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Article: Trephine Minimally Invasive Procedure for Pilonidal Sinus.

Zoarets, Itay / Nevo, Yehonatan / Schwartz, Chaya / Cordoba, Moti / Shapira, Udi / Gutman, Motti / Zmora, Oded

The Israel Medical Association journal : IMAJ

2022 Volume 24, Issue 2, Page(s) 96–100

Abstract: Background: Pilonidal sinus is a chronic, inflammatory condition. Controversy exists regarding the best surgical management for pilonidal sinus, including the extent of excision and type of closure of the surgical wound.: Objectives: To assess the ... ...

Abstract	Background: Pilonidal sinus is a chronic, inflammatory condition. Controversy exists regarding the best surgical management for pilonidal sinus, including the extent of excision and type of closure of the surgical wound. Objectives: To assess the short- and long-term outcomes and success rate of the trephine procedure for the treatment of pilonidal sinus. Methods: A retrospective observational cohort study was conducted at a single center. Patients who underwent trephine procedure between 2011 and 2015 were included. Data collection included medical records review and a telephone interview to establish long-term follow-up. Results: A total of 169 patients underwent the trephine technique for the repair of pilonidal sinus. Follow-up included 113 patients, median age 20 years. Initial postoperative period, 35.6% recalled no pain and 58.6% reported a mild to moderate pain. Postoperative complications included local infection (7.5%) and mild bleeding (15.1%). On early postoperative follow-up, 47.1% recalled no impairment in quality of life, and 25%, 21.2 %, and 6.7% had mild, moderate and sever disturbance respectively. The median time to return to work or school was 10 days. At a median follow-up of 29 months (IQR 19-40), recurrence rate was 45.1% (51/113), and 38 (33.9%) of the patients underwent another surgical procedure Overweight, smoking, and family history were associated with higher recurrence rate. Conclusions: The trephines technique has a significant long-term recurrence rate. Short-term advantages include low morbidity, enhanced recovery, and minimal to mild postoperative impairment to quality of life. The trephine procedure may be justified as a first treatment of pilonidal disease.
MeSH term(s)	Adult ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Minimally Invasive Surgical Procedures/methods ; Pilonidal Sinus/surgery ; Postoperative Complications/epidemiology ; Quality of Life ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2022-02-20
Publishing country	Israel
Document type	Journal Article ; Observational Study
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article: Clinical Presentation of Acute Cholecystitis during the COVID-19 Outbreak.

Hershkovitz, Yehuda / Zmora, Oded / Nativ, Hilli / Ashkenazi, Itamar / Hammerschlag, Jonathan / Jeroukhimov, Igor

The Israel Medical Association journal : IMAJ

2022 Volume 24, Issue 5, Page(s) 306–309

Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. The fear of seeking medical attention to avoid the possibility of being infected may have altered the course of some diseases.: ... ...

Abstract	Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. The fear of seeking medical attention to avoid the possibility of being infected may have altered the course of some diseases. Objectives: To describe our experience with the management of patients with acute cholecystitis during the pandemic at our medical center. Methods: We compared patients treated for acute cholecystitis between 1 March and 31 August 2020 (Group I) to patients admitted with the same diagnosis during the same months in 2019 (Group II). We evaluated demographics, presenting symptoms, laboratory and imaging findings at presentation, the disease's clinical course, management, and outcome. Results: Group I consisted of 101 patients and group II included 94 patients. No differences were noted for age (66 years, IQR 48-78 vs. 66 years, IQR 47-76; P = 0.50) and sex (57.4% vs. 51.1% females; P = 0.39) between the two groups. The delay between symptom onset and hospital admission was longer for Group I patients (3 days, IQR 2-7 vs. 2 days, IQR 1-3; P = 0.002). Moderate to severe disease was more commonly encountered in Group I (59.4% vs. 37.2%, P = 0.003). Group I patients more often failed conservative management (36% vs. 6%, P = 0.001) and had a higher conversion rate to open surgery (15.4% vs. 0%, P = 0.025). Conclusions: Patients presenting with acute cholecystitis during the COVID-19 pandemic more often presented late to the emergency department and more showed adverse outcomes.
MeSH term(s)	Aged ; COVID-19 ; Cholecystitis, Acute/diagnosis ; Cholecystitis, Acute/epidemiology ; Cholecystitis, Acute/therapy ; Disease Outbreaks ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Retrospective Studies
Language	English
Publishing date	2022-04-30
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Chronic pain following totally extra-peritoneal inguinal hernia repair: a randomized clinical trial comparing glue and absorbable tackers.

