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Stent A pancreaticojejunostomy after pancreatoduodenectomy:Is it always necessary?

World Journal of Methodology 2024年第3期14卷 23-29页

作者： Dimitrios Symeonidis Dimitris Zacharoulis Georgios Tzovaras Labrini Kissa Athina A Samara Eleana Petsa konstantinos tepetes Department of Surgery University Hospital of LarissaLarissa 41110Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

The establishment of a postoperative pancreatic fistula(POPF)is considered the most common and,concomitantly,the most serious complication associated with pancreaticoduodenectomy(PD).The search for either technical modifications of the operative technique or pharmaceutical interventions that could possibly aid in decreasing the incidence of this often-devastating complication appears justified.The stenting of the pancreatic duct,with the use of either internal or external stents,has been evaluated in this direction.In theory,it is an approach that could eliminate many pathophysiological factors responsible for the occurrence of a POPF.The purpose of the present study was to review the current data regarding the role of pancreatic duct stenting on the incidence of POPF,after PD,by using PubMed and Reference Citation Analysis.In general,previous studies seem to highlight the superiority of external stents over their internal counterparts in regard to the incidence of POPF;this is at the cost,however,of increased morbidity associated mainly with the stent removal.Certainly,the use of an internal stent is a less invasive approach with acceptable results and is definitely deprived of the drawbacks arising through the complete diversion of pancreatic juice from the gastrointestinal tract.Bearing in mind the scarcity of high-quality data on the subject,an approach of reserving stent placement for the high-risk for POPF patients and individualizing the selection between the use of an internal or an external stent according to the distinct characteristics of each individual case scenario appears appropriate.

关键词： Pancreaticoduodenectomy Postoperative pancreatic fistula Pancreatic stent Pancreaticojejunostomy

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Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

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World Journal of Methodology 2024年第1期14卷 71-79页

作者： Grigorios Christodoulidis Marina Nektaria Kouliou konstantinos Eleftherios Koumarelas konstantinos Argyriou Garyfallia Apostolia Karali konstantinos tepetes Department of General Surgery University Hospital of LarissaLarissa 41110Greece Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,Billroth II among them.Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(Billroth II:74 patients and Billroth II and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(P<0.0001).Mean daily postoperative NGT output was also statistically significantly lower in Braun group.According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group,while 9 patients who underwent Christodoulidis G et al.Billroth II and Braun compared with Billroth II WJM https://*** 2 March 20,2024 Volume 14 Issue 1 Billroth II and Braun anastomosis were presented with the same conditions(P<0.05).CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux,alkaline gastritis and NGT output.

关键词： Billroth II Billroth II and Braun Reconstruction techniques Gastrectomy Distal gastrectomy

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Single incision laparoscopic fundoplication: A systematic review of the literature

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World Journal of Gastrointestinal Surgery 2019年第3期11卷 179-190页

作者： konstantinos Perivoliotis Chamaidi Sarakatsianou konstantinos tepetes Ioannis Baloyiannis Department of Surgery University Hospital of Larissa Department of Anesthesiology University Hospital of Larissa

BACKGROUND Fundoplication, was first introduced as a surgical treatment method of gastroesophageal reflux disease. Consequently, several modifications of this method have been described, whereas laparoscopic fundoplication was recently introduced. Although single incision(SI) fundoplication was considered as an alternative to the conventional laparoscopic approach, several studies reported an increased operation duration, and high rates of multiport conversion and incisional hernia.AIM To provide a current overview of the technical variations and the postoperative outcomes of patients submitted to SI fundoplication.METHODS The present systematic review of the literature was designed and conducted on the basis of the PRISMA guidelines. A systematic screening of the electronic scholar databases(Medline, Scopus and Web of Science) was performed.RESULTS Literature search resulted in the identification of 19 studies. Overall, 266, 137 and110 SI Nissen, Dor and Toupet fundoplications were reported, respectively. In the majority of the trials, standard laparoscopic instruments were used. The left liver lobe was displayed through the use of forceps, graspers, retractors, drains or even glue. Both intra-corporeal and extracorporeal suturing was described. Mean operative time was 136.3 min. Overall complication rate was 5.2% and the rate of incisional hernia was 0.9%. No mortality was reported.CONCLUSIONDue to the methodological heterogeneity and the lack of high quality studies comparing multi to single access techniques and the several variations, we conclude that further well designed studies are necessary, in order to evaluate the role of SI fundoplication.

