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Article: Surgery and Reason: The End of History and the Last Surgeon.

Magouliotis, Dimitrios E / Athanasiou, Thanos / Zacharoulis, Dimitrios

2023 Volume 12, Issue 17

Abstract: Arguably, Georg Wilhelm Friedrich Hegel has been one of the most influential philosophers of the 19th century [ ... ]. ...

Abstract	Arguably, Georg Wilhelm Friedrich Hegel has been one of the most influential philosophers of the 19th century [...].
Language	English
Publishing date	2023-09-01
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12175708
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Article: The Immunomodulatory Effect of Various Anaesthetic Practices in Patients Undergoing Gastric or Colon Cancer Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Konstantis, Georgios / Tsaousi, Georgia / Kitsikidou, Elisavet / Zacharoulis, Dimitrios / Pourzitaki, Chryssa

Journal of clinical medicine

2023 Volume 12, Issue 18

Abstract: Background: Gastric and colorectal carcinomas are associated with increased mortality and an increasing incidence worldwide, while surgical resection remains the primary approach for managing these conditions. Emerging evidence suggests that the ... ...

Abstract	Background: Gastric and colorectal carcinomas are associated with increased mortality and an increasing incidence worldwide, while surgical resection remains the primary approach for managing these conditions. Emerging evidence suggests that the immunosuppression induced by the chosen anaesthesia approach, during the perioperative period, can have a significant impact on the immune system and consequently the prognosis of these patients. Aim: This systematic review aims to comprehensively summarize the existing literature on the effects of different anaesthesia techniques on immune system responses, focusing on cellular immunity in patients undergoing the surgical removal of gastric or colorectal carcinomas. There is no meta-analysis investigating anaesthesia's impact on immune responses in gastric and colorectal cancer surgery. Anaesthesia is a key perioperative factor, yet its significance in this area has not been thoroughly investigated. The clinical question of how the anaesthetic technique choice affects the immune system and prognosis remains unresolved. Methods: Major electronic databases were searched up to February 2023 to May 2023 for relevant randomized controlled trials (RCTs). The study protocol has been registered with Prospero (CRD42023441383). Results: Six RCTs met the selection criteria. Among these, three RCTs investigated the effects of volatile-based anaesthesia versus total intravenous anaesthesia (TIVA), while the other three RCTs compared general anaesthesia alone to the combination of general anaesthesia with epidural anaesthesia. According to our analysis, there were no significant differences between TIVA and volatile-based anaesthesia, in terms of primary and secondary endpoints. The combination of general anaesthesia with epidural analgesia had a positive impact on NK cell counts (SMD 0.61, 95% CI 0.28 to 0.94, I Conclusions: The combination of epidural analgesia and general anaesthesia can potentially improve, postoperatively, the NK cell count and CD4
Language	English
Publishing date	2023-09-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12186027
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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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Article: From Classic Whipple to Pylorus Preserving Pancreaticoduodenectomy and Ultimately to Pylorus Resecting - Stomach Preserving Pancreaticoduodenectomy: A Review.

Symeonidis, Dimitrios / Zacharoulis, Dimitrios / Kissa, Labrini / Samara, Athina A / Petsa, Eleana / Tepetes, Konstantinos

Chirurgia (Bucharest, Romania : 1990)

2023 Volume 118, Issue 4, Page(s) 335–347

Abstract: Pancreaticoduodenectomy is the procedure of choice for benign or malignant tumors of the periampullary region. The preservation of the pylorus has been established as the mostly utilized approach during pancreaticoduodenectomy among the majority of ... ...

Abstract	Pancreaticoduodenectomy is the procedure of choice for benign or malignant tumors of the periampullary region. The preservation of the pylorus has been established as the mostly utilized approach during pancreaticoduodenectomy among the majority of specialized, in the surgical treatment of pancreatic cancer, centers worldwide. The factors that influenced this predilection are the shorter operation times, the less intraoperative blood loss, the decreased technical difficulty, and the quite similar short- and long-term outcomes compared to the classic Whipple. However, there is a notable trend in the literature highlighting the increased incidence of delayed gastric emptying following pylorus preserving pancreaticoduodenectomy. Among other factors, pylorus dysfunction attributable to the surgical maneuvers has been implemented in the etiology of this complication. In an attempt to overcome this limitation of the pylorus preserving pancreaticoduodenectomy, pylorus resecting pancreaticoduodenectomy with the preservation of the stomach was proposed. In theory, pylorus resecting pancreaticoduodenectomy could maintain the advantages of organ sparing surgery, but at the same time guarantee a more seamless gastric emptying. Only three RCTs, to date, aimed to evaluate the approach with only one reporting results in favor of the pylorus resecting pancreaticoduodenectomy in regard to the incidence of delayed gastric emptying. Further well-designed prospective randomized studies are needed for an accurate assessment of the true role of each of these surgical alternatives on the treatment of pancreatic cancer.
MeSH term(s)	Humans ; Pancreaticoduodenectomy ; Pylorus/surgery ; Gastroparesis/etiology ; Gastroparesis/prevention & control ; Prospective Studies ; Treatment Outcome ; Pancreatic Neoplasms/surgery ; Pancreatic Neoplasms
Language	English
Publishing date	2023-09-12
Publishing country	Romania
Document type	Review ; 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.2023.v.118.i.4.p.335
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Article ; Online: The role of systematic pelvic and para-aortic lymphadenectomy in the management of patients with advanced epithelial ovarian, tubal, and peritoneal cancer: A systematic review and meta-analysis.

