Georgi Popivanov

• MD, PhD
• Professor (Associate) at Military Medical Academy

A practical flow-chart illustrating the management approach for high-surgical risk and frail patients with moderate to severe acute cholecystitis.

Background The management of high-surgical risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high-surgical risk, alternative treatment...

Aim Approximately 9 million HAIs occur yearly worldwide or 5–15% of all admissions. According to a recent systematic review the cumulative incidence of SSIs is 11%. According to the Middle East Expert Forum, NPWT with instillation (NPWTi) offers the following benefits over the conventional NPWT ‘reduction in bioburden, decreased time to wound closu...

Introduction: Hepatitis E virus (HEV) infection is caused by viruses belonging to the Hepeviridae family. HEV infection can be self-limiting; however, extrahepatic manifestations may be present. The purpose of the current study was to establish the seroprevalence of HEV among Bulgarian liver transplant recipients (LTRs) and to identify associated r...

AIM: Electrochemotherapy (ECT) combines chemotherapy with an electric pulse to directly target tumor cells by increasing cell membrane permeability, facilitating the efficient uptake of chemotherapeutic agents by tumor cells and improving their therapeutic efficacy. It is widely used for treating skin metastatic nodules or metastases of subcutaneou...

Въведение Актиномикозата е хронично и инвазивно грануломатозно възпаление, което най-често засяга лицето и шията (55%), корема (20%) и белия дроб (15%). Предоперативната диагноза при коремна локализация е трудна (< 10%). При ранна диагностика антибиотичното лечение може да спести или да намали обема на обикновено големите хирургичните интервенции....

Background The history of inguinal hernia repair has been marked by the description of several therapies over ages, each with its own approach to managing the hernial sac. An analysis of hernia sac transection (with or without high ligation) versus reduction (invagination) in adults who underwent Lichtenstein open tension‐free inguinal hernia repai...

Inguinal–iliac–obturator lymph node dissection is essential in the treatment of patients with cutaneous melanoma exhibiting the clinical or radiological involvement of pelvic lymph nodes. The open procedure is associated with elevated mortality rates. Numerous minimally invasive approaches have been suggested to mitigate the impact of this surgery...

Background One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19 th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sect...

The rapid spread of carbapenemase-producing strains has led to increased levels of resistance among Gram-negative bacteria, especially enterobacteria. The current study aimed to collect and genetically characterize the colistin- and carbapenem-resistant isolates, obtained in one of the biggest hospitals (Military Medical Academy) in Sofia, Bulgaria...

Aim Approximately 9 million HAIs occur yearly worldwide or 5-15% of all admissions.1 According to a recent systematic review the cumulative incidence of SSIs is 11%.2 According to the Middle East Expert Forum, NPWT with instillation (NPWTi) offers the following benefits over the conventional NPWT “reduction in bioburden, decreased time to wound clo...

Citation: Popivanov, G.; Markovska, R.; Gergova, I.; Konaktchieva, M.; Cirocchi, R.; Kjossev, K.; Mutafchiyski, Abstract: Background and Objective: Klebsiella pneumoniae appears to be a significant problem due to its ability to accumulate antibiotic-resistance genes. After 2013, alarming colistin resistance rates among carbapenem-resistant K. pneum...

Background and objective K. pneumoniae appeared to be a significant problem due to its ability to accumulate antibiotic-resistance genes. After 2013, alarming colistin resistance rates among carbapenem-resistant K. pneumoniae have been reported in the Balkans. The study aims to perform an epidemiological, clinical, and genetic analysis of a local o...

Никой, кога запали светило, не го туря на скрито място, нито под крина, а на светилник, за да виждат светлината ония, които влизат (Лука 11:33) Според Хипократ медицината е там, където има любов към човешките същества. Главата на Църквата, Лекарят Христос завещава: „Тази е Моята заповед: да любите един другиго, както Аз ви възлюбих. Никой няма любо...

Всеки се нуждае от неповторимостта на останалите, за да постигне собствената си цялост. J. Bajis Екипът се дефинира като "група индивиди които работят заедно за постигане на обща цел". Успешните екипи се отличават с уважение и подкрепа между членовете на екипа и позитивно емоционално пространство с много възможности за действие и творчество, което...

Introduction: Transanal endoscopic total mesorectal excision is an innovative surgical technique for the treatment of low rectal neoplasms. The method can improve both oncological outcomes and reduce the frequency of perioperative complications. However, there is no strong evidence to support such claims, and high-quality studies in the field are n...

The war afflicts the whole human being – spirit, soul and body. Usually, the focus is on the wounded. Recently, more attention has been paid to the psychological consequences, which affect significantly more people than the physical injuries. The purpose of this paper is to outline the place of the priest in dealing with post-traumatic stress disor...

