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Article ; Online: Comparison of intracorporeal and extracorporeal anastomosis in laparoscopic right colectomy: an updated meta-analysis and trial sequential analysis.

Perivoliotis, Konstantinos / Tzovaras, George / Tepetes, Konstantinos / Baloyiannis, Ioannis

2024 Volume 76, Issue 2, Page(s) 375–396

Abstract: This meta-analysis was conducted to provide updated evidence regarding perioperative safety and efficacy, of IC and EC anastomosis in laparoscopic right colectomies. In this study, the Cochrane Handbook for Systematic Reviews of Interventions and the ... ...

Abstract	This meta-analysis was conducted to provide updated evidence regarding perioperative safety and efficacy, of IC and EC anastomosis in laparoscopic right colectomies. In this study, the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines were applied. The study protocol received a PROSPERO registration (CRD42020214596). A systematic literature search of the electronic scholar databases (Medline, Web of Science and Scopus) was performed. To reduce type I error, a trial sequential analysis (TSA) algorithm was introduced. The quality of evidence was evaluated based on the GRADE methodology. In total, 46 studies were included in this meta-analysis, Pooled comparisons and TSA confirmed that IC is superior in terms of incisional hernia (0.29; 95%CI: 0.19, 0.44), open conversion (0.45; 95%CI: 0.30, 0.67), reoperation (0.62; 95%CI: 0.46, 0.84]), LOS (- 0.76; 95%CI: - 1.03, - 0.49), blood loss (- 11.50; 95%CI: - 18.42, - 4.58), and cosmesis (- 1.71; 95%CI: - 2.01, - 1.42). Postoperative pain and return of bowel function were, also, shortened when the anastomosis was fashioned intracorporeally. The grading of most evidence ranged from 'low' to 'high'. Due to the discrepancy in the results of RCTs and non-RCTs, and the proportionally smaller sample size of the former, further randomized trials are required to increase the evidence of this comparison.
MeSH term(s)	Humans ; Laparoscopy/methods ; Colectomy/methods ; Anastomosis, Surgical/methods ; Incisional Hernia ; Pain, Postoperative ; Treatment Outcome
Language	English
Publishing date	2024-01-12
Publishing country	Italy
Document type	Meta-Analysis ; Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-023-01737-8
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Article ; Online: Cecorectal (CRA) versus ileorectal (IRA) anastomosis after colectomy for slow transit constipation (STC): a meta-analysis.

Perivoliotis, Konstantinos / Baloyiannis, Ioannis / Tzovaras, George

International journal of colorectal disease

2022 Volume 37, Issue 3, Page(s) 531–539

Abstract: Introduction: We conducted this meta-analysis, to compare cecorectal (CRA) and ileorectal anastomosis (IRA), regarding perioperative safety and efficacy, in patients submitted to colectomy for refractory slow transit constipation (STC).: Methods: ... ...

Abstract	Introduction: We conducted this meta-analysis, to compare cecorectal (CRA) and ileorectal anastomosis (IRA), regarding perioperative safety and efficacy, in patients submitted to colectomy for refractory slow transit constipation (STC). Methods: This study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. To identify all eligible records, a systematic literature search in the electronic scholar databases (Medline, Scopus, Web of Science) was performed. Results: Overall, 5 trials and 291 patients were included in this meta-analysis. Pooled comparisons confirmed the comparability of the two techniques regarding perioperative complications (p = 0.55). CRA was associated with a shorter operation (p = 0.0004) and hospitalization duration (p = 0.001). Although there was no difference in terms of gastrointestinal symptoms, functional outcomes, and patient satisfaction, CRA resulted in lower long-term Wexner scores (p < 0.0001). Conclusion: Due to several study limitations, further large-scale RCTs are required to verify the findings of the present meta-analysis.
MeSH term(s)	Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Colectomy/adverse effects ; Colectomy/methods ; Constipation ; Gastrointestinal Transit ; Humans ; Rectum/surgery ; Treatment Outcome
Language	English
Publishing date	2022-01-12
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-022-04093-y
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Article ; Online: The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis.

