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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 ; Online: Spinal accessory nerve anatomy in the posterior cervical triangle: A systematic review with meta-analysis.

Koliarakis, Ioannis / Manatakis, Dimitrios K / Tsitsipanis, Christos / Drakonaki, Elena / Tsamandouras, Ioannis / Tsiaoussis, John

Clinical anatomy (New York, N.Y.)

2023 Volume 37, Issue 1, Page(s) 130–139

Abstract: This study aimed to investigate the anatomy of the spinal accessory nerve (SAN) in the posterior cervical triangle, especially in relation to adjacent anatomical landmarks, along with a systematic review of the current literature with a meta-analysis of ... ...

Abstract	This study aimed to investigate the anatomy of the spinal accessory nerve (SAN) in the posterior cervical triangle, especially in relation to adjacent anatomical landmarks, along with a systematic review of the current literature with a meta-analysis of the data. Overall, 22 cadaveric and three prospective intraoperative studies, with a total of 1346 heminecks, were included in the analysis. The major landmarks relevant to the entry of the SAN at the posterior border of the SCM muscle (PBSCM) were found to be the mastoid apex, the great auricular point (GAP), the nerve point (NP), and the point where the PBSCM meets the upper border of the clavicle. The SAN was reported to enter the posterior cervical triangle above GAP in 100% of cases and above NP in most cases (97.5%). The mean length of the SAN along its course from the entry point to its exit point from the posterior triangle of the neck was 4.07 ± 1.13 cm. The SAN mainly gave off 1 or 2 branches (32.5% and 31%, respectively) and received either no branches or one branch in most cases (58% and 23%, respectively) from the cervical plexus during its course in the posterior cervical triangle. The major landmarks relevant to the entry of the SAN at the anterior border of the TPZ muscle (ABTPZ) were found to be the point where the ABTPZ meets the upper border of the clavicle and the midpoint of the clavicle, along with the mastoid apex, the acromion, and the transverse distance of the SAN exit point to the PBSCM. The results of the present meta-analysis will be helpful to surgeons operating in the posterior cervical triangle, aiding the avoidance of the iatrogenic injury of the SAN.
MeSH term(s)	Humans ; Accessory Nerve/anatomy & histology ; Prospective Studies ; Cadaver ; Neck/innervation ; Neck Muscles/innervation
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	1025505-9
ISSN	1098-2353 ; 0897-3806
ISSN (online)	1098-2353
ISSN	0897-3806
DOI	10.1002/ca.24119
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Article ; Online: Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis.

Manatakis, Dimitrios K / Gouvas, Nikolaos / Pechlivanides, George / Xynos, Evangelos

Updates in surgery

2021 Volume 74, Issue 1, Page(s) 11–21

Abstract: Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. ... ...

Abstract	Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
MeSH term(s)	Defecation ; Digestive System Surgical Procedures ; Female ; Humans ; Prostheses and Implants ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2021-10-19
Publishing country	Italy
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-01177-2
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Article: The Role of Inflammatory Markers in Predicting Resectability of Pancreatic Ductal Adenocarcinoma.

Agalianos, Christos / Gouvas, Nikolaos / Manatakis, Dimitrios K / Sideris, Ioannis / Passas, Ioannis / Dervenis, Christos

Chirurgia (Bucharest, Romania : 1990)

2022 Volume 117, Issue 4, Page(s) 431–436

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adenocarcinoma/surgery ; Biomarkers ; Carcinoma, Pancreatic Ductal/surgery ; Humans ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Pancreatic Neoplasms
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-09-01
Publishing country	Romania
Document type	Journal Article
ZDB-ID	419244-8
ISSN	1842-368X ; 1221-9118 ; 0009-4730 ; 0377-5003
ISSN (online)	1842-368X
ISSN	1221-9118 ; 0009-4730 ; 0377-5003
DOI	10.21614/chirurgia.2603
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Article ; Online: Elective surgery for conservatively treated acute uncomplicated diverticulitis: a systematic review of postoperative outcomes.

Gouvas, Nikolaos / Agalianos, Christos / Manatakis, Dimitrios K / Pechlivanides, George / Xynos, Evaghelos

Minerva surgery

2022 Volume 77, Issue 6, Page(s) 591–601

Abstract: Introduction: Elective surgery has been proposed, after at least two episodes of acute diverticulitis, initially treated conservatively, in order to prevent further episodes or chronic complaints. However, prophylactic surgery has been questioned, due ... ...

Abstract	Introduction: Elective surgery has been proposed, after at least two episodes of acute diverticulitis, initially treated conservatively, in order to prevent further episodes or chronic complaints. However, prophylactic surgery has been questioned, due to the associated risks of postoperative mortality and morbidity, as well as the risk of recurrent diverticulitis. This systematic review attempts to assess the role of prophylactic left colonic resection, after episodes of uncomplicated acute diverticulitis treated either conservatively with antibiotics and/or other supportive measures. Evidence acquisition: A systematic search was performed using Medline, Embase, Ovid, and Cochrane databases for studies reporting on the treatment of acute uncomplicated diverticulitis (Hinchey I). The main endpoint was treatment failure, defined as persistent/recurrent symptoms or need for readmission and/or reintervention. Secondary endpoints were the immediate postoperative outcomes. Evidence synthesis: In total, 24 studies with 2855 patients were included in the analysis. Intra- and postoperative complications rate were 5% and 16%, respectively. Anastomotic leak was 1.3% and emergency reoperation was 2.4%. Long-term symptomatic resolve was reported at 91%. Persistent or recurrent symptoms were observed in 5.4% of cases. Meta-analysis showed no significant difference in recurrence rates between surgical and conservative management. Conclusions: Elective surgery to prevent recurrent diverticulitis is not recommended, irrespective of the number of previous episodes. Generally, elective sigmoidectomy should not be recommended to patients with ongoing atypical lower abdominal symptoms after acute diverticulitis, but should aim primarily at improving quality of life. It should be offered to patients with ongoing inflammation, or diverticular complications.
MeSH term(s)	Humans ; Diverticulitis, Colonic/surgery ; Quality of Life ; Recurrence ; Diverticulitis/surgery ; Elective Surgical Procedures/adverse effects
Language	English
Publishing date	2022-11-04
Publishing country	Italy
Document type	Systematic Review ; Meta-Analysis ; Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.22.09726-X
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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: Large cystic lymphangioma of the pancreas: unusual finding with differential diagnosis and therapeutic considerations.

