the remaining four patients and we used here 2-cm longitudinal choledochotomy. In two patients the control cholangiography following the extraction of stones demonstrated complete clearance of the biliary tree and free passage of contrast agent from bile duct to duodenum (patent ampulla of Vater). In these two patients we performed a primary closure of the choledochotomy with a single interrupted suture (“ideal choledochotomy”). In two patients from the choledochotomy group, the control cholangiography showed the presence of residual stones or fragments trapped above the sphincter of Oddi with no contrast medium in the duodenum. In these cases we completed this procedure with latero-lateral choledochoduodenostomy by Flërken. All patients had a smooth postoperative course with no recorded complications. The average hospital stay was 5 days. CONCLUSIONS: Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

The aim of the present retrospective study was to assess the surgical approaches to acute perforated diverticulitis of the colon causing peritonitis and in some cases complicated with abdominal compartment syndrome (ACS).A total of eight patients (6 males and 2 females) have been operated on for 5 years for perforated diverticulum of the colon. The males had a mean age of 72 +/- 2.6 years and the females--69 +/- 3.1 years. Case history records of the patients were studied retrospectively to evaluate the effectiveness of different surgical approaches used in patients with such disorders. The females had perforation of cecal diverticulum, five of the males had perforated diverticulum of the sigmoid colon and one had perforation of diverticulum of the descending colon. The diagnosis in all patients was made intraoperatively and only in two cases was it assumed prior to operation. In the female patient with cecal pathology right-sided hemicolectomy with primary anastomosis was performed. In the other six patients Hartmann's procedure was applied with a subsequent second-stage intervention to restore the intestinal continuity.Total feculent peritonitis was found in four of the patients with perforated diverticulum of the sigmoid colon, with signs of multiorgan failure, intra-abdominal hypertension (IAH25 cm H2O level) and developed ACS. Despite the severity of the condition there was no lethal outcome. Two patients developed incisional hernia on the anterior abdominal wall.Based on the retrospective clinical analysis the authors conclude that primary hemicolectomy with one-stage anastomosis is the best procedure in patients in good condition and early stage on Hinchey classification. Total feculent peritonitis, associated with stage IV on Hinchey classification and signs of ACS requires Hartmann's procedure, following the principles of damage control surgery with obligatory use of temporary abdominal closure technique to control the syndrome and prevent a secondary one in the postoperative period. The indirect intravesical method of verification of IAH and ACS (the golden standard) is sufficiently precise for the clinical practice.

The aim of the present study was to evaluate the role of the preoperative antithyroid drug treatment and hormonal status in the development of early postoperative hypothyroidism after subtotal thyroidectomy in patients with Graves' disease.Eighty-five patients with Graves' disease (males : females ratio 1:5.54, age range 19 to 64, 37.52 +/- 1.09 yrs) who had previously undergone surgical treatment were enrolled in the study. All patients underwent bilateral subtotal thyroidectomy with the amount of remnant tissue of 2-3 g for each lobe (total 4-6 g). Development of early (within one year after the operation) postoperative hypothyroidism was analyzed regarding the type of the antithyroid drug, preoperative dose, duration of the preoperative medical treatment, FT3, FT4, FT3/FT4 and hTSH.Forty six percent of all examined patients (54.12%) were euthyroid and 39 (45.88%/)--hypothyroid. Postoperative hypothyroidism was developed by 33.33% of the patients that had received preoperatively propylthiouracil compared with 50.82% of those treated with methymazol (p0.05). The duration of the preoperative treatment was 38.36 +/- 3.53 months for the hypothyroid patients and 30.11 +/- 2.34 months for the euthyroid patients (p0.05). Postoperative hypothyroidism developed in 58.70% of the patients with preoperatively suppressed thyroid-stimulating hormone (hTSH) and in 33.33% of those with normalized values of hTSH (p0.05). No statistically significant between-group difference was found in the preoperative dose of antithyroid agent, mean values of free triiodothyronine (FT3), free thyroxine (FT4), FT3/FT4, thyrotropic hormone (TSH).Longer preoperative antithyroid drug treatment and suppression of hTSH in the preoperative period correlated with higher risk of hypothyroidism after subtotal thyroidectomy. The type and the preoperative dose of the antithyroid agent, as well as the mean values of thyroid hormones before the operation have no prognostic significance for postoperative thyroid hypofunction.

Iatrogenic lesions of the recurrent laryngeal nerves remain one of the most severe and frequent complications in thyroid surgery. According to Eisele (Laryngoscope 1996;106:443) their incidence varies between 1% and 12% depending on the size of surgery.The aim of the study was to examine experimentally the type of neural lesion and the efficiency of stimulation electromyography for immediate evaluation of the recurrent laryngeal nerve function in the most common surgical traumas.Ten clinically healthy and parasite-free male dogs of mixed breed weighing from 11 to 18 kg were used in the experiment. The injured laryngeal nerves of the experimental animals were examined histologically using Sudan III staining for myelin and Bilshovsky staining for neurofibrils. The intraoperative electromyography was performed with Neurostim 100.The results show severe damage both of the myelin sheath and neurofibrils in most of the surgical traumas of the nerve fiber. The electromyography of the laryngeal musculature shows complete interruption of the conduction of the action potential in all types of experimental lesions.EMG intraoperative monitoring of the laryngeal nerves appears the most effective measure to avoid the complication.