Theodosios Papavramidis

The Effect of Biliopancreatic Diversion with Pylorus-Preserving Sleeve Gastrectomy and Duodenal Switch on Fasting Serum Ghrelin, Leptin and Adiponectin Levels: Is there a Hormonal Contribution to the Weight-Reducing Effect of this Procedure?

Background: Ghrelin is a peptide hormone with orexigenic properties, primarily produced by the stomach. Different changes in fasting ghrelin levels have been reported following bariatric surgery. In this study, we investigate the hypothesis that because ghrelin is mainly produced by the fundus of the stomach, biliopancreatic diversion with sleeve gastrectomy with total resection of the gastric fundus and duodenal switch (BPD-DS) will cause substantial decrease in circulating ghrelin levels. Methods: Serum fasting ghrelin, leptin and adiponectin concentrations were measured by ELISA in 13 patients with morbid obesity who achieved weight loss by BPD-DS, before the operation and 18 months after. Results: After BPD-DS, BMI decreased significantly, from 59.15±15.82 kg/m2 to 32.91±6.46 kg/m2 (P=0.001). Serum fasting ghrelin level decreased from 1.44±0.77 ng/ml to 0.99±0.35 ng/ml (P=0.019). Serum leptin level decreased from 1.81±0.38 ng/ml to 1.65±0.32 ng/ml, (P=0.196), and adiponectin level increased from 37.85±11.24 μg/ml to 39.84±16.27 μg/ml (P=0.422). Conclusions: BPD-DS is associated with markedly suppressed ghrelin levels, possibly contributing to the longlasting weight-reducing effect of the procedure. Leptin levels decreased and adiponectin increased, as expected, after weight loss. Sleeve gastrectomy with resection of the gastric fundus seems to be the main cause of the postoperative reduction in ghrelin levels.

Neuromonitoring during thyroid surgery

This overview has been prepared to assist members of the Greek Society of Endocrine Surgeons (GSES) in making recommendations about the safety and efficacy of the use of neuromonitoring during thyroid surgery. The international literature was reviewed and 149 articles relevant to neuromonitoring in thyroid surgery were retrieved. All studies were carefully analyzed in order to assist the members of GSES in globally recognizing and defining the subject, and in issuing guidelines. Neuromonitoring (NM) is the use of electrophysiological methods to monitor the functional integrity of neural structures during surgery. We can distinguish continuous intraoperative neuromonitoring (IONM) and stimulated intraoperative neuromonitoring (IONS). From a review of the literature we can definitively conclude that: (i) no type of NM can zero the palsies of Recurrent Laryngeal Nerf (RLN), (ii) high-volume surgeons have the same rates of RLN palsies with or without NM, (iii) the use of NM requires previous training. When NM is employed the algorithm predissection laryngoscopy-vagus nerve stimulation-RLN stimulation and postdissection RLN stimulation- vagus nerve stimulation-laryngoscopy (L1-V1-R1-R2-V2-L2) should be used. Moreover, there seems to be evidence that low-volume surgeon may profit from NM in order to reach complication rates of high-volume surgeons.

Defining and limiting minimal invasive thyroid surgery

This overview has been prepared to assist members of the Greek Society of Endocrine Surgeons (GSES) in making definitions and recommendations concerning minimally invasive techniques employed in thyroid surgery. It is based on a review of the medical literature and specialist opinion. It should not be regarded as a definitive assessment of the procedure. The international literature was reviewed and 467 relevant articles concerning minimal invasive thyroid surgery were retrieved. All studies were carefully analyzed in order to help members of GSES to globally recognize the subject, define it and issue guidelines. In a tentative to define minimal invasive thyroidectomy (MIT), we could say that it is any thyroidectomy performed via a small incision or through holes aiming to minimize tissue damage, which means less pain, less traumatic surface with acceptable complication rate. By definition, MITs include minimal invasive video-assisted thyroidectomies (MIVAT), loupes-assisted