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  • Sotiropoulos, Georgios C.  (22)
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  • 1
    Language: English
    In: Thyroid : official journal of the American Thyroid Association, July 2008, Vol.18(7), pp.721-7
    Description: The aim of this study was to test the hypothesis that minimally invasive video-assisted thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery in dealing with patients with small thyroid nodules. Randomized controlled trials comparing the MIVAT with open thyroidectomy were ascertained by methodical search using Medline, Embase, Pubmed, and The Cochrane Library. Primary meta-analysis outcomes were adverse events (laryngeal nerve palsy and hypoparathyroidism), and cosmesis and secondary outcomes were operative time, blood loss, and early and late postoperative pain. Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain at 6 hours postoperatively. Blood loss did not reached significance between procedures. Comparisons between two procedures concerning pain score of 24 and 48 hours, respectively, depicted statistically significant differences in favor of the MIVAT but only in the fixed effects model. MIVAT was associated with less scarring. There were no statistically significant differences for the presence of transient recurrent laryngeal nerve palsy and the presence of transient hypoparathyroidism. MIVAT is a safe procedure that produces outcomes; in view of short-term adverse events, similar to those of open thyroidectomy, it needs a longer operative time to be accomplished and is superior in terms of immediate postoperative pain and cosmetic results.
    Keywords: Evidence-Based Medicine ; Minimally Invasive Surgical Procedures -- Methods ; Thyroid Nodule -- Surgery ; Thyroidectomy -- Methods ; Video-Assisted Surgery -- Methods
    ISSN: 1050-7256
    E-ISSN: 15579077
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  • 2
    Language: English
    In: The American Journal of Surgery, 2010, Vol.199(6), pp.776-781
    Description: The aim of this study was to compare the immediately postoperative and follow-up results of open and laparoscopic surgery of hepatic cysts in a tertiary hepatobiliary referral center. From March 1999 to February 2007, 59 patients underwent surgical treatment for nonparasitic liver cysts. Patients were assigned to the laparoscopic (n = 42) or open group (n = 17) for analysis. Three conversions to open procedures had to be performed in the laparoscopic group. One patient had to be reoperated because of a bile leakage in the laparoscopic group. Follow-up examination showed 2 recurrences in the laparoscopic and 3 in the open group. Three out of 17 patients in the open group had to be operated for incisional hernias. Time to previous activities was significantly shorter after laparoscopy. Laparoscopic treatment of symptomatic nonparasitic liver cysts is superior concerning short- and long-term results in a vast majority of cases.
    Keywords: Liver Cysts ; Laparoscopy ; Open Treatment ; Follow-Up ; Recurrence
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 3
    In: Transplantation, 2010, Vol.89(12), pp.1518-1525
    Description: BACKGROUND.: The knowledge of “venous dominance” is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections. AIMS.: The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage. METHODS.: One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. “Risky” configurations were identified and classified. RESULTS.: The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed. CONCLUSIONS.: Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at “high risk” for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.
    Keywords: Hepatic Veins -- Pathology ; Image Processing, Computer-Assisted -- Methods ; Liver -- Blood Supply ; Liver Transplantation -- Methods ; Tomography, X-Ray Computed -- Methods;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 4
    Language: English
    In: Journal of the American College of Surgeons, 2010, Vol.211(3), pp.S21-S21
    ISSN: 1072-7515
    E-ISSN: 1879-1190
    Source: ScienceDirect Journals (Elsevier)
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  • 5
    In: Transplantation, 2009, Vol.87(11), pp.1672-1680
    Description: BACKGROUND.: The purpose of this study was to compare outcomes after duct-to-duct anastomoses with or without biliary T-tube in orthotopic liver transplantation. METHODS.: We pooled the outcomes of 1027 patients undergoing choledocho-choledochostomy with or without T-tube in 9 of 46 screened trials by means of fixed or random effects models. RESULTS.: The “without T-tube” and “with T-tube” groups had equivalent outcomes for: anastomotic bile leaks or fistulas, choledocho-jejunostomy revisions, dilatation and stenting, hepatic artery thromboses, retransplantation, and mortality due to biliary complications. The “without T-tube” group had better outcomes when considering “fewer episodes of cholangitis,” “fewer episodes of peritonitis,” and showed a favorable trend for “overall biliary complications.” Although the “with T-tube” group showed superior result for “anastomotic and nonanastomotic strictures,” the incidence of interventions was not diminished. CONCLUSIONS.: Our systematic review and meta analysis favor the abandonment of T-tubes in orthotopic liver transplantation.
