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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: Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis.

    Perivoliotis, K / Tzovaras, G / Sarakatsianou, C / Baloyiannis, I

    Hernia : the journal of hernias and abdominal wall surgery

    2019  Volume 23, Issue 2, Page(s) 217–233

    Abstract: A meta-analysis was conducted to provide an up-to-date comparison of single-port and multi-port approach, in laparoscopic inguinal hernia mesh repair. This meta-analysis was performed on the basis of the PRISMA guidelines and the Cochrane Handbook for ... ...

    Abstract A meta-analysis was conducted to provide an up-to-date comparison of single-port and multi-port approach, in laparoscopic inguinal hernia mesh repair. This meta-analysis was performed on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases (MEDLINE, Web of Science and Cochrane Central Register of Controlled Clinical Trials) were systematically screened. Fixed Effects or Random Effects model was used, according to the Cochran Q test. In total 16 eligible studies were found. There was no statistically significant difference, regarding unilateral operation duration, between the two approaches, in TEP (OR - 4.61; 95% CI - 9.70, 0.47, p = 0.08) or TAPP (OR - 1.96; 95% CI - 4.89, 0.97, p = 0.19) procedures. Similarly, in both operative modalities, no superiority of either approach was proven, in terms of conversion rate (TEP OR 0.69, p = 0.48; TAPP OR 5.46, p = 0.31), length of hospital stay (TEP WMD 0.00, p = 0.76; TAPP WMD - 0.11, p = 0.42) and overall complication rate (TEP OR 1.10, p = 0.51; TAPP OR 0.74, p = 0.43). Overall, single-port and the established multi-port approach in inguinal hernia mesh repair, are equivalent, regarding the postoperative outcomes. Given several limitations, further RCTs, of higher methodological and quality level are required.
    MeSH term(s) Hernia, Inguinal/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Male ; Surgical Mesh
    Language English
    Publishing date 2019-01-07
    Publishing country France
    Document type Comparative Study ; Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-018-01876-7
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  4. Article ; Online: Virtual ileostomy in elective colorectal surgery: a systematic review of the literature.

    Baloyiannis, I / Perivoliotis, K / Diamantis, A / Tzovaras, G

    Techniques in coloproctology

    2019  Volume 24, Issue 1, Page(s) 23–31

    Abstract: Background: Anastomotic leak (AL) following colorectal surgery can be a life-threatening complication. The use of a diverting stoma has been proposed, to prevent or reduce morbidity and mortality associated with AL. Stomas, however, have their own ... ...

    Abstract Background: Anastomotic leak (AL) following colorectal surgery can be a life-threatening complication. The use of a diverting stoma has been proposed, to prevent or reduce morbidity and mortality associated with AL. Stomas, however, have their own distinct complications. Thus, virtual ileostomy (VI) has been proposed as an alternative to diverting stoma. The aim of the present study was to further evaluate the role of VI through systematic review of existing literature.
    Methods: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane handbook for systematic reviews of interventions. The primary endpoint of our study was the estimation of the overall VI complication rate. Secondary endpoints included the identification of the VI-specific adverse outcomes, perioperative endpoints such as the length of hospital stay, transfusion and postoperative leak rates, description of the operative variations of VI reported VI operative variations and details regarding the primary operation and previous neoadjuvant therapy.
    Results: In total, 11 studies and 554 patients were included in this systematic review. Overall, 158 laparoscopic and 191 open procedures were performed. The AL and VI conversion rates were 11.9% and 10.46%, respectively. The total complication rate was estimated to be 13.9%, while VI-specific adverse events were recorded in 2.1% of all cases.
    Conclusions: VI could be a safe and effective alternative to a diverting stoma. Although currently, VI is not widely used, it could have a widespread application in laparoscopic surgery. However, definitive trials are needed before firm recommendations on the use of VI can be made.
    MeSH term(s) Anastomosis, Surgical ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Colorectal Surgery ; Female ; Humans ; Ileostomy/adverse effects ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Retrospective Studies ; Surgical Stomas
    Language English
    Publishing date 2019-12-09
    Publishing country Italy
    Document type Journal Article ; Systematic Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-019-02127-2
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  5. Article ; Online: Quality of life after laparoscopic trans-abdominal pre-peritoneal inguinal hernia repair: spinal vs general anesthesia.

