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  1. 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

    Updates in surgery

    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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  2. 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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  3. 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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  4. 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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  5. 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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  6. Article ; Online: Comparison of Selected Older and Younger Patients Regarding Optimal Surgical Treatment of Colorectal Cancer: A Prospective Cohort Study.

    Aggelakopoulou, Chrysa / Perivoliotis, Konstantinos / Stergiannis, Pantelis / Intas, George / Mouzakis, George / Tepetes, Konstantinos

    Cancer diagnosis & prognosis

    2023  Volume 3, Issue 4, Page(s) 504–513

    Abstract: Background/aim: Current evidence regarding the optimal management of older colorectal cancer patients, is conflicting. Functional deficits impact long-term survival prognosis, while frailty often results to optimal treatment postponement. Thus, the ... ...

    Abstract Background/aim: Current evidence regarding the optimal management of older colorectal cancer patients, is conflicting. Functional deficits impact long-term survival prognosis, while frailty often results to optimal treatment postponement. Thus, the characteristics of this subgroup combined with treatment deviations further perplex optimal oncological management. The study aim was to compare survival and optimal surgery rates between older and younger colorectal cancer patients.
    Patients and methods: This study was designed as a prospective cohort. All adult (³18 years) colorectal cancer patients operated, during the 2016-2020 period, in the Department of Surgery, University Hospital of Larissa, were considered as eligible. The primary endpoint of the study was the difference in terms of the overall survival between older (>70 year) and younger (<70 years) colorectal cancer patients.
    Results: Overall, 166 patients (60 younger and 106 older) were enrolled. Although the older subgroup displayed a higher rate (p=0.007) of ASA II and ASA III patients, mean CCI scores were comparable (p=0.384). The two subgroups were similar in terms of performed operations (p=0.140). No delay in surgery was noted. Most operations were performed using an open approach (open: 57.8% vs. laparoscopic: 42.2%), under an elective status (elective: 91% vs. emergency: 1.8%). There was no difference in terms of overall complications rate (p=0.859). Overall survival was similar (p=0.227) between the older and younger subgroups (25.68 vs. 28.48 months).
    Conclusion: Older operated patients did not differ from their younger counterparts with regard to their overall survival. Due to several study limitations, further trials are required to confirm these findings.
    Language English
    Publishing date 2023-07-03
    Publishing country Greece
    Document type Journal Article
    ISSN 2732-7787
    ISSN (online) 2732-7787
    DOI 10.21873/cdp.10247
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  7. Article ; Online: Microvessel Density (MVD) in Patients with Osteosarcoma: A Systematic Review and Meta-Analysis.

    Perivoliotis, Konstantinos / Ntellas, Panagiotis / Dadouli, Katerina / Samara, Athina A / Sotiriou, Sotirios / Ioannou, Maria / Tepetes, Konstantinos

    Cancer investigation

    2024  Volume 42, Issue 1, Page(s) 104–114

    Abstract: A meta-analysis was designed and conducted to estimate the effect of tumoral microvessel density (MVD) on the survival of patients with osteosarcoma. There was no difference between high and low MVD regarding the overall (OS) and disease-free (DFS) ... ...

    Abstract A meta-analysis was designed and conducted to estimate the effect of tumoral microvessel density (MVD) on the survival of patients with osteosarcoma. There was no difference between high and low MVD regarding the overall (OS) and disease-free (DFS) survival. Low MVD tumors displayed a lower DFS at the third year of follow-up. Although primary metastases did not affect the mean MVD measurements, tumors with a good chemotherapy response had a higher MVD value. Although no significant differences between tumoral MVD, OS and DFS were found, good adjuvant therapy responders had a significant higher vascularization pattern.
    MeSH term(s) Humans ; Microvascular Density ; Osteosarcoma/drug therapy ; Neovascularization, Pathologic ; Combined Modality Therapy ; Bone Neoplasms/therapy ; Prognosis ; Disease-Free Survival
    Language English
    Publishing date 2024-02-12
    Publishing country England
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 604942-4
    ISSN 1532-4192 ; 0735-7907
    ISSN (online) 1532-4192
    ISSN 0735-7907
    DOI 10.1080/07357907.2024.2311266
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    Zs.A 1862: Show issues Location:
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  8. 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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  9. 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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  10. 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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