236 www.jwmr.org Dear Editor, We read with interest the paper of Sung et al. published in your journal [1]. We congratulate the authors for the excellent results using the improvised continuous instilla-tion negative-pressure wound therapy (NPWTi) system in complex wounds not healed by conventional dressings. We started using a similar system in 20...

We read with interest the recent paper of Avellaneda et al. published in Digestive and Liver Disease and congratulate the authors for their hard work [1]. We agree that a change of tactic is needed, because despite the widely proclaimed “era” of biological therapy for Crohn's disease (CD) “the number of patients requiring surgery for Crohn's diseas...

INTRODUCTION: Parathyroid cancer (PTC) is an extremely rare malignancy with an incidence of 5.7 per 10 million people. The exact preoperative or intraoperative diagnosis is difficult, but of paramount importance, because resection with negative margins is the only effective treatment. CASE REPORT: A 46-years-old female was referred from another hos...

„Повече пот в тренировката, по-малко кръв в боя“ полк. Б. Дрангов (1872-1917) Посвещава се на всички жертви на войните и всички медицински чинове отдали времето и живота си в помощ на ранените, предавайки ни безценния си опит. „Смъртността зависи не само от оръжието на врага, но и от качеството на медицинския отговор.“ Така започва монографията п...

Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PH...

Introduction: Leiomyomatosis peritonei or disseminated peritoneal leiomyomatosis (DPL) is an extremely rare condition affecting mainly women of childbearing age with estrogen hypersecretion. It is characterized by the presence of multiple histologically benign smooth muscle nodules on the peritoneal surface and subperitoneal tissue mimicking perito...

Introduction: The penetration into adjacent organs is a classical complication of peptic ulcer despite being less frequent than the other complications. The current work presents a rare case of gastric ulcer penetrating the duodenojejunal flexure and discusses the diagnostic difficulties, pitfalls, and current treatment strategy. Case report: A 63-...

„Църквата е единствената организация, която не съществува заради самата себе си, а заради онези, които са извън нея“. архиеп. Уилям Темпъл (1881-1944) „От рабите, които ти дадох, никой да не загине, защото Аз ще ги изискам от тебе“. (3 Езд. 2:26) „Ако сте това, което трябва да бъдете, ще възпламените целия свят“. св. Катерина Сиенска (1347-1380)...

Introduction: Rosai-Dorfman-Destombes disease (RDD) is a rare “R” group histiocytic disease with a prevalence of 1:200,000. Herein, we present an extr4mely rare case with localized retroperitoneal RDD manifested as a fever of unknown origin (FUO). This case was managed in an academic setting and illustrates the challenging diagnostics of RDD and FU...

Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnorma...

Introduction: Approximately 90% of the cases with anal stenosis (AS) occur after haemorrhoidectomy. Although often neglected, AS significantly worsens the quality of life leading to social deprivation due to the pain and difficulties in defecation. The present work presents a case of recurrent AS and a brief review of the literature as well. Case r...

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about t...

Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review...

Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs remain “a nightmare” for the patient, the surgeon, and the hospital. Here we describe a case of ri...

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features – presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It i...

The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analy...

По време на война цялото същество на човека - дух, душа и тяло, е подложено на страдание. Обикновено, вниманието е фокусирано върху телесните увреди, но в последните десетилетия все по-голямо внимание се обръща и на психологическите последствия, които засягат много повече хора. Целта на настоящия труд е да потърси мястото на свещеника при справяне...

Pancreatic encephalopathy belongs to the group of metabolic encephalopathies. It is a part of the syndrome of multiple organ failure in acute pancreatitis. It usually occurs early in the course of the disease. The late occurs after the second week or during the recovery period and is referred to as Wernicke’s encephalopathy. The aim of the paper is...

Все още нерешен и спорен остава въпросът с приложението на остеопластиката в оперативното лечение на фрактурите на проксималния хумерус. Дискусионни са въпросите дали, при кои случаи и какви присадъци да се използват? Aвтоложният костен присадък в това отношение е „златен“ стандарт, тъй като притежава необходимите за костната регенерация свойства и...

Introduction Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II–IV complicated acute divert...

В монографията е отразена промяната в цялостната философия към острия панкреатит с дискусия на новите класификации, изместването към максимално изчаквателно консервативно лечение с адекватно флуидно заместване, ранно захранване и по-строги индикации за антибиотично лечение, по-строги индикации за хирургично лечение и въвеждане на стъпаловиден лечеб...

God Christ Himself exalts the ministry to the highest place "the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many" (Matthew 20:28) and "I am among you as a servant" (Luke 22:27). He equates the service of one's neighbour as a service to Himself – “I was sick and you looked after me” (Matthew 25: 35-40)....