Jeroukhimov, Igor / Dykman, Daniel / Hershkovitz, Yehuda / Poluksht, Natan / Nesterenko, Vladimir / Yehuda, Amir Ben / Stephansky, Albert / Zmora, Oded

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 190

Abstract: Purpose: Chronic pain following inguinal hernia repair occurs in up to 20% of patients. The underlying mechanism probably involves sensory nerve damage and abnormal healing that might be influenced by the materials chosen for mesh fixation. The main ... ...

Abstract	Purpose: Chronic pain following inguinal hernia repair occurs in up to 20% of patients. The underlying mechanism probably involves sensory nerve damage and abnormal healing that might be influenced by the materials chosen for mesh fixation. The main objective of this study was to compare glue and absorbable tackers on the rate of chronic pain after surgery in patients undergoing totally extraperitoneal inguinal hernia repair (TEP). Methods: Patients undergoing (TEP) inguinal hernia repair were enrolled in a single-blind randomized clinical trial and were randomized for mesh fixation with glue (LIQUIBAND FIX 8 Neopharm) or absorbable tackers (SECURE STRAP Johnson & Johnson). Pain was assessed using a validated 4-point verbal-rank scale (none, mild, moderate, and severe) at 1 week, 1 month, 6 months, and 1 year postoperatively. Chronic pain was defined as pain persisting beyond 3 months. Results: Two hundred and eight patients were analyzed. The groups were similar in age, gender, and hernia side. Chronic pain of any intensity was reported in 31.7% (66/208) after 6 months and in 13% (29/208) after 12 months. No differences in postoperative pain were observed between the two forms of mesh fixation. Still, when only those with severe pain were considered, mesh fixation with glue resulted in less pain compared to fixation by tackers (log-rank p = 0.025). At 1 year, 4 symptomatic recurrent hernias were identified in patients whose mesh was fixated with absorbable tackers. Conclusions: Patients who underwent TEP inguinal hernia repair with mesh fixated by glue suffered from less pain.
MeSH term(s)	Humans ; Chronic Pain/etiology ; Hernia, Inguinal/surgery ; Treatment Outcome ; Single-Blind Method ; Peritoneum ; Pain, Postoperative/etiology ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Surgical Mesh/adverse effects ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Recurrence
Language	English
Publishing date	2023-05-12
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/s00423-023-02932-2
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Article ; Online: Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

Nevo, Yehonatan / Shaltiel, Tali / Constantini, Naama / Rosin, Danny / Gutman, Mordechai / Zmora, Oded / Nevler, Avinoam

The American surgeon

2021 Volume 88, Issue 2, Page(s) 226–232

Abstract: Background: Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function.: ... ...

Abstract	Background: Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods: Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results: 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( Discussion: Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.
MeSH term(s)	Actigraphy/statistics & numerical data ; Adult ; Aged ; Defecation ; Digestive System Surgical Procedures/adverse effects ; Early Ambulation/statistics & numerical data ; Enhanced Recovery After Surgery ; Female ; Fitness Trackers ; Flatulence ; Humans ; Incidence ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Postoperative Complications/epidemiology ; Time Factors ; Walking/statistics & numerical data
Language	English
Publishing date	2021-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/0003134820988818
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Article ; Online: Harnessing cancer immunotherapy during the unexploited immediate perioperative period.

