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Article: Critical View of Safety in Laparoscopic Cholecystectomy: A Word of Caution in Cases of Aberrant Anatomy.

Antonopoulou, Maria Ioanna / Manatakis, Dimitrios K

2022 Volume 8, Issue 3, Page(s) e157–e161

Abstract: ... ...

Abstract	Introduction
Language	English
Publishing date	2022-10-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2864275-2
ISSN	2378-5136 ; 2378-5128
ISSN (online)	2378-5136
ISSN	2378-5128
DOI	10.1055/s-0042-1744154
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Article: Critical View of Safety in Laparoscopic Cholecystectomy: A Word of Caution in Cases of Aberrant Anatomy

Antonopoulou, Maria Ioanna / Manatakis, Dimitrios K.

The Surgery Journal

2022 Volume 08, Issue 03, Page(s) e157–e161

Abstract: Introduction: To avoid vasculobiliary injuries, the Critical View of Safety (CVS) technique is strongly recommended during dissection of the hepatocystic triangle. It entails three basic steps as follows: (1) complete clearance of the hepatocystic ... ...

Abstract	Introduction: To avoid vasculobiliary injuries, the Critical View of Safety (CVS) technique is strongly recommended during dissection of the hepatocystic triangle. It entails three basic steps as follows: (1) complete clearance of the hepatocystic triangle of fibrofatty tissue, (2) separation of the lower part of the gallbladder from the cystic plate, so that (3) two and only two structures are seen entering the gallbladder. Case History: In this video vignette, we present the case of an aberrant hepatic artery, coursing subserosally parallel to the gallbladder wall. Despite presumably achieving all three CVS requirements, the surgeon did not proceed to clipping and dividing the two structures, preventing a major vascular injury. Due to its unusually large caliber, the artery was carefully dissected, and multiple smaller branches to the gallbladder were ligated instead, until it was definitively identified entering into the hepatic parenchyma of segments IVb–V. Discussion: The CVS approach was originally conceived as a means for the conclusive recognition of the cystic duct and artery to prevent misidentification errors. However, in such cases of extreme anatomical variations, the CVS may indeed have certain limitations. Therefore the surgeon should always maintain a high degree of suspicion and a low threshold for alternative bail-out options.
Keywords	anatomy ; gallbladder ; laparoscopic cholecystectomy ; vasculobiliary injury
Language	English
Publishing date	2022-07-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2864275-2
ISSN	2378-5136 ; 2378-5128
ISSN (online)	2378-5136
ISSN	2378-5128
DOI	10.1055/s-0042-1744154
Database	Thieme publisher's database

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Article: Traumatic lumbar hernia: A systematic review of the literature.

Tsouknidas, Ioannis / Tasis, Nikolaos / Antonopoulou, Maria Ioanna / Acheimastos, Vasileios / Manatakis, Dimitrios K

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2023 Volume 27, Issue 1, Page(s) 53–57

Abstract: Purpose: Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.: Methods: A systematic review of the ... ...

Abstract	Purpose: Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases. Methods: A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0. Results: A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%. Conclusions: TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.
MeSH term(s)	Male ; Female ; Humans ; Adult ; Middle Aged ; Herniorrhaphy/methods ; Surgical Mesh ; Hernia, Abdominal/epidemiology ; Hernia, Abdominal/etiology ; Hernia, Abdominal/surgery ; Tomography, X-Ray Computed ; Laparoscopy
Language	English
Publishing date	2023-06-02
Publishing country	China
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Review
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
DOI	10.1016/j.cjtee.2023.05.006
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Article: Primary adrenal Ewing sarcoma: A systematic review of the literature.

Manatakis, Dimitrios K / Tsouknidas, Ioannis / Mylonakis, Emmanouil / Tasis, Nikolaos / Antonopoulou, Maria Ioanna / Acheimastos, Vasileios / Mastoropoulou, Aikaterini / Korkolis, Dimitrios P

World journal of clinical cases

2023 Volume 11, Issue 28, Page(s) 6782–6791

Abstract: Background: Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly ...