Introduction: Although ileosigmoid fistulas (ISFs) in Crohn’s disease (CD) are rare they can be quite challenging, especially for the inexperienced surgeons. Furthermore, current guidelines offer no clear recommendation regarding the surgical strategy in such cases. A systematic review of the literature to determine the best surgical strategy and a...

The article is focused on the different types of bone graft substitutes, their classification and biological potential.

The article discusses the potential of beta tricalcium phosphate and biphasic calcium phosphate for achieving structural repair of the bone defect. in benign tumors. Characteristics like biodegradation and incorporation of these ceramics are compared based on their physical and chemical properties and the observed rentgenological results. The "rest...

With this report is presented our experience in managing diffuse peritonitis following anastomotic disruption after colorectal resection with open abdomen technique.

Introduction: Approximately 10% of the comminuted and displaced proximal humeral fractures (PHF) occur after high-energy trauma. Surprisingly, despite the vast body of literature on the treatment of fractures, very few papers deal with the high-energy PHFs. The work aims to compare the influence of three surgical techniques on the postoperative fun...

Introduction ‒ Hepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons. Materials and methods ‒ A new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion i...

Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of...

Background Laparoscopic cholecystectomy (LC) is considered to be the gold standard in the early management of acute cholecystitis however, recommendations for routine drain insertion in the acute setting are unavailable. Study design A systematic review of literature review and metanalysis was conducted. All studies comparing drain versus no drain...

Acute appendicitis (AA) is the most common non-traumatic abdominal emergency. Despite the improved knowledge, experience, and technological advance, its diagnosis remains a challenge. Herein we report an example of a difficult diagnosis of acute appendicitis and comment on the possible pitfalls in the differential diagnosis and surgical tactics. We...

The reported incidence of intestinal endometriosis varies between 22% and 37%, with bowel obstruction in only 2.3% of cases, but few series report acute obstruction. We report a rare case of acute bowel obstruction due to multiple bilateral deep intestinal endometriosis lesions localised in the ileum, ileocaecal valve and upper rectum, requiring sy...

Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS...

Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and t...

Background: Adhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consist of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although ad...

We read with interest the response to our paper "Endoluminal negative pressure therapy in colorectal anastomotic leaks" by Dioscoridi et al. [1]. We would like to congratulate the authors for the excellent and innovative work, which substantially contributes to better treatment of colorectal anastomotic leaks. Their successful management is of para...

Introduction The delayed diagnosis in emergency surgery can be associated with significant morbidity and mortality and often lead to litigations. The aim of the present work is to analyse the outcome in cases with non-trauma surgical emergencies wrongly admitted in non-surgical departments. Methods A retrospective trial in two independent Universit...

Background and Objectives: The diverticular disease includes a broad spectrum of different "clinical situations" from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diver...

Въведение Макар, че взривната травма (ВТ) е добре проучена, в литературата са публикувани само няколко проучвания, в които тя е сравнена с цивилната травма. По-доброто разбиране на разликите в профила на увредите и лечебната тактика би довело до по-добра подготовка на хирурзите и подобряване на медицинския отговор. Материал и методи Извършен е ретр...

Приложението на негативното налягане за лечение на рани датира от десетилетия с първоначално с вакуумните дренажи и постепенно еволюирайки до съвременните комерсиални или импровизирани системи. Въпреки натрупания опит и научна литература по въпроса, на практика все още има редица неизяснени проблеми, на фона на липса на категорични, базирани на док...

Background: Nowadays sigmoidectomy is recommended as "gold standard" treatment for generalized purulent or faecal peritonitis from sigmoid perforated diverticulitis. This systematic review and meta-analysis aimed to assess effectiveness and safety of laparoscopic access versus open sigmoidectomy in acute setting. Methods: A systematic literature...

Aim: The aim of the present work is to perform an up-to-date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. Method: An electronic search in PubMed, Google Scholar and a manual search without language restrictions was performed on 25 January 2019. Only original series reporting endoluminal negat...

Въведение Хирургичната практика се отнася към професиите с висок риск за грешка и изисква експертиза в множество аспекти - точна диагностика, решение за извършване оперативна интервенция или не, способност за извършване на съответната операция, адекватно водене на следоперативния период с ранно откриване на усложненията и адекватното им третиране....

Objective The anastomotic leak rate in colorectal surgery is highest in patients receiving anterior rectal resections. The placement of prophylactic pelvic drains remains a routine option for preventing postoperative leaks, despite increasing evidence suggesting no clinical benefit. The present study seeks to identify a consensus on the use of prop...

Introduction Although inguinal hernia repair is a routine procedure and frequently performed as one-day surgery, we should be particularly aware of the possible complications, which could be life-threatening if not recognized in due course. Case report We report a case of life-threatening extra-peritoneal bleeding after open inguinal hernia repair...