Matzner, Pini / Sandbank, Elad / Neeman, Elad / Zmora, Oded / Gottumukkala, Vijaya / Ben-Eliyahu, Shamgar

Nature reviews. Clinical oncology

2020 Volume 17, Issue 5, Page(s) 313–326

Abstract: The immediate perioperative period (days before and after surgery) is hypothesized to be crucial in determining long-term cancer outcomes: during this short period, numerous factors, including excess stress and inflammatory responses, tumour-cell ... ...

Abstract	The immediate perioperative period (days before and after surgery) is hypothesized to be crucial in determining long-term cancer outcomes: during this short period, numerous factors, including excess stress and inflammatory responses, tumour-cell shedding and pro-angiogenic and/or growth factors, might facilitate the progression of pre-existing micrometastases and the initiation of new metastases, while simultaneously jeopardizing immune control over residual malignant cells. Thus, application of anticancer immunotherapy during this critical time frame could potentially improve patient outcomes. Nevertheless, this strategy has rarely been implemented to date. In this Perspective, we discuss apparent contraindications for the perioperative use of cancer immunotherapy, suggest safe immunotherapeutic and other anti-metastatic approaches during this important time frame and specify desired characteristics of such interventions. These characteristics include a rapid onset of immune activation, avoidance of tumour-promoting effects, no or minimal increase in surgical risk, resilience to stress-related factors and minimal induction of stress responses. Pharmacological control of excess perioperative stress-inflammatory responses has been shown to be clinically feasible and could potentially be combined with immune stimulation to overcome the direct pro-metastatic effects of surgery, prevent immune suppression and enhance immunostimulatory responses. Accordingly, we believe that certain types of immunotherapy, together with interventions to abrogate stress-inflammatory responses, should be evaluated in conjunction with surgery and, for maximal effectiveness, could be initiated before administration of adjuvant therapies. Such strategies might improve the overall success of cancer treatment.
MeSH term(s)	Animals ; Antineoplastic Agents, Immunological/administration & dosage ; Antineoplastic Agents, Immunological/adverse effects ; Chemotherapy, Adjuvant ; Drug Administration Schedule ; Humans ; Immunotherapy/adverse effects ; Neoadjuvant Therapy/adverse effects ; Neoplasms/immunology ; Neoplasms/pathology ; Neoplasms/therapy ; Oncolytic Virotherapy/adverse effects ; Perioperative Care/adverse effects ; Perioperative Period ; Time Factors ; Treatment Outcome ; Tumor Microenvironment
Chemical Substances	Antineoplastic Agents, Immunological
Language	English
Publishing date	2020-02-17
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2491410-1
ISSN	1759-4782 ; 1759-4774
ISSN (online)	1759-4782
ISSN	1759-4774
DOI	10.1038/s41571-019-0319-9
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Article: Planned Re-Laparotomy in a Non-Trauma Setting: A Single Center Experience.

Hershkovitz, Yehuda / Ashkenazi, Itamar / Shapira, Zahar / Zmora, Oded / Jeroukhimov, Igor

The Israel Medical Association journal : IMAJ

2018 Volume 20, Issue 5, Page(s) 300–303

Abstract: Background: Damage control laparotomy (DCL) is the widely accepted procedure of choice in management of severely injured trauma patient. It has been implemented in non-trauma-related surgical pathology in the last decade.: Objectives: To evaluate our ...