Abstract	Background: Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland. Aim: To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes. Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0. Results: A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%. Conclusion: The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Journal Article
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v11.i28.6782
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Article ; Online: Congenital lumbar herniae: a systematic review.

Tasis, N / Tsouknidas, I / Antonopoulou, M I / Acheimastos, V / Manatakis, D K

Hernia : the journal of hernias and abdominal wall surgery

2021 Volume 26, Issue 6, Page(s) 1419–1425

Abstract: Purpose: Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare ... ...

Abstract	Purpose: Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making. Methods: The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients. Results: Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months. Conclusion: Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.
MeSH term(s)	Male ; Infant, Newborn ; Female ; Child ; Humans ; Herniorrhaphy ; Hernia, Abdominal/surgery ; Lumbosacral Region/surgery ; Abdominal Wall/surgery ; Laparoscopy/methods
Language	English
Publishing date	2021-08-04
Publishing country	France
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1388125-5
ISSN	1248-9204 ; 1265-4906
ISSN (online)	1248-9204
ISSN	1265-4906
DOI	10.1007/s10029-021-02473-x
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Zs.A 5390: Show issues

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Article ; Online: Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives.

Manatakis, Dimitrios K / Antonopoulou, Maria-Ioanna / Tasis, Nikolaos / Agalianos, Christos / Tsouknidas, Ioannis / Korkolis, Dimitrios P / Dervenis, Christos

World journal of surgery

2022 Volume 47, Issue 3, Page(s) 640–648

Abstract: Background: The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been ... ...

Abstract	Background: The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. Method: We systematically reviewed the literature (1995-2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). Results: 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail-out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS-related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). Conclusion: Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail-out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.
MeSH term(s)	Humans ; Cholecystectomy, Laparoscopic/methods ; Bile Duct Diseases ; Surgeons ; Intraoperative Complications/prevention & control ; Bile Ducts/injuries
Language	English
Publishing date	2022-12-06
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-022-06842-0
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Article ; Online: Correction to: Morphology of the sulcus of the caudate process (Rouviere's sulcus) in a Greek population and a systematic review with meta-analysis.

Manatakis, Dimitrios K / Tasis, Nikolaos / Antonopoulou, Maria Ioanna / Agalianos, Christos / Piagkou, Maria / Tsiaoussis, John / Natsis, Konstantinos / Korkolis, Dimitrios P

Anatomical science international

2021 Volume 97, Issue 1, Page(s) 100

Language	English
Publishing date	2021-10-17
Publishing country	Japan
Document type	Published Erratum
ZDB-ID	2079994-9
ISSN	1447-073X ; 1447-6959 ; 0022-7722
ISSN (online)	1447-073X
ISSN	1447-6959 ; 0022-7722
DOI	10.1007/s12565-021-00637-4
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Article ; Online: Morphology of the sulcus of the caudate process (Rouviere's sulcus) in a Greek population and a systematic review with meta-analysis.

Manatakis, Dimitrios K / Tasis, Nikolaos / Antonopoulou, Maria Ioanna / Agalianos, Christos / Piagkou, Maria / Tsiaoussis, John / Natsis, Konstantinos / Korkolis, Dimitrios P

Anatomical science international

2021 Volume 97, Issue 1, Page(s) 90–99

Abstract: The purpose of this study was to determine the prevalence and to investigate the morphology of the sulcus of the caudate process in a Greek population, along with a systematic review and meta-analysis of the literature. Overall, 103 consecutive patients ... ...