Tzanis, Alexander A / Antoniou, Stavros A / Zacharoulis, Dimitrios / Ntafopoulos, Konstantinos / Tsouvali, Hara / Daponte, Alexandros

European journal of obstetrics, gynecology, and reproductive biology

2023 Volume 285, Page(s) 198–203

Abstract: Objective: To investigate whether systematic pelvic and para-aortic lymphadenectomy offers superior survival rates in patients with advanced epithelial ovarian cancer (EOC), tubal, or peritoneal cancer.: Methods: We searched the electronic databases ... ...

Abstract	Objective: To investigate whether systematic pelvic and para-aortic lymphadenectomy offers superior survival rates in patients with advanced epithelial ovarian cancer (EOC), tubal, or peritoneal cancer. Methods: We searched the electronic databases PubMed (from 1996), Cochrane Central Register of Controlled trials (from 1996), and Scopus (from 2004) to September 2021. We considered randomised controlled trials (RCTs) comparing systematic pelvic and para-aortic lymphadenectomy with no lymphadenectomy in patients with advanced EOC. Primary outcomes were overall survival and progression-free survival. Secondary outcomes were peri-operative morbidity and operative mortality. The revised Cochrane tool for randomised trials (RoB 2 tool) was utilised for the risk of bias assessment in the included studies. We performed time-to-event and standard pairwise meta-analyses, as appropriate. Results: Two RCTs with a total of 1074 patients were included in our review. Meta-analysis demonstrated similar overall survival (HR = 1.03, 95% CI [0.85-1.24]; low certainty) and progression-free survival (HR = 0.92, 95% CI [0.63-1.35]; very low certainty). Regarding peri-operative morbidity, systematic lymphadenectomy was associated with higher rates of lymphoedema and lymphocysts formation (RR = 7.31, 95% CI [1.89-28.20]; moderate certainty) and need for blood transfusion (RR = 1.17, 95% CI [1.06-1.29]; moderate certainty). No statistically significant differences were observed in regard to other peri-operative adverse events between the two arms. Conclusions: Systematic pelvic and para-aortic lymphadenectomy is likely associated with similar overall survival and progression-free survival compared to no lymphadenectomy in optimally debulked patients with advanced EOC. Systematic lymphadenectomy is also associated with an increased risk for certain peri-operative adverse events. Further research needs to be conducted on whether we should abandon systematic lymphadenectomy in completely debulked patients during primary debulking surgery.
MeSH term(s)	Female ; Humans ; Lymph Node Excision/adverse effects ; Carcinoma, Ovarian Epithelial/surgery ; Progression-Free Survival ; Peritoneal Neoplasms/surgery ; Ovarian Neoplasms/surgery
Language	English
Publishing date	2023-04-27
Publishing country	Ireland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2023.04.020
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Article ; Online: Extent of Surgical Resection for Gastric Cancer: The Safety Distance Between the Tumor and the Proximal Resection Margin.

Symeonidis, Dimitrios / Zacharoulis, Dimitrios / Petsa, Eleana / Samara, Athina A / Kissa, Labrini / Tepetes, Konstantinos

Cancer diagnosis & prognosis

2022 Volume 2, Issue 5, Page(s) 520–524

Abstract: A potentially curative treatment scheme for gastric cancer is considered futile without a proper surgical resection. An oncological, surgical resection for gastric cancer prerequisites a proper resection of the stomach, and a D2 lymph node dissection ... ...

Abstract	A potentially curative treatment scheme for gastric cancer is considered futile without a proper surgical resection. An oncological, surgical resection for gastric cancer prerequisites a proper resection of the stomach, and a D2 lymph node dissection followed by reconstruction of the gastrointestinal tract continuity. Recently, as the favorable impact of organ preserving surgery on functional outcomes has been increasingly appreciated; distal gastrectomy represents a valid alternative to total gastrectomy provided that the proper oncological principles are not violated. However, the appropriateness of distal gastrectomy as a valid type of resection becomes synonymous with achieving a negative proximal resection margin. The purpose of the present study was to assess the optimal distance between the tumor and the resection margin in a gastrectomy with curative intent, performed for gastric cancer, by reviewing the relevant literature. Having in mind, the well documented discrepancy between the gross and the pathologic boundaries of the tumor, pitfalls might be encountered. Current published guidelines have used a "safety distance" i.e., >4 or 5 cm between the proximal macroscopic tumor border and the proximal resection margin in order to guarantee a negative resection margin on pathology. An increased distance of safety is currently proposed in high-risk tumors such as tumors of the diffuse histological type.
Language	English
Publishing date	2022-09-03
Publishing country	Greece
Document type	Journal Article ; Review
ISSN	2732-7787
ISSN (online)	2732-7787
DOI	10.21873/cdp.10136
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Article: Surgical Repair of Iatrogenic Duodenal Injuries with a Roux-en-Y Duodenojejunostomy: A Physiology-oriented Approach.