Introduction: Although inguinal hernia repair is a routine procedure and frequently performed as one-day surgery, we should be particularly aware of the possible complications, which could be life-threatening if not recognized in due course. Case report: We report a case of life-threatening extra-peritoneal bleeding after open inguinal hernia re...

Background: Injuries to the recurrent inferior laryngeal nerve (RILN) remain one of the major post-operative complications after thyroid and parathyroid surgery. Damage to this nerve can result in a temporary or permanent palsy, which is associated with vocal cord paresis or paralysis. Visual identification of the RILN is a common procedure to pre...

Aim In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, during treatment of diverticular disease, IMA ligation is not mandatory. The object of this meta‐analysis was to assess if IMA preservation reduces the risk of anastomotic leak. Method The search was performed up to August 2018...

Rationale: Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforati...

Болестта на Крон е хронично-рецидивиращо заболяване, засягащо целия гастроинтестинален тракт. Макар и сравнително рядко, то е с голяма социална значимост поради засягането на предимно млади хора в трудоспособна възраст, необходимостта от продължително приемане на медикаменти, честите хоспитализации, хирургичните интервенции в голяма част от пациент...

Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatom...

Introduction For a long time, the military doctrine inarguably stated that wartime wounds must be managed by debridement, lavage, saline-soaked dressing and healing by secondary intention. However, the new reality of the changed warfare and medical support doctrine (improved prehospital care, higher rate of survivors with extensive soft tissue loss...

Background: Three-dimensional (3D) vision technology has recently been validated for the improvement of surgical skills in a simulated setting. Clinical studies on specific operations have been published in the field of general, urologic, and gynecologic laparoscopic surgery. We hypothesized that 3D vision laparoscopic right colectomy has better i...

Introduction: The unceasing terrorist attacks became a constant threat for our society directed toward innocent people. Blast trauma is frequently associated with mass casualty events and continues to challenge our preparedness. Material and methods: Three mass casualty events were analyzed and compared. The terrorist events were combat attack agai...

BACKGROUND: Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitiv...

Introduction: A postoperative cervical hematoma is a relatively rare, but potentially life-threatening complication after thyroid surgery. However, few cases with delayed manifestation after discharge of the patient are available in the literature. Case report: A 63-year-old Caucasian woman underwent total thyroidectomy for recurrent benign nodula...

Диатермичната коагулация (ДК) се прилага в тироидната хирургия от около две десетилетия. През тези години тя е доказала своята безопасност и ефективност, като често нейната икономическа ефективност е подлагана на дискусия. Данните за икономическата ефективност на ДК в тироидната хирургия в световен мащаб са оскъдни, а у нас липсват такива. Материал...

Rationale: Differentiated thyroid cancer is the most common endocrine malignancy with concomitant hematological malignancy in 7%. Patient concerns: We present a case of a synchronous papillary thyroid cancer and a follicular variant of non-Hodgkin lymphoma and discuss the possible diagnostic and treatment dilemmas. Diagnosis: A 48-year-old fem...

Nowadays all of us are witnesses of the exciting progress of science and medicine in particular. The rapidly expanded knowledge of human physiology and genome and technological advance made possible the treatment of previously incurable disease and a successfull performance of more complex surgical interventions. The holistic approach in medicine c...

Neoplasms of the jejunum are uncommon in surgical practice, where the majority are benign, and about 15% are malignant. Primary intestinal melanoma occurs extremely rarely because it develops from melanocytic cells, which do not occur in the intestine. However, these cells have occasionally been found in the ali-mentary tract, the respiratory tract...

Despite the significant medical progress deep surgical site infections continue to be unresolved problem worldwide. On other hand, although negative pressure wound therapy has been received worldwide recognition, few studies examined its effectiveness in fascial dehiscence. The aim was to perform a microbiological and cost analysis of deep surgical...

Wound frequently complicates the quality of life of these patients. Despite the significant number of publications made on the subject are very few randomized trials published. It follows that the available evidence in the literature is of low level. The application of NPWT in treatment of the wound is very heterogeneous: negative-pressure wound th...

REVIEW Abstract: Pressure ulcers are a highly prevalent source of morbidity with an equally high incidence of up to 38.0% amongst different categories of healthcare institutions. Therefore , the management and therapeutic approach toward these often hospital-or facility-acquired problems remain critical aspects of long-term care. Negative pressure...

ABSTRACT Rapidly progressive and potentially fatal necrotizing fasciitis of the external genitalia, perineal and perianal area is defined as Fourniers gangrene. Despite advancements in treatment that required multidisciplinary approach, the mortality rate averages 20-30%. Extended and repeated surgical wound debridement may lead to extensive wound...

Background: Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. Methods: A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma...