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Neovascularization in the Region of Saphenofemoral Junction Following Babcock Excision of Great Saphenous Vein

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Mikusek W. , Waniczek D. , Arendt J. , Buda K. , Rudzki M.

Polish Journal of Surgery

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2009

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tom 81

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nr 9

383-391

EN

Recurrent varicose veins are an important problem in the surgical practice. They can be caused by neovascularization. New venous anastomoses, formed at the site of primary surgical intervention, can result in venous reflux and then recurrence of the disease.The aim of the study was to investigate whether there is a neovascularization at the site of saphenofemoral junction and if so, how common it is, in patients undergoing surgical treatment for varicose veins of the lower limbs.Material and methods. The study enrolled 60 patients: 43 women and 17 men. In all study subjects the region of saphenofemoral junctions was dissected, visualized collateral vessels and great saphenous vein were ligated and cut; the latter was dissected using Babcock method. Ultrasound imaging of the saphenofemoral junction was performed twice: 30 days and 6 months after the surgical procedure. We sough vessels that persisted after the primary procedure as well as vessels formed in the process of neovascularization.Results. Thirty days after the surgical procedure, we did not find any blood vessels in the study group that would suggest that the process of neovascularization took place. In 10 (16.7%) patients we found collaterals left in the region of saphenofemoral junction. Six months after the surgical procedure, small newly formed venules were found in 17 (28.3%) patients in the region of previous surgical intervention. Certain neovascularization was found in 12 (20%) patients and probable neovascularization in 5 (8.3%) of the study group.Conclusions. Six months after the surgical procedure small, tortuous veins appeared at the site of saphenofemoral junction. Their formation is inevitable and occurs irrespectively of completeness of the primary surgical procedure. Throughout six months of follow-up we did not find any evidence to support the assumption that neovascularization could be the cause of recurrent varicose veins.

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The Usefulness of Preoperative Doppler Ultrasonographic Evaluation of Saphenofemoral Complex For Improving Lower Limb Varicose Veins Surgery

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Mikusek W. , Arendt J. , Waniczek D. , Rudzki M. , Buda K. , Orkisz W.

Polish Journal of Surgery

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2008

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tom 80

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nr 11

594-603

EN

The aim of the study was to determine whether detailed preoperative Doppler ultrasonographic examination of saphenofemoral complex can improve the results of the lower limb varicose veins surgery.Two groups of patients (30 people each) were operated due to lower limbs primary varicose veins caused by saphenous vein insufficiency. All patients had a routine duplex examination performed. Group B had additional ultrasound examination before the operation to evaluate the number, diameter, and localization of the tributary vessels in the area of saphenofemoral junction. 30 days after the operation, in both groups control duplex examination was performed to evaluate the sparingness of the surgical procedure. The control ultrasonography showed 8 and 2 tributary vessels overlooked in groups A and B, respectively. The differences were statistically significant. The conformity of the preoperative ultrasound and the scene found during the operation in group B was 83.3%. The chance of overlooking peripheral vessels in group A increased 5.1 times.Preoperative Doppler ultrasound estimates localization of tributary vessels within the saphenofemoral junction, which makes detecting vessels during the operation much easier. It allows to minimize the number of technical mistakes and improve the lower limb varicose veins surgery results.

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Mikulicz’S Procedure with Levator Muscle and External Anal Sphincter Plasty in the Treatment of Rectal Prolapse

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Waniczek D. , Copija A. , Janiszewska J. , Maruszczak P. , Raźnikiewicz A. , Arendt J.

Polish Journal of Surgery

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2012

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tom 84

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nr 12

626-631

EN

Rectal prolapse is the partial or complete protrusion of the rectal wall into the anal canal. The most common etiology consists in the insufficiency of the diaphragm of the lesser pelvis and anal sphincter apparatus. Methods of surgical treatment involve perineal or abdominal approach surgical procedures. The aim of the study was to present the method of surgical rectal prolapse treatment, according to Mikulicz’s procedure by means of the perineal approach, based on our own experience and literature review. Material and methods. The study group comprised 16 patients, including 14 women and 2 men, aged between 38 and 82 years admitted to the department, due to rectal prolapse, during the period between 2000 and 2012. Nine female patients, aged between 68 and 82 years (mean age-76.3 years) with fullthickness rectal prolapse underwent surgery by means of Mikulicz’s method with levator muscle and external anal sphincter plasty. The most common comorbidities amongst patients operated by means of Mikulicz’s method included cardiovascular and metabolic diseases. Results. Mean hospitalization was 14.4 days (ranging between 12 and 17 days). Despite advanced age and poor general condition of the patients, complications during the perioperative period were not observed. Good early and late functional results were achieved. The degree of anal sphincter continence was determined 6-8 weeks after surgery showing significant improvement, as compared to results obtained prior to surgery. One case of recurrence consisting in mucosal prolapse was noted, being treated surgically by means of Whitehead’s method. Good treatment results were observed. Conclusion. Transperineal rectosigmoidectomy using Mikulicz’s method with levator muscle and external anal sphincter plasty seems to be an effective, minimally invasive and relatively safe procedure that does not require general anesthesia. It is recommended in case of patients with significant comorbidities and high surgical risk.