Symeonidis, Dimitrios / Samara, Athina A / Diamantis, Alexandros / Sgantzou, Ioanna-Konstantina / Floros, Theodoros / Zacharoulis, Dimitrios

Chirurgia (Bucharest, Romania : 1990)

2022 Volume 117, Issue 3, Page(s) 341–348

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Aged, 80 and over ; Anastomosis, Roux-en-Y ; Duodenum/injuries ; Duodenum/surgery ; Female ; Humans ; Iatrogenic Disease ; Jejunum/surgery ; Male ; Treatment Outcome
Language	English
Publishing date	2022-06-30
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.2524
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Article ; Online: Gastric Cancer Invading the Pancreas: A Review of the Role of Pancreatectomy.

Symeonidis, Dimitrios / Zacharoulis, Dimitrios / Kissa, Labrini / Samara, Athina A / Bompou, Efrosyni / Tepetes, Konstantinos

In vivo (Athens, Greece)

2022 Volume 36, Issue 5, Page(s) 2014–2019

Abstract: Gastric cancer is quite a common type of cancer, with significant associated mortality. Traditionally, combined resections of affected organs have been advocated in cases of locally advanced gastric cancer, in order to achieve an R0 resection. The ... ...

Abstract	Gastric cancer is quite a common type of cancer, with significant associated mortality. Traditionally, combined resections of affected organs have been advocated in cases of locally advanced gastric cancer, in order to achieve an R0 resection. The purpose of the present study was to evaluate the role of pancreatectomy in the treatment of gastric cancer invading the pancreas by reviewing the relevant literature. The oncological benefits to survival rates of multivisceral resection are not always obvious from the relevant survival charts, especially when the pancreas is the organ invaded by the gastric cancer and gastrectomy needs to be combined with a pancreatectomy, an operation with high morbidity rates. In conclusion, careful patient selection is essential to achieving optimal results, balancing the oncological benefits in these properly selected patients against the associated morbidity of extensive resection.
MeSH term(s)	Gastrectomy/methods ; Humans ; Pancreas/surgery ; Pancreatectomy/methods ; Retrospective Studies ; Stomach Neoplasms/surgery
Language	English
Publishing date	2022-09-13
Publishing country	Greece
Document type	Journal Article ; Review
ZDB-ID	807031-3
ISSN	1791-7549 ; 0258-851X
ISSN (online)	1791-7549
ISSN	0258-851X
DOI	10.21873/invivo.12927
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Article ; Online: Laparoscopic Spigelian Hernia Repair: Intraperitoneal Onlay Mesh-Plus Technique-Video Presentation.

Zacharoulis, Dimitrios / Sioka, Eleni

Journal of laparoendoscopic & advanced surgical techniques. Part A

2017 Volume 28, Issue 2, Page(s) 201–203

Abstract: Background: Spigelian hernia represents a rare entity. Traditionally, it was repaired by the open technique. Various laparoscopic techniques have emerged periodically. Most laparoscopic repairs use the technique of placing an intraperitoneal onlay mesh ( ...

Abstract	Background: Spigelian hernia represents a rare entity. Traditionally, it was repaired by the open technique. Various laparoscopic techniques have emerged periodically. Most laparoscopic repairs use the technique of placing an intraperitoneal onlay mesh (IPOM). There is currently a tendency to close the hernia defect. Methods: A 68-year-old man was admitted to our hospital complaining of vague abdominal pain and discomfort. Physical examination revealed a bulky palpable mass on the left side of the patient. Computed tomography of abdomen revealed a left-sided incarcerated spigelian hernia containing bowel. The aim of this study was to report an educational video providing a successful laparoscopic IPOM-plus technique with muscles approximation of spigelian hernia repair step by step. Results: Total operative time was 120 minutes. The postoperative period was uneventful. The patient reported no pain and the cosmetic result was excellent. No bulging or seroma was noted. The patient was discharged on postoperative day 1. Conclusion: The IPOM-plus technique may improve the outcome of spigelian hernia repair.
MeSH term(s)	Aged ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Male ; Operative Time ; Peritoneum/surgery ; Surgical Mesh/adverse effects ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2017-04-26
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2608063-1
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2017.0009
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Article: Averting an Unnecessary Revision of a Roux-en-Y Hepaticojejunostomy by Surgically Creating an Access Point for the Endoscopic Assessment of the Anastomosis: A Report of a Case.

Symeonidis, Dimitrios / Paraskeua, Ismini / Samara, Athina A / Bompou, Effrosyni / Valaroutsos, Alexandros / Ntalouka, Maria P / Zacharoulis, Dimitrios

Medicines (Basel, Switzerland)

2023 Volume 10, Issue 5

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2023-05-11
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2777965-8
ISSN	2305-6320
ISSN	2305-6320
DOI	10.3390/medicines10050031
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