关键词： Single incision Single port Fundoplication Nissen Dor Toupet

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Isoperistaltic vs antiperistaltic anastomosis after right hemicolectomy:A comprehensive review

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World Journal of Clinical Cases 2023年第8期11卷 1694-1701页

作者： Dimitrios Symeonidis Kostas-Sotirios Karakantas Labrini Kissa Athina A Samara Effrosyni Bompou konstantinos tepetes Georgios Tzovaras Department of Surgery University Hospital of LarissaLarissa 41110Greece

To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.

关键词： Isoperistaltic side-to-side anastomosis Antiperistaltic side-to-side anastomosis Ileocolic anastomosis Right hemicolectomy Scenario

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Microvessel density in patients with gastrointestinal stromal tumors:A systematic review and meta-analysis

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World Journal of Methodology 2023年第3期13卷 153-165页

作者： konstantinos Perivoliotis Ioannis Baloyiannis Athina A Samara Prodromos Koutoukoglou Panagiotis Ntellas Katerina Dadouli Maria Ioannou konstantinos tepetes Department of Surgery University Hospital of LarissaLarissa 41110Greece Research Methodology in Biomedicine Biostatistics and Clinical BioinformaticsUniversity of Thessaly***Greece Department of Pathology University Hospital of LarissaLarissa 41110Greece

BACKGROUND Gastrointestinal stromal tumors(GISTs)are considered the most common mesenchymal tumors of the gastrointestinal tract.Microvessel density(MVD)constitutes a direct method of vascularity quantification and has been associated with survival rates in multiple malignancies.AIM To appraise the effect of MVD on the survival of patients with GIST.METHODS This study adhered to Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.Electronic scholar databases and grey literature repositories were systematically screened.The Fixed Effects or Random Effects models were used according to the Cochran Q test.RESULTS In total,6 eligible studies were identified.The pooled hazard ratio(HR)for disease free survival(DFS)was 8.52(95%CI:1.69-42.84,P=0.009).The odds ratios of disease-free survival between high and low MVD groups at 12 and 60 mo did not reach statistical significance.Significant superiority of the low MVD group in terms of DFS was documented at 36 and 120 mo(OR:8.46,P<0.0001 and OR:22.71,P=0.0003,respectively)as well as at metastases rate(OR:0.11,P=0.0003).CONCLUSION MVD significantly correlates with the HR of DFS and overall survival rates at 36 and 120 mo.Further prospective studies of higher methodological quality are required.

关键词： Vascularity Microvessel density Gastrointestinal stromal Survival Meta-analysis

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Microvessel density in differentiated thyroid carcinoma:A systematic review and meta-analysis

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World Journal of Methodology 2022年第5期12卷 448-458页

作者： konstantinos Perivoliotis Athina A Samara Prodromos Koutoukoglou Panagiotis Ntellas Katerina Dadouli Sotirios Sotiriou Maria Ioannou konstantinos tepetes Department of Surgery University Hospital of LarissaLarissa 41110Greece Postgraduate Programme Research Methodology in Biomedicine Biostatistics and Clinical BioinformaticsUniversity of ThessalyLarissa 41110Greece Department of Pathology University of ThessalyLarissa 41100Greece Department of Embryology University of ThessalyLarissa 41100Greece

BACKGROUND Microvessel density(MVD)has been proposed as a direct quantification method of tumor neovascularization.However,the current literature regarding the role of MVD in differentiated thyroid carcinoma(DTC)remains inconclusive.AIM To appraise the effect of tumoral MVD on the survival of patients with DTC.METHODS This meta-analysis was based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.The electronic databases Medline,Web of Science,and Scopus were systematically screened.A fixedeffects or random-effects model was used,according to the Cochran Q test.The data were then extracted and assessed on the basis of the Reference Citation Analysis(https://***/).RESULTS A total of nine studies were included in the present study.Superiority of low MVD tumors in terms of 10-year disease free survival(OR:0.21,95%CI:0.08–0.53)was recorded.Lowly vascularized thyroid cancers had a lower recurrence rate(OR:13.66,95%CI:3.03–61.48).Moreover,relapsing tumors[weighed mean difference(WMD):11.92,95%CI:6.32–17.52]or malignancies with regional lymph node involvement(WMD:8.53,95%CI:0.04–17.02)presented with higher tumoral MVD values.CONCLUSION MVD significantly correlates with the survival outcomes of thyroid cancer patients.However,considering several study limitations,further prospective studies of higher methodological and quality level are required.