    Keywords: Hepatic Artery ; Mortality ; Cholangitis ; Peritonitis ; Bile ; Reviews ; Stenosis ; Clinical Trials ; Models ; Liver Transplantation ; Transplantation;
    ISSN: 0041-1337
    E-ISSN: 15346080
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  • 6
    Language: English
    In: International Journal of Colorectal Disease, 2008, Vol.23(9), pp.825-832
    Description: AIMSThe objective of this study was to compare the perioperative, short-term, and long-term outcomes of stapled hemorrhoidectomy with Ferguson hemorrhoidectomy. MATERIALS AND METHODSThe present meta-analysis pooled the effects of outcomes of a total 926 patients treated with stapled or Ferguson hemorrhoidectomy in five out of 122 screened for retrieval randomized controlled trials using the fixed-effects or a random-effects model. RESULTSStapled hemorroidectomy was equivalent to the Ferguson procedure in comparisons pertaining to the following outcomes: hospital stay, postoperative hemorrhage requiring intervention, early postoperative bleeding 〈4 weeks, late postoperative bleeding 〈8 weeks, and the presence of anal pathology at 1 year follow-up. Stapled hemorrhoidectomy was superior with impact to operative time, pain visual analogue scale score at 24 h, urinary retention, and wound healing. CONCLUSIONSThere is convincingly apparent evidence about the safety and efficacy of stapled hemorrhoidectomy in the comparison with the well-established Ferguson procedure.
    Keywords: Meta-analysis ; Evidence-based ; Publication bias ; Jadad composite scale ; Stapled hemorrhoidectomy ; Ferguson hemorrhoidectomy
    ISSN: 0179-1958
    E-ISSN: 1432-1262
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  • 7
    Language: English
    In: Hepato-gastroenterology, 2010, Vol.57(104), pp.1337-40
    Description: Our objective was to evaluate liver transplantation as a treatment option for Klatskin tumor. Results for transplanted patients suffering from hilar cholangiocarcinoma were therefore compared to patients after hemihepatectomy. In a retrospective case-control study, seven patients transplanted for hilar cholangiocarcinoma were matched in terms of UICC stage with seven patients who underwent resection of the hilar bifurcation combined with a hemihepatectomy. Median survival was 22 months (range 1-55 months) for patients after liver resection and 64 months (range 1-138 months) for patients after liver transplantation. One and three year overall survival was 71% and 43% after liver resection versus 71% and 57% after liver transplantation. One patient from each group died within one month after surgery. Fatal cerebral bleeding and post-resection liver failure leading to multi-organ failure and sepsis were the causes of early mortality. Three patients are currently alive: one with 64 months after transplantation and two patients with 42 and 55 months after liver resection. Based on our findings and recently published promising results using liver transplantation for Klatskin tumor, it seems worthwhile to reconsider its potential use in the light of multimodal tumor treatment.
    Keywords: Hepatic Duct, Common ; Liver Transplantation ; Bile Duct Neoplasms -- Surgery ; Hepatectomy -- Methods ; Klatskin Tumor -- Surgery
    ISSN: 0172-6390
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 8
    Language: English
    In: The American surgeon, January 2013, Vol.79(1), pp.90-5
    Description: Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. Between April 1998 and January 2007, 96 patients with hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n = 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age (P = 0.048), pT status (P = 0.046), R class (P = 0.034), and adjuvant chemoradiation (P = 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older = 1:2 points; pT1:pT2 to 4 = 1:2 points; R0:R1/2 = 1:2 points; and chemoradiation yes:no = 1:2 points. The only model that reached statistical significance (P = 0.0332) described the following three groups: score 6 or less; score = 7; and score = 8. Median survival for score 6 or less, score = 7, and score = 8 was 26.5, 12, and 2.2 months, respectively (P = 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially improve patient selection for further postoperative oncologic treatment for Klatskin tumors.