    Sarakatsianou, C / Baloyiannis, I / Perivoliotis, K / Georgopoulou, S / Tzovaras, G

    Hernia : the journal of hernias and abdominal wall surgery

    2020  Volume 25, Issue 3, Page(s) 789–796

    Abstract: Purpose: The aim of the present study was to evaluate the effect of the anesthesia type on the postoperative quality of life in patients who underwent trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair.: Methods: In this study, 70 patients ... ...

    Abstract Purpose: The aim of the present study was to evaluate the effect of the anesthesia type on the postoperative quality of life in patients who underwent trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair.
    Methods: In this study, 70 patients submitted to TAPP for inguinal hernia repair, were randomized between spinal and general anesthesia. Overall, 58 patients completed the follow-up process and were, therefore, included. The quality of life evaluation was based on the SF-36 questionnaire. Significance was considered at the level of P < 0.05 RESULTS: General anesthesia was applied to 31 patients, whereas 27 operations were performed under spinal anesthesia. Except gender, the two study subgroups were similar in terms of demographics. Although spinal anesthesia displayed higher energy, emotional health, and general health scores these findings were not statistically significant. A positive correlation was identified between age and physical and emotional role. Operative time was associated with the estimated energy and general health.
    Conclusion: Our study could not identify a difference between spinal and general anesthesia on the postoperative quality of life. Spinal anesthesia is as effective as general anesthesia and remains an attractive anesthetic alternative for TAPP inguinal hernia repair. Given several study limitations, further high-quality trials are required.
    MeSH term(s) Anesthesia, General ; Anesthesia, Spinal ; Hernia, Inguinal/surgery ; Herniorrhaphy/adverse effects ; Humans ; Laparoscopy ; Pain, Postoperative ; Quality of Life
    Language English
    Publishing date 2020-09-30
    Publishing country France
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02313-4
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  6. Article ; Online: Systemic immune response after open tension-free inguinal hernia repair under different anesthetic alternatives: a prospective comparative study.

    Symeonidis, D / Diamantis, A / Baloyiannis, I / Tzovaras, G / Tepetes, K

    Il Giornale di chirurgia

    2020  Volume 41, Issue 1, Page(s) 103–109

    Abstract: Purpose: The purpose of the present study was a comparison of the systemic inflammatory response intensity through the estimation of C- reactive protein and albumin levels before and after open tension free inguinal hernia repair performed under ... ...

    Abstract Purpose: The purpose of the present study was a comparison of the systemic inflammatory response intensity through the estimation of C- reactive protein and albumin levels before and after open tension free inguinal hernia repair performed under different anesthetic alternatives.
    Patients and methods: Totally, 125 inguinal hernia patients scheduled for unilateral primary open tension free inguinal repair unRomader local (50 patients), spinal (50 patients) and general anesthesia (25 patients) have been included in this prospective study.
    Results: The group of local anesthesia was associated with the higher postoperative serum levels of albumin compared to the group of general anesthesia (P 0.013). Local anesthesia was also associated with higher postoperative serum albumin levels compared to regional anesthesia but however the difference was not statistically significant (P 0.282). The group of local anesthesia was also associated with the lower postoperative levels of CRP compared to the regional (P 0.0094) and general anesthesia (P 0.0009) groups.
    Conclusion: Local anesthesia proved superior to regional or general anesthesia for open tension free inguinal hernia repair in the given patient sample from the standpoint of the inflammatory and acute phase response.
    MeSH term(s) Anesthesia/methods ; Anesthesia, General ; Anesthesia, Local ; Anesthesia, Spinal ; C-Reactive Protein/analysis ; Hernia, Inguinal/blood ; Hernia, Inguinal/immunology ; Hernia, Inguinal/surgery ; Herniorrhaphy/methods ; Herniorrhaphy/statistics & numerical data ; Humans ; Prospective Studies ; Serum Albumin/analysis ; Systemic Inflammatory Response Syndrome/immunology
    Chemical Substances Serum Albumin ; C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2020-02-10
    Publishing country Italy
    Document type Comparative Study ; Journal Article
    ZDB-ID 605974-0
    ISSN 1971-145X ; 0391-9005
    ISSN (online) 1971-145X
    ISSN 0391-9005
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  7. Article ; Online: One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: a meta-analysis.