Abstract	The purpose of this study was to determine the prevalence and to investigate the morphology of the sulcus of the caudate process in a Greek population, along with a systematic review and meta-analysis of the literature. Overall, 103 consecutive patients undergoing laparoscopic cholecystectomy were included in the analysis. The sulcus was present in 91% and three morphological variants were identified (groove 69%, slit 21% and scar 10%). The sulcus had a horizontal course in 90% of patients and a mean length of 25 ± 13 mm. The meta-analysis included 27 surgical and 11 cadaveric studies with 6661 cases in total. The pooled prevalence of the sulcus was 80% and did not differ significantly among various geographical regions. Concerning sulcus subtypes, the binary "open/fused" classification was used to unify the heterogeneous data. The "open" type was more frequent than the "fused" (64.5% vs 35.5%). A horizontal course was observed in 53.5% and an oblique in 45.7%. The sulcus contained the right portal pedicle in 38%, the right posterior portal pedicle in 37%, and the right posteroinferior pedicle in 23.5%. In conclusion, the sulcus of the caudate process is a very helpful anatomical landmark in hepatectomy and laparoscopic cholecystectomy and can be identified in the majority of patients. However, various classifications for the morphological variants and diverse terminology cause discrepancy in the literature and create the need for a single classification system. The proposed 3-tier classification (groove, slit, scar) is simple and easy to remember and avoids ambiguous nomenclature.
MeSH term(s)	Cholecystectomy, Laparoscopic ; Greece ; Humans
Language	English
Publishing date	2021-09-17
Publishing country	Japan
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2079994-9
ISSN	1447-073X ; 1447-6959 ; 0022-7722
ISSN (online)	1447-073X
ISSN	1447-6959 ; 0022-7722
DOI	10.1007/s12565-021-00628-5
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Article: Gastrointestinal Seed Bezoars: A Systematic Review of Case Reports and Case Series.

Manatakis, Dimitrios K / Acheimastos, Vasileios / Antonopoulou, Maria Ioanna / Balalis, Dimitrios / Korkolis, Dimitris P

Cureus

2019 Volume 11, Issue 5, Page(s) e4686

Abstract: Seed bezoars are a distinct subcategory of phytobezoars, caused by indigestible vegetable or fruit seeds. The aim of our study was to present a comprehensive review on seed bezoars, focusing on epidemiology, symptomatology, diagnosis and treatment ... ...

Abstract	Seed bezoars are a distinct subcategory of phytobezoars, caused by indigestible vegetable or fruit seeds. The aim of our study was to present a comprehensive review on seed bezoars, focusing on epidemiology, symptomatology, diagnosis and treatment options. A systematic review of the English literature (1980-2018) was conducted, using PubMed, Embase and Google Scholar databases. Fifty-two studies fulfilled the inclusion criteria, with a total of 153 patients, the majority of whom (72%) came from countries around the Eastern Mediterranean and the Middle East. Patients complained primarily about constipation (63%), abdominal/rectal pain (19%) or intestinal obstruction (17%). Most seed bezoars were found in the rectum (78%) and the terminal ileum (16%). Risk factors were recognised in 12% of cases. Manual disimpaction under general anaesthesia was the procedure of choice in 69%, while surgery was required in 22% of cases. Seed bezoars appear to represent a different pathophysiological process compared to fibre bezoars. Seeds usually pass through the pylorus and ileocaecal valve, due to their small size, and accumulate gradually in the colon. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. History and digital rectal examination are the mainstay of diagnosis, with manual extraction under general anaesthesia being the procedure of choice.
Language	English
Publishing date	2019-05-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.4686
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Article ; Online: Unfinished Business: A Systematic Review of Stump Appendicitis.

Manatakis, Dimitrios K / Aheimastos, Vasileios / Antonopoulou, Maria-Ioanna / Agalianos, Christos / Tsiaoussis, John / Xynos, Evanghelos

World journal of surgery

2019 Volume 43, Issue 11, Page(s) 2756–2761

Abstract: Background: Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis ...

Abstract	Background: Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. Methods: The English literature (1945-2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms "appendix", "appendicitis", "stump", "residual", "recurrent" and "retained". In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). Results: Index surgery was open in 59% and laparoscopic in 38%. It was described as "difficult" or "complicated" in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as "difficult" or "complicated" in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5-10 cm). Conclusions: Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.
MeSH term(s)	Adolescent ; Adult ; Aged ; Appendectomy/adverse effects ; Appendicitis/diagnosis ; Appendicitis/etiology ; Appendicitis/therapy ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology ; Young Adult
Language	English
Publishing date	2019-08-02
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-019-05101-z
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