Dimitrios Zacharoulis

Impact of Bariatric Surgery on Metabolic and Gut Microbiota Profile: a Systematic Review and Meta-analysis.

We aim to review the available literature on obese patients treated with bariatric procedures, in order to assess their effect on the metabolic and gut microbiota profiles. A systematic literature search was performed in PubMed, Cochrane library, and Scopus databases, in accordance with the PRISMA guidelines. Twenty-two studies (562 patients) met the inclusion criteria. This study points to significant amelioration of postoperative levels of glucose, insulin, triglycerides, total cholesterol, LDL, HDL, HOMA-IR, food intake, and diabetes remission. Branched-chain amino acids (BCAAs) decreased, while trimethylamine-n-oxide (TMAO); glucagon-like peptide 1, 2 (GLP-1, GLP-2); and peptide YY (PYY) increased postoperatively. Postoperative gut microbiota was similar to that of lean and less obese objects. Well-designed randomized trials are necessary to further assess the host metabolic-microbial cross-talk after bariatric procedures.

Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis

We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness.

One-Anastomosis Gastric Bypass Versus Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis

We aim to review the available literature on obese patients treated with one-anastomosis gastric bypass (OAGB) or laparoscopic sleeve gastrectomy (LSG), in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library, and Scopus databases, in accordance with the PRISMA guidelines. Seventeen studies met the inclusion criteria incorporating 6761 patients. This study reveals increased weight loss, remission of comorbidities, shorter mean hospital stay, and lower mortality in the OAGB group. The incidence of leaks and intra-abdominal bleeding was similar between the two approaches. Well-designed, randomized controlled studies, comparing LSG to OAGB, are necessary to further assess their clinical outcomes.

A giant adrenal cyst difficult to diagnose except by surgery

INTRODUCTION Adrenal cysts represent rare clinical entities. Although surgical indications are well defined, pitfalls arise from the failure to establish an accurate preoperative diagnosis. Cystic lesions of other abdominal organs especially the pancreas complicate the diagnostic field. PRESENTATION OF CASE We present the case of a giant adrenal cyst in a young female causing diagnostic dilemma. Imaging studies revealed a large cystic lesion of uncertain origin located between the spleen and the tail of the pancreas. It was decided to perform a laparotomy which confirmed the presence of an adrenal cyst and enucleation of the cyst was performed. Examination at one year confirmed no complications. DISCUSSION Adrenal cysts should always be included in the differential diagnosis of cystic abdominal lesions. CONCLUSION When the preoperative diagnosis is uncertain, surgical intervention can be both diagnostic and therapeutic.

The use of over-the-scope clip in the treatment of persistent staple line leak after re-sleeve gastrectomy: Review of the literature

Staple line leak after sleeve gastrectomy (SG) is a severe complication associated with increased mortality rates and the potential need for reoperation. We report the successful management of a re-SG staple line leak with the use of an endoscopic over-the-scope clip.

Patient Derived Xenografts (PDX) for personalized treatment of pancreatic cancer: emerging allies in the war on a devastating cancer?

The prognosis of pancreatic ductal adenocarcinoma (PDAC), the eighth most lethal cancer for men and ninth for women worldwide, remains dismal. The increasing rates of deaths by PDAC indicate that the overall management of the disease in 21st century is still insufficient. Thus it is obvious that there is an unmet need to improve management of PDAC by finding new biomarkers to screen high risk patients, confirm diagnosis, and predict response to treatment as well more efficacious and safer treatments. Patient Derived Xenografts (PDX) have been developed as a new promising tool in an effort to mirror genetics, tumor heterogeneity and cancer microenvironment of the primary tumor. Herein we aim to give an updated overview of the current status and the perspectives of PDX in the search for the identification of novel biomarkers and improved therapeutic outcomes for PDAC but also their use as a valuable tool towards individualized treatments to improve the outcome of the disease. Furthermore, we critically review the applications, advantages, limitations, and perspectives of PDX in the research towards an improved management of PDAC. SIGNIFICANCE This review provides a comprehensive overview of the current status and the potential role as well as the challenges of PDX in the road to fight one of the most lethal cancers in the developed countries, pancreatic ductal adenocarcinoma.

