Despite the advances in medicine regarding diagnosis and therapeutic options, the treatment of femoral hernias remains a challenge for the surgeon. In the past, this type of hernia was repaired with conventional surgery. Today, mini-invasive techniques are preferred method of choice by many surgeons. The aim of our study is to compare the results of open and minimally invasive surgery in patients with femoral hernias.In the present study we include patients with primary unilateral femoral hernias operated in the Surgical Department of EUROHOSPITAL- Plovdiv and the Department of General Surgery of University Hospital “St. George” for the period January 2018 to December 2022. The patients were divided into two groups - conventional and minimally invasive operations. Comparative analysis was performed regarding sex, age, duration of operative intervention, postoperative pain, hospital stay and complications.33 patients in total were diagnosed and operated for femoral hernias for a period of 5 years. Of these, 16 patients were operated conventionally and 17 underwent laparoscopic surgery. Patients in the minimally-invasive group had a significantly shorter hospital stay (2.1 vs 3.0 days) and less postoperative pain (1.8 vs 3.6 on the 1 to 5 scale). The incidence of the postoperative complications was similar in both groups.Surgery is the only method of treatment of femoral hernias. Nowadays, minimally invasive techniques became a method of choice compared with conventional surgery. We believe that laparoscopic operations for femoral hernia, performed by experienced surgeon, are effective and safe and could be applied to all type of patients.

INTRODUCTION: A spontaneous pneumothorax occurring in a patient with underlying lung pathology is classified as a secondary spontaneous pneumothorax (SSP). Its main cause is the chronic obstructive pulmonary disease (COPD), more rarely-a tuberculosis infection (TB). Untreated TB could lead to carnification of a part or the whole lung. CASE REPORT: A 35-year-old female patient was admitted with complaints of sudden right chest pain and severe dyspnea. The physical examination showed retracted and deformed left chest part, missing breathing sounds in the left and weakened breathing in the right. Chest CT revealed partial right-sided pneumothorax, bullous changes of the right lung and carnification of the whole left lung. Right thoracocentesis was performed. The postoperative period was uneventful. The chest drain was removed on the fifth day. After more detailed examinations the patient was diagnosed with COPD and TB and was transferred to the Department of Pulmonology and Phthisiatry for further treatment. CONCLUSION: In a patient who has two advanced and complicated lung diseases at the same time (COPD and TB), a spontaneous pneumothorax, even partial, is a life-threatening condition and requires special consideration and urgent therapeutic measures.

Spontaneous pneumothorax (SP) is a rare complication of COVID-19 pneumonia; it affects both intubated and non-intubated patients. The pathogenesis includes barotrauma and pneumatocele formation. In the following article, we present case series of 18 patients with COVID-19 associated pneumothorax - a detailed demographic and clinical analysis were performed. The study revealed that men were more affected than women, especially above the age of 55 years; whilst, the distribution of intubated patients and those with spontaneous breathing were equal. Importantly, tube thoracostomy was the preferred method of treatment. The lethal outcome was observed in all patients on mechanical ventilation, due to the severe course of the underlying disease. The occurrence of pneumothorax in patients with COVID-19 is associated with poorer outcome of the disease, especially in those placed on mechanical ventilation.

Secondary spontaneous pneumothorax (SSP) may be a result of different rare diseases. In the following article are presented two interesting cases of SSP related to genetic disorders – Ehlers-Danlos syndrome (EDS) and Neurofibromatosis type 1 (NF-1). We share our clinical, laboratory and imaging findings as well as the surgical techniques we used and the postoperative complications we had. We performed a detailed literature review on this topic.

Objective: Traditional approaches to thymectomy for myasthenia gravis (MG) formerly included open sternotomy and later video-assisted-(VATS) and robot-assisted thoracic surgery (RATS) through traditional double-lumen intubation anaesthesia. The aim of the review was to describe current role of non-intubated (NI) minimally invasive techniques in thoracic surgery with emphasis on NI-VATS thymectomy and point out advantages and disadvantages of the method from both the surgical-and anaesthesiological point of view.Background: With the introduction of non-intubated thoracic surgery (NITS) pioneer surgeons and anaesthesiologists have managed to carry out various thoracic surgery procedures from major lung resections to thymectomy without having to deal with the disadvantages of traditional intratracheal tube placement and reduce adverse effects of intubation, such as tracheal injury, lung infections, or hoarseness. Without the need of muscle relaxants, faster overall recovery can be achieved, granting improved postoperative patient outcomes, especially in cases of MG.Methods: Evolution of the NI technique and important results are presented through literature data and references. Only published manuscripts written in English language were considered including case reports, retrospective-, and prospective cohorts, meta-analysis, systematic reviews and randomized controlled trials.Conclusions: Although NI-VATS thymectomy remains a promising novel approach with numerous apparent benefits, further data evaluation and larger scale of patient outcome analysis is needed to determine exact indications and feasibility of the technique.

Background: Spontaneous bladder perforation (SBP) is an exceedingly rare, life-threatening event with almost all of the cases reported having a history of previous bladder manipulation, lower urinary tract obstruction, pelvic radiotherapy or surgery, inflammation, and malignancy. There are very few cases in the medical literature about SBP connected with thoracic surgery. Case Summary: We present a rare case of SBP in a female patient who underwent a thoracic operation. A 45-year-old patient was admitted to our department with clinical, laboratory and image findings of a chronic right lung abscess. After right thoracotomy, an upper right bilobectomy was performed. On the day of her discharge, she complained of a sudden abdominal pain, ballooning of the abdomen, nausea and vomiting. The ultrasonography showed a free fluid in the peritoneal cavity. An urgent laparotomy was performed, a perforation of the bladder was found, urologist performed a resection of the necrotic part of the wall and two layer suture of the bladder. Postoperatively, we had multiple complications. Tuberculosis was considered as one of the most likely diagnosis but was subsequently rejected. The patient was discharged after 70 days of hospital stay in a good health condition. Conclusion: SBP can have various underlying causes, and it is exceedingly rare connected with thoracic operations. A general surgeon should always be aware of that condition in the differential diagnosis of the acute abdomen.