Christodoulou, Prokopis / Baloyiannis, Ioannis / Perivoliotis, Konstantinos / Symeonidis, Dimitrios / Tzovaras, George

Techniques in coloproctology

2022 Volume 27, Issue 2, Page(s) 103–115

Abstract: Background: The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD).: Methods: This study was based on the Cochrane Handbook for Systematic Reviews of ... ...

Abstract	Background: The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD). Methods: This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8-26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5-12.5%), thrombosis (2.2%, 95% CI 0.4-4.8%), and pain (1.6%, 95% CI 0.2-3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3-3.4%) and 4.8% (95% CI 1.2-8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7-96.6%) and 95% (95% CI 89.8-100%), correspondingly. Overall CoE was "Very Low". Conclusions: Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.
MeSH term(s)	Humans ; Hemorrhoids/surgery ; Retrospective Studies ; Prospective Studies ; Neoplasm Recurrence, Local ; Pain
Language	English
Publishing date	2022-11-13
Publishing country	Italy
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-022-02730-w
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Article ; Online: Is magnetic anal sphincter augmentation still an option in fecal incontinence treatment: a systematic review and meta-analysis.

Liapis, Stavros Chrysovalantis / Perivoliotis, Konstantinos / Moula, Amalia Ioanna / Christodoulou, Prokopis / Psarianos, Kyriakos / Stavrou, Alexios / Baloyiannis, Ioannis / Lytras, Dimitrios

Langenbeck's archives of surgery

2024 Volume 409, Issue 1, Page(s) 98

Abstract: Purpose: Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and ...

Abstract	Purpose: Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and the functional efficacy of this device. Methods: The study followed the PRISMA guidelines. Literature databases (Medline, Scopus, Web of Science, CENTRAL) were screened for eligible articles. The primary endpoint was the pooled effect of MAS in the Cleveland Clinic Incontinence Score (CCIS) score. Quality evaluation was based on the ROBINS-I and Risk of Bias 2 tool. Results: Overall, 8 studies with 205 patients were included. MAS resulted in a significant reduction of CCIS values (p = 0.019), and improvement only in the embarrassment domain of FIQoL scores (p = 0.034). The overall morbidity rate was 61.8%. Postoperative adverse events included MAS explantation in 12%, infection in 5.1%, pain in 10% and obstructed defecation in 5.8% of patients. Conclusion: The application of MAS in patients with fecal incontinence results in the improvement of some clinical parameters with a notable morbidity rate. Due to several study limitations, further, high-quality RCTs are required to delineate the efficacy and safety of MAS.
MeSH term(s)	Humans ; Anal Canal/surgery ; Device Removal ; Fecal Incontinence/surgery ; Magnetic Phenomena ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2024-03-19
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-024-03288-x
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Article ; Online: Efficacy of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy: a randomized controlled trial.

Sarakatsianou, Chamaidi / Perivoliotis, Konstantinos / Baloyiannis, Ioannis / Georgopoulou, Stavroula / Tsiaka, Aikaterini / Tzovaras, George

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 197

Abstract: Purpose: We designed this study to evaluate the impact of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy.: Methods: In total, 98 patients scheduled for elective laparoscopic ... ...

Abstract	Purpose: We designed this study to evaluate the impact of intraoperative intravenous lidocaine infusion on postoperative opioid consumption after laparoscopic cholecystectomy. Methods: In total, 98 patients scheduled for elective laparoscopic cholecystectomy were included and randomized. In the experimental group, intravenous lidocaine (bolus 1.5 mg/kg and continuous infusion 2 mg/kg/h) was administered intraoperatively additionally to the standard analgesia, whereas the control group received a matching placebo. Blinding existed at the level of both the patient and the investigator. Results: Our study failed to confirm any benefit in opioid consumption, during the postoperative period. Lidocaine resulted to reduced intraoperative systolic, diastolic, and mean arterial pressure. Lidocaine administration did not change postoperative pain scores or the incidence of shoulder pain, at any time endpoint. Moreover, we did not identify any difference in terms of postoperative sedation levels and nausea rates. Conclusion: Overall, lidocaine did not have any effect on postoperative analgesia after laparoscopic cholecystectomy.
MeSH term(s)	Humans ; Analgesics, Opioid/therapeutic use ; Anesthetics, Local/therapeutic use ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Double-Blind Method ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Pain, Postoperative/etiology ; Postoperative Period
Chemical Substances	Analgesics, Opioid ; Anesthetics, Local
Language	English
Publishing date	2023-05-18
Publishing country	Germany
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-02937-x
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Article ; Online: Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of randomized controlled trials.