Abstract	Background: Damage control laparotomy (DCL) is the widely accepted procedure of choice in management of severely injured trauma patient. It has been implemented in non-trauma-related surgical pathology in the last decade. Objectives: To evaluate our experience with planned re-laparotomy (PRL) in non-trauma patients and compare it to other reports. Methods: Charts of all patients admitted to Assaf Harofeh Medical Center who underwent PRL for non-trauma-related abdominal pathology during a 6 year period were reviewed. Data regarding demographics, vital signs, laboratory tests, indications for surgery, length of hospital stay, and mortality were obtained from medical charts. Indications for surgery, risk factors, and mortality were analyzed. Results: The study was comprised of 181 patients. Primary abdominal sepsis (50), postoperative sepsis (49), mesenteric event (32), and intestinal obstruction (28) were the most common indications for PRL. Mortality rate was 48.6%. Factors correlating with increased mortality were advanced age, hypotension, hypothermia, metabolic acidosis, and renal failure. Bowel resection was performed on 122 patients (67%) and primary intestinal anastomosis constructed in 46.7%. Mortality rate was lower in patients who underwent PRL with primary anastomosis compared to patients with postponed bowel anastomosis (33.3% vs. 55.4%, P = 0.018). Conclusions: PRL in abdominal emergencies carries a high mortality rate. Primary anastomosis may be considered in non-trauma-related PRL.
MeSH term(s)	Abdomen/pathology ; Abdomen/surgery ; Abdominal Cavity/pathology ; Abdominal Cavity/surgery ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Humans ; Intestinal Diseases/pathology ; Intestinal Diseases/surgery ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Sepsis/pathology ; Sepsis/surgery ; Treatment Outcome
Language	English
Publishing date	2018-05-14
Publishing country	Israel
Document type	Journal Article ; Observational Study
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article: Laparoscopy for Crohn disease.

Zmora, Oded

Seminars in laparoscopic surgery

2003 Volume 10, Issue 4, Page(s) 159–167

Abstract: The laparoscopic approach to Crohn disease offers the multiple potential benefits of faster recovery, better cosmesis, and a lower incidence of adhesion-related complications and incisional hernias. Most of these advantages are unproven, but a review of ... ...

Abstract	The laparoscopic approach to Crohn disease offers the multiple potential benefits of faster recovery, better cosmesis, and a lower incidence of adhesion-related complications and incisional hernias. Most of these advantages are unproven, but a review of the current literature reveals that advantages have been suggested in almost all series that have compared laparoscopy to laparotomy. Some features of Crohn disease, such as fistula, abscess, and phlegmon, may pose a surgical challenge; however, laparoscopic resection is often feasible, with morbidity rates comparable to or lower than those associated with laparotomy. Experience both in advanced laparoscopic techniques and surgery for Crohn disease, coupled with sound surgical judgment and a reasonably low threshold to convert to laparotomy before intraoperative complications occur, are essential for the successful and safe employment of these procedures.
MeSH term(s)	Crohn Disease/surgery ; Humans ; Laparoscopy/economics ; Laparoscopy/methods ; Length of Stay/statistics & numerical data ; Patient Selection ; Postoperative Complications ; Quality of Life
Language	English
Publishing date	2003-10-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1233569-1
ISSN	1071-5517
ISSN	1071-5517
DOI	10.1177/107155170301000402
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Article ; Online: Reduction in surgical site infections by localized administration with D-PLEX

Senagore, Anthony J / Stark, Yafit / Belotserkovsky, Olga / Reichert, Malka / Wasserberg, Nir / Tulchinsky, Hagit / Segev, Lior / Zmora, Oded / Kozloski, Goldi A / Emanuel, Noam

American journal of surgery

2022 Volume 225, Issue 3, Page(s) 485–488

Abstract: Background: D-PLEX: Patients and methods: A post-hoc analysis of a previously reported prospective randomized trial assessing D-PLEX: Results: The overall incidence of SSI was significantly lower for the D-PLEX: Conclusions: D- ... ...