关键词： Cancer Density Microvessel Thyroid Vascularization

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Giant abdominal osteosarcoma causing intestinal obstruction treated with resection and adjuvant chemotherapy

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World Journal of Gastrointestinal Surgery 2017年第2期9卷 68-72页

作者： Alexandros Diamantis Grigorios Christodoulidis Dionysia Vasdeki Foteini Karasavvidou Evangelos Margonis konstantinos tepetes Depart-ment of General Surgery University Hospital of Larisa Division of Anatomic Pathology Univer-sity Hospital of Larisa

Extraskeletal osteosarcoma(ESOS)is an uncommon tumor that accounts for 1% of all soft tissue sarcomas and 4% of all osteosarcomas. Its presentation may be atypical,while pain has been described as the most common symptom. Radiological findings include a large mass in the soft-tissues with massive calcifications,but no attachment to the adjacent bone or periosteum. We present the case of a 73-year-old gentle man who presented with a palpable,tender abdominal mass and symptoms of bowel obstruction. Computer tomography images revealed a large space-occupying heterogeneous,hyper dense soft tissue mass involving the small intestine. Explorative laparotomy revealed a large mass in the upper mesenteric root of the small intestine,measuring 22 cm × 12 cm × 10 cm in close proximity with the cecum,which was the cause of the bowel obstruction. Pathology confirmed the diagnosis of an ESOS. ESOS is an uncommon malignant soft tissue tumor with poor prognosis and a 5-year survival rate of less than 37%. Regional recurrence and distant metastasis to lungs,regional lymph nodes and liver can occur within the first three years of diagnosis in a high rate(45% and 65% respectively). Wide surgical resection of the mass followed by adjuvant chemotherapy or radiotherapy has been the treatment of choice.

关键词： Osteosarcoma 肉瘤 Extraskeletal 肠的阻塞腹的质量软织物

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Large solitary retroperitoneal echinococcal cyst:A rare case report

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World Journal of Gastroenterology 2007年第45期13卷 6101-6103页

作者： konstantinos tepetes Gregory Christodoulidis Michael Spryridakis konstantinos Hatzitheofilou General Surgery Department University Hospital of Larissa Mezourlo Larissa Greece

Echinococcal disease remains a problem within some endemic areas. Echinococcal cysts usually involve the liver and lungs, but any other organ can potentially be involved. Extrahepatic localization is reported in 14%-19% of all cases of abdominal hydatid disease. We report the case of a large echinococcal cyst localized in the lower pelvis. A 28-year-old woman was admitted to a surgical ward with lower abdominal pain and discomfort lasting for a month. Ultrasonography and computed tomography scanning revealed a large retroperitoneal cystic mass (9 cm × 4 cm) in contact with the left ovary and left ureter. There were no cysts in any other location. Serological tests were positive for Echinococcus. The patient was operated on and the entire cyst was excised intact. Histopathological results confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient was discharged after 6 d, and is now being closely followed up. Total cystectomy when possible represents the treatment of choice for large extrahepatic echinococcal cysts.

关键词：棘球绦虫超声检查血清药物治疗

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Sentinel node navigation surgery in gastric cancer: Current status

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World Journal of Gastrointestinal Surgery 2014年第6期6卷 88-93页

作者： Dimitrios Symeonidis George Koukoulis konstantinos tepetes Department of Surgery University Hospital of Larissa

The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgi-cal tissue dissection around the affected organ and subsequently the accompanied morbidity. However, ob-stacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasion-ally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisti-cated technology such as infrared ray endoscopy, flo-rescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced dis-ease should still be managed conventionally with resec-tion plus standard lymph node dissection.

关键词：哨兵节点胃的癌症最低限度地侵略的外科

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Modification of end-loop ileostomy for the treatment of ischemic or radiation enteritis

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World Journal of Gastroenterology 2008年第30期14卷 4776-4778页

作者： konstantinos tepetes Paraskevi Liakou Ioannis Balogiannis Maria Kouvaraki konstantinos Hatzitheofilou University of Thessaly University Hospital of Larissa

AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS: Five patients underwent enterectomy and partially anastomosed end-loop ileostomy at the University Hospital of Larissa between 2000 and 2006. Enterectomy was performed because of conditions such as mesenteric vascular occlusive disease, radiation entritis and small bowel injury. RESULTS: Postoperatively, none of the patients developed any stoma-related or anastomotic complications. There were no major complications. All patients were discharged between the 8th and 15th day after the procedure, and the stoma was closed 3 wk to 4 wk later. CONCLUSION: We believe that our proposed modification of end-loop ileostomy is a simple, quick and safe technique with minimal stoma-related morbidity, and with simple and safe reversion. This technique can be considered as a useful option in the treatment of ischemic or radiation-induced enteritis, and in the management of severe intestinal trauma.

关键词：缺血性肠炎回肠造口术手术治疗消化道疾病

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