Perivoliotis, Konstantinos / Chatzinikolaou, Charito / Symeonidis, Dimitrios / Tepetes, Konstantinos / Baloyiannis, Ioannis / Tzovaras, George

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 401

Abstract: Introduction: Efficient postoperative pain control is important after hemorrhoidal surgery. Although several locally applied medications have been used, current evidence regarding the optimal strategy is still conflicting. This network meta-analysis ... ...

Abstract	Introduction: Efficient postoperative pain control is important after hemorrhoidal surgery. Although several locally applied medications have been used, current evidence regarding the optimal strategy is still conflicting. This network meta-analysis assessed analgesic efficacy and safety of the various topical medications in patients submitted to excisional procedures for hemorrhoids. Methods: The present study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The last systematic literature screening was performed at 15 June 2023. Comparisons were based on a random effects multivariate network meta-analysis under a Bayesian framework. Results: Overall, 26 RCTs and 2132 patients were included. Regarding postoperative pain, EMLA cream (surface under the cumulative ranking curve (SUCRA) 80.3%) had the highest ranking at 12-h endpoint, while aloe vera cream (SUCRA 82.36%) scored first at 24 h. Metronidazole ointments had the highest scores at 7 and 14 days postoperatively. Aloe vera had the best analgesic profile (24-h SUCRA 84.8% and 48-h SUCRA 80.6%) during defecation. Lidocaine (SUCRA 87.9%) displayed the best performance regarding overall morbidity rates. Conclusions: Due to the inconclusive results and several study limitations, further RCTs are required.
MeSH term(s)	Humans ; Hemorrhoids/surgery ; Ointments/therapeutic use ; Network Meta-Analysis ; Bayes Theorem ; Randomized Controlled Trials as Topic ; Pain, Postoperative ; Analgesics/therapeutic use
Chemical Substances	Ointments ; Analgesics
Language	English
Publishing date	2023-10-14
Publishing country	Germany
Document type	Meta-Analysis ; Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-03128-4
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Article ; Online: The Role of Percutaneous Tibial Nerve Stimulation (PTNS) in Low Anterior Resection Syndrome (LARS): A Systematic Review and Meta-analysis.

Liapis, Stavros Chrysovalantis / Baloyiannis, Ioannis / Perivoliotis, Konstantinos / Lytras, Dimitrios / Theodoropoulos, Georgios / Tzovaras, Georgios

Journal of gastrointestinal cancer

2023 Volume 54, Issue 4, Page(s) 1128–1139

Abstract: Purpose: The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS).: Material and methods: This study was based on the Cochrane Handbook ... ...

Abstract	Purpose: The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS). Material and methods: This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score-FIC, Obstructive Defecation Syndrome-ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool. Results: Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: - 5.68, 95%CI: - 7.73, - 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS. Conclusions: The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS.
MeSH term(s)	Humans ; Transcutaneous Electric Nerve Stimulation/methods ; Quality of Life ; Low Anterior Resection Syndrome ; Postoperative Complications ; Treatment Outcome ; Rectal Neoplasms ; Tibial Nerve/physiology
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2452514-5
ISSN	1941-6636 ; 1559-0739 ; 1941-6628 ; 1537-3649
ISSN (online)	1941-6636 ; 1559-0739
ISSN	1941-6628 ; 1537-3649
DOI	10.1007/s12029-023-00910-x
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Article ; Online: Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis.

Perivoliotis, Konstantinos / Baloyiannis, Ioannis / Sarakatsianou, Chamaidi / Tzovaras, George

Langenbeck's archives of surgery

2020 Volume 405, Issue 2, Page(s) 125–135

Abstract: Purpose: A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety.: Methods: The ...

Abstract	Purpose: A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety. Methods: The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed. Results: Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45). Conclusions: Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.
MeSH term(s)	Adrenalectomy ; Humans ; Laparoscopy ; Robotic Surgical Procedures
Language	English
Publishing date	2020-03-04
Publishing country	Germany
Document type	Comparative Study ; Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-020-01860-9
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Article ; Online: Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis.