Spontaneous perirenal hemorrhage in end-stage renal disease treated with selective embolization.

Spontaneous nontraumatic rupture of the kidney (Wunderlich syndrome) is an extremely uncommon condition on hemodialysis. We report a case of 44-year-old hemodialysis patient presented with hemorrhagic shock and a right quadrant abdominal pain to the emergency department. There was no history of trauma. A kidney rupture was revealed by abdominal computed tomography, and active bleeding was successfully managed with arterial embolization. This case illustrates the safe and successful application of interventional radiology in the management of nontraumatic renal hemorrhage in the specific group of hemodialyzed patients even in the emergency setting.

Thyroid abscess requiring emergency intervention.

A 31-year-old man was admitted to the Emergency Department complaining of fever, chills, and a painful neck. Physical examination revealed a markedly enlarged and exquisitely tender left lobe of the thyroid gland (Figure 1). The oxygen saturation (SpO2) was 96%. The patient did not complain of any symptoms associated with respiratory distress. He had neither stridor nor any other signs of compromised airway. At that point, a decision was made not to intubate the patient given the fact that he would soon be transferred to the operating room. However, considering the risk for acute airway obstruction, he was placed in close observation while he was awaiting his emergency surgery. Ultrasound imaging of the thyroid gland demonstrated non-homogeneous, enlarged left lobe and edema of the subcutaneous adipose tissue. The patient was admitted to the operating room approximately half an hour after his admission. The patient was electively intubated in the operating room without any difficulties. An emergency incision and drainage of an anterior neck space abscess located superficial to the strap muscles was performed. Culture of the pus grew Streptococcus sanguinis. On postoperative day 1, after liquid oral diet intake, outlet of water from the incision was marked. The patient was then further evaluated. The laryngoscopy showed retention of saliva at the piriform fossa without a fistula being visible. The gastroscopy, however, depicted a fistulous tract opening superiorly to the upper esophageal sphincter.

Gastritis might be considered as a technical factor affecting laparoscopic sleeve gastrectomy

Abstract There is a paucity of data regarding gastritis as a technical factor affecting the surgical technique. Antritis and gastritis usually cause stomach wall thickness which can interrupt stapler function or even can cause serosal tear during the dissection. We report a video presentation of laparoscopic sleeve gastrectomy in a morbidly obese patient with antritis. Choosing black cartridge for patients with Helicobacter pylori gastritis might be the optimal technique for division of the antrum in laparoscopic sleeve gastrectomy. Further studies are required to clarify this parameter.

Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis

Introduction A meta-analysis was conducted in order to provide an up-to-date comparison of laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric plication (LGP) for morbid obesity. Materials and Methods The PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were used for the conduction of this study. A systematic literature search was performed in the electronic databases (MEDLINE, CENTRAL, and Web of Science and Scopus). The fixed effects or random effects model was used according to the Cochran Q test. Results Totally, 12 eligible studies were extracted. LSG displayed a statistically significant lower rate of overall complications (OR: 0.35; 95% CI: 0.17, 0.68; p=0.002) and a sustainable higher %EWL through all time endpoints (OR: 4.86, p=0.04; OR: 7.57, p < 0.00001; and OR: 13.74; p < 0.00001). There was no difference between the two techniques in terms of length of hospital stay (p=0.16), operative duration (p=0.81), reoperation rate (p=0.51), and cost (p=0.06). Conclusions LSG was demonstrated to have a lower overall complications and a higher weight loss rate, when compared to LGP. Further RCTs of a higher methodological quality level, with a larger sample size, are required in order to validate these findings.