    Keywords: Decision Support Techniques ; Hepatectomy ; Bile Duct Neoplasms -- Surgery ; Hepatic Duct, Common -- Surgery ; Klatskin Tumor -- Surgery
    ISSN: 00031348
    E-ISSN: 1555-9823
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  • 9
    Language: English
    In: Journal of Surgical Research, 2011, Vol.166(1), pp.146-155
    Description: Venous drainage patterns are of vital importance in live donor liver transplantation. The purpose of this study was to delineate “anatomical-topographical” and “territorial-physiologic” patterns of the middle hepatic vein (MHV) in a 3-D liver model as determined by the Pringle line and its drainage volume of the right and left hemilivers. One hundred thirty-seven consecutive live donor candidates were evaluated by 3-D CT reconstructions and virtual hepatectomies. Based on right (R) and left (L), anatomical (A) and territorial (T) belonging patterns of the MHV, each individual was assigned to one of four possible types: type I:A –T ; type II:A –T ; type III:A –T ; type IV:A –T . Couinaud's anatomical MHV variants A–C were subsequently included in our combined anatomical/territorial MHV belonging classification. The MHV showed a significant predominance of right “anatomical” (59.1%) and left “territorial” belonging patterns (65.7%). The paradoxical combinations A –T (type III) and A –T (type IV) were encountered in 36.5% and 11.7% of cases, respectively. The constellations Couinaud's A-belonging type IV and Couinaud's C-belonging type IV were predictive of right hemiliver venous congestion. (1) Almost half of all livers in our series had paradoxical “anatomical”/“territorial” MHV belonging patterns that placed them at risk for right and left hepatectomies. (2) The proposed combined “anatomical”/“territorial” MHV belonging types (I–IV) provide useful preoperative information. (3) Combined types III and IV as well as Couinaud's A–IV, and Couinaud's C–IV should be considered particularly risky for venous congestion in right hemiliver grafts and in extended left hepatectomies.
    Keywords: Liver Surgery ; Living Donor Liver Transplantation ; Liver Anatomy ; 3-D Reconstruction ; 3-D CT ; Liver Imaging ; Liver Venous Drainage ; Hepatic Vein Anatomy ; Hepatic Vein Dominance ; Hepatic Vein Classification
    ISSN: 0022-4804
    E-ISSN: 1095-8673
    Source: ScienceDirect Journals (Elsevier)
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  • 10
    Language: English
    In: The Journal of surgical research, March 2011, Vol.166(1), pp.146-55
    Description: Venous drainage patterns are of vital importance in live donor liver transplantation. The purpose of this study was to delineate "anatomical-topographical" and "territorial-physiologic" patterns of the middle hepatic vein (MHV) in a 3-D liver model as determined by the Pringle line and its drainage volume of the right and left hemilivers. One hundred thirty-seven consecutive live donor candidates were evaluated by 3-D CT reconstructions and virtual hepatectomies. Based on right (R) and left (L), anatomical (A) and territorial (T) belonging patterns of the MHV, each individual was assigned to one of four possible types: type I:A(R)-T(R); type II:A(L)-T(L); type III:A(R)-T(L); type IV:A(L)-T(R). Couinaud's anatomical MHV variants A-C were subsequently included in our combined anatomical/territorial MHV belonging classification. The MHV showed a significant predominance of right "anatomical" (59.1%) and left "territorial" belonging patterns (65.7%). The paradoxical combinations A(R)-T(L) (type III) and A(L)-T(R) (type IV) were encountered in 36.5% and 11.7% of cases, respectively. The constellations Couinaud's A-belonging type IV and Couinaud's C-belonging type IV were predictive of right hemiliver venous congestion. (1) Almost half of all livers in our series had paradoxical "anatomical"/"territorial" MHV belonging patterns that placed them at risk for right and left hepatectomies. (2) The proposed combined "anatomical"/"territorial" MHV belonging types (I-IV) provide useful preoperative information. (3) Combined types III and IV as well as Couinaud's A-IV, and Couinaud's C-IV should be considered particularly risky for venous congestion in right hemiliver grafts and in extended left hepatectomies.
    Keywords: Hepatic Veins ; Living Donors ; Hepatectomy -- Methods ; Liver Transplantation -- Methods
    ISSN: 00224804
    E-ISSN: 1095-8673
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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