Perivoliotis, Konstantinos / Baloyiannis, Ioannis / Sarakatsianou, Chamaidi / Tzovaras, George

International journal of colorectal disease

2020 Volume 35, Issue 7, Page(s) 1173–1182

Abstract: Background: In order to assess the various surgical modalities for local resection of rectal tumors, a systematic review of the current literature and a network meta-analysis (NMA) was designed and conducted.: Methods: The present study adhered to ... ...

Abstract	Background: In order to assess the various surgical modalities for local resection of rectal tumors, a systematic review of the current literature and a network meta-analysis (NMA) was designed and conducted. Methods: The present study adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions principles. Scholar databases (Medline, Scopus, Web of Science) were systematically screened up to 23/12/2019. A Bayesian NMA, implementing a Markov chain Monte Carlo analysis, was introduced for the probability ranking of the available surgical methods. Odds ratio (OR) and weighted mean difference (WMD) of the categorical and continuous variables, respectively, were reported with the corresponding 95% confidence interval (95%CI). Results: Overall, 16 studies and 2146 patients were introduced in our study. Transanal minimal invasive surgery (TAMIS) displayed the highest performance regarding the overall postoperative morbidity, the perioperative blood loss, the length of hospitalization, and the peritoneal violation rate. Transanal endoscopic microsurgery (TEM) was the most efficient modality for resecting an intact specimen. Although transanal local excision (TAE) had the highest ranking considering operative duration, it was associated with a significant risk for positive resection margins and tumor recurrence. Conclusions: In conclusion, TEM and TAMIS display superior oncological results over TAE. Due to several limitations, validation of these results requires further RCTs of a higher methodological level.
MeSH term(s)	Bayes Theorem ; Humans ; Neoplasm Recurrence, Local ; Network Meta-Analysis ; Rectal Neoplasms/surgery ; Transanal Endoscopic Microsurgery ; Treatment Outcome
Language	English
Publishing date	2020-05-24
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-020-03634-7
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Article ; Online: The role of bursectomy in the surgical management of gastric cancer: a meta-analysis and systematic review.

Perivoliotis, Konstantinos / Baloyiannis, Ioannis / Symeonidis, Dimitrios / Tepetes, Konstantinos

Updates in surgery

2020 Volume 72, Issue 4, Page(s) 939–950

Abstract: In order to delineate the exact role of bursectomy (BS) in gastric cancer surgery, we designed and conducted the present meta-analysis. This meta-analysis adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. ...

Abstract	In order to delineate the exact role of bursectomy (BS) in gastric cancer surgery, we designed and conducted the present meta-analysis. This meta-analysis adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature review of the electronic databases (Medline, Scopus, Web of Science) was performed. Trial sequential analysis (TSA) was introduced for the validation of the pooled analyses. The level of evidence was attributed based on the GRADE approach. Overall, nine studies and 3599 patients were included in our meta-analysis. BS did not lead to an increase in the overall morbidity rate (OR 1.17, 95% CI 0.97-1.42, p = 0.09). Equivalence was, also, identified in all specific postoperative complications. Similarly, mortality rates were comparable (p = 0.69). Moreover, BS was related to a significantly higher operative time (p < 0.001) and perioperative blood loss (p = 0.002). Finally, resection of the omental bursa was not associated with improved R0 excision rates (p = 0.92), lymph node harvest (p = 0.1) or survival outcomes (OS p = 0.15 and DFS p = 0.97). BS displayed a suboptimal perioperative performance without any significant oncological efficacy. Due to certain limitations and the low level of evidence, further high-quality RCTs are required.
MeSH term(s)	Blood Loss, Surgical/statistics & numerical data ; Gastrectomy/methods ; Humans ; Operative Time ; Peritoneal Cavity/surgery ; Postoperative Complications/epidemiology ; Stomach Neoplasms/mortality ; Stomach Neoplasms/surgery ; Survival Rate ; Treatment Outcome
Language	English
Publishing date	2020-06-03
Publishing country	Italy
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00801-x
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