Abstract	Background: D-PLEX Patients and methods: A post-hoc analysis of a previously reported prospective randomized trial assessing D-PLEX Results: The overall incidence of SSI was significantly lower for the D-PLEX Conclusions: D-PLEX
MeSH term(s)	Humans ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/etiology ; Anti-Bacterial Agents/therapeutic use ; Prospective Studies ; Colorectal Surgery/adverse effects ; Risk Factors ; Antibiotic Prophylaxis
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.11.021
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Article ; Online: Perioperative COX2 and β-adrenergic blockade improves biomarkers of tumor metastasis, immunity, and inflammation in colorectal cancer: A randomized controlled trial.

Haldar, Rita / Ricon-Becker, Itay / Radin, Arielle / Gutman, Mordechai / Cole, Steve W / Zmora, Oded / Ben-Eliyahu, Shamgar

Cancer

2020 Volume 126, Issue 17, Page(s) 3991–4001

Abstract: Background: Preclinical studies have implicated excess release of catecholamines and prostaglandins in the mediation of prometastatic processes during surgical treatment of cancer. In this study, we tested the combined perioperative blockade of these ... ...

Abstract	Background: Preclinical studies have implicated excess release of catecholamines and prostaglandins in the mediation of prometastatic processes during surgical treatment of cancer. In this study, we tested the combined perioperative blockade of these pathways in patients with colorectal cancer (CRC). Methods: In a randomized, double-blind, placebo-controlled biomarker trial involving 34 patients, the β-blocker propranolol and the COX2-inhibitor etodolac were administered for 20 perioperative days, starting 5 days before surgery. Excised tumors were subjected to whole genome messenger RNA profiling and transcriptional control pathway analyses. Results: Drugs were well-tolerated, with minor complications in both the treatment group and the placebo group. Treatment resulted in a significant improvement (P < .05) of tumor molecular markers of malignant and metastatic potential, including 1) reduced epithelial-to-mesenchymal transition, 2) reduced tumor infiltrating CD14 Conclusions: The favorable biomarker impacts and clinical outcomes provide a rationale for future randomized placebo-controlled trials in larger samples to assess the effects of perioperative propranolol/etodolac treatment on oncological clinical outcomes.
MeSH term(s)	Adrenergic beta-Antagonists/administration & dosage ; Adrenergic beta-Antagonists/adverse effects ; Adult ; Aged ; Biomarkers, Tumor/genetics ; Biomarkers, Tumor/immunology ; Cell Line, Tumor ; Colorectal Neoplasms/drug therapy ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/immunology ; Colorectal Neoplasms/pathology ; Cyclooxygenase 2/genetics ; Cyclooxygenase 2 Inhibitors/administration & dosage ; Cyclooxygenase 2 Inhibitors/adverse effects ; Female ; Humans ; Immunity, Innate/drug effects ; Immunity, Innate/immunology ; Inflammation/blood ; Inflammation/genetics ; Inflammation/pathology ; Killer Cells, Natural/drug effects ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/genetics ; Neoplasm Recurrence, Local/immunology ; Neoplasm Recurrence, Local/pathology ; Signal Transduction/drug effects
Chemical Substances	Adrenergic beta-Antagonists ; Biomarkers, Tumor ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2 (EC 1.14.99.1)
Language	English
Publishing date	2020-06-13
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.32950
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Article ; Online: Sexual Dysfunction in Patients With Inflammatory Bowel Disease.

Katsanos, Konstantinos H / Saridi, Maria / Albani, Eleni / Mantzouranis, George / Zmora, Oded / Christodoulou, Dimitrios K

Inflammatory bowel diseases

2018 Volume 24, Issue 11, Page(s) 2348–2349

MeSH term(s)	Humans ; Inflammatory Bowel Diseases/complications ; Prognosis ; Sexual Dysfunction, Physiological/etiology ; Sexual Dysfunctions, Psychological/etiology
Language	English
Publishing date	2018-11-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1340971-2
ISSN	1536-4844 ; 1078-0998
ISSN (online)	1536-4844
ISSN	1078-0998
DOI	10.1093/ibd/izy206
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