    Magouliotis, D E / Tasiopoulou, V S / Tzovaras, G

    Clinical obesity

    2018  Volume 8, Issue 3, Page(s) 159–169

    Abstract: We aim to review the available literature on morbidly obese patients treated with one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) in order to compare the clinical outcomes of the two methods. A literature search was performed in ... ...

    Abstract We aim to review the available literature on morbidly obese patients treated with one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) in order to compare the clinical outcomes of the two methods. A literature search was performed in PubMed, Cochrane library and Scopus, in accordance with the PRISMA guidelines. Twelve studies met the inclusion criteria (7452 patients). OAGB was associated with shorter mean operative time. The length of hospital stay was comparable between the two procedures. The incidence of leaks, marginal ulcer, dumping, bowel obstruction, revisions and mortality was similar between the two approaches. The incidence of malnutrition was increased in patients treated with OAGB, while the incidence of internal hernia and bowel obstruction was greater in the RYGB group. In addition, the percentage excess weight loss at 1, 2 and 5 years post-operatively was greater for the OAGB group. The rate of type 2 diabetes remission was greater in the OAGB group. The rate of hypertension and dyslipidemia remission was also similar between OAGB and RYGB. Randomized controlled trials, comparing RYGB to OAGB, are necessary to further assess their clinical outcomes.
    MeSH term(s) Adult ; Aged ; Diabetes Mellitus, Type 2/therapy ; Dyslipidemias/therapy ; Female ; Gastric Bypass/adverse effects ; Gastric Bypass/methods ; Humans ; Hypertension/therapy ; Male ; Middle Aged ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Postoperative Complications ; Postoperative Period ; Weight Loss ; Young Adult
    Language English
    Publishing date 2018-03-24
    Publishing country England
    Document type Comparative Study ; Journal Article ; Meta-Analysis ; Review
    ZDB-ID 2625816-X
    ISSN 1758-8111 ; 1758-8103
    ISSN (online) 1758-8111
    ISSN 1758-8103
    DOI 10.1111/cob.12246
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  8. Article: BILE: A Literature Review Based Novel Clinical Classification and Treatment Algorithm of Iatrogenic Bile Duct Injuries.

    Symeonidis, Dimitrios / Tepetes, Konstantinos / Tzovaras, George / Samara, Athina A / Zacharoulis, Dimitrios

    Journal of clinical medicine

    2023  Volume 12, Issue 11

    Abstract: Purposes: The management of patients with iatrogenic bile duct injuries (IBDI) is a challenging field, often with dismal medico legal projections. Attempts to classify IBDI have been made repeatedly and the final results were either analytical and ... ...

    Abstract Purposes: The management of patients with iatrogenic bile duct injuries (IBDI) is a challenging field, often with dismal medico legal projections. Attempts to classify IBDI have been made repeatedly and the final results were either analytical and extensive but not useful in everyday clinical practice systems, or simple and user friendly but with limited clinical correspondence approaches. The purpose of the present review is to propose a novel, clinical classification system of IBDI by reviewing the relevant literature.
    Methods: A systematic literature review was conducted by performing bibliographic searches in the available electronic databases, including PubMed, Scopus, and the Cochrane Library.
    Results: Based on the literature results, we propose a five (5) stage (A, B, C, D and E) classification system for IBDI (BILE Classification). Each stage is correlated with the recommended and most appropriate treatment. Although the proposed classification scheme is clinically oriented, the anatomical correspondence of each IBDI stage has been incorporated as well, using the Strasberg classification.
    Conclusions: BILE classification represents a novel, simple, and dynamic in nature classification system of IBDI. The proposed classification focuses on the clinical consequences of IBDI and provides an action map that can appropriately guide the treatment plan.
    Language English
    Publishing date 2023-05-31
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12113786
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  9. 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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  10. 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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