Tasis, Nikolaos / Mpalampou, Eleni / Sarafi, Aikaterini / Skafida, Evangelia / Tsouknidas, Ioannis / Fradelos, Evangelos / Manatakis, Dimitrios K / Korkolis, Dimitrios P

Journal of surgical case reports

2023 Volume 2023, Issue 12, Page(s) rjad676

Abstract: Lymphangiomas are rare benign tumours of lymphatic vascular origin. They are more common in the paediatric population and manifest mainly in the neck and axillary region. Retroperitoneal lymphangiomas are <1% and pancreatic origin is even rarer. We ... ...

Abstract	Lymphangiomas are rare benign tumours of lymphatic vascular origin. They are more common in the paediatric population and manifest mainly in the neck and axillary region. Retroperitoneal lymphangiomas are <1% and pancreatic origin is even rarer. We present a case of a pancreatic cystic lymphangioma in a 60-year-old woman with chronic diffuse symptoms, diagnosed because of newly onset of diabetes mellitus. She was successfully managed with distal pancreatectomy and spleenectomy en-bloc with the cystic mass without any complications. Cystic lymphangioma of the pancreas is a rare entity presenting with a challenging preoperative diagnosis as imaging modalities may provide ambiguous information. The clinician should be aware of its complicated differential diagnosis and its persistent and subtle symptomatology.
Language	English
Publishing date	2023-12-19
Publishing country	England
Document type	Case Reports
ZDB-ID	2580919-2
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjad676
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Article ; Online: A comprehensive review of childbearing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Papageorgiou, Dimitrios / Manatakis, Dimitrios K / Papakonstantinou, Katerina / Kyriazanos, Ioannis D

Archives of gynecology and obstetrics

2020 Volume 302, Issue 4, Page(s) 793–799

Abstract: Purpose: Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy.: Methods: A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic ...

Abstract	Purpose: Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy. Methods: A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic databases, following the MOOSE guidelines. The terms "Cytoreductive Surgery", "Hyperthermic Intraperitoneal Chemotherapy", "Peritoneal Carcinomatosis", "Pregnancy", "Fertility Preservation", "Conception" were used. All study designs were eligible for inclusion in the final analysis. Results: In total, 7 studies (5 case reports and 2 case series) were included in the final analysis, reporting on 14 successful pregnancies after CRS and HIPEC. The mean age of patients at the time of CRS/HIPEC was 28.8 ± 5.9 years (range 18-36), while the mean interval between CRS/HIPEC and pregnancy was 29.6 ± 20.3 months (range 9-80 months). Nine patients were treated for pseudomyxoma peritonei, four for primary peritoneal mesothelioma and one for endocrine carcinoma. Mean Peritoneal Carcinomatosis Index was 9.8 ± 7.8 (range 1-26). All patients underwent fertility-sparing CRS (preservation of at least one ovary and the uterus). In 12 cases, conception was spontaneous, whereas two pregnancies were achieved through in-vitro fertilization. One patient developed gestational hypertension, while two labors were preterm. Mean disease-free survival was 64.1 months (range 24-106 months). Conclusion: A successful pregnancy is feasible in selected patients, after CRS and HIPEC. Assisted reproduction techniques (IVF using frozen oocytes or frozen embryos, ovarian tissue cryopreservation, preoperative treatment with GnRH analogs) should be discussed pre-operatively with the patient, without, however, compromising overall survival or risking locoregional recurrence.
MeSH term(s)	Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Child, Preschool ; Combined Modality Therapy ; Cytoreduction Surgical Procedures/adverse effects ; Cytoreduction Surgical Procedures/methods ; Disease-Free Survival ; Endocrine Gland Neoplasms ; Female ; Fertility Preservation ; Humans ; Hyperthermia, Induced/adverse effects ; Hyperthermia, Induced/methods ; Infant ; Lung Neoplasms/pathology ; Male ; Mesothelioma/pathology ; Mesothelioma, Malignant ; Middle Aged ; Peritoneal Neoplasms/pathology ; Peritoneal Neoplasms/therapy ; Peritoneum/surgery ; Pseudomyxoma Peritonei/pathology ; Pseudomyxoma Peritonei/therapy ; Reproductive Techniques, Assisted ; Treatment Outcome
Language	English
Publishing date	2020-07-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	896455-5
ISSN	1432-0711 ; 0932-0067
ISSN (online)	1432-0711
ISSN	0932-0067
DOI	10.1007/s00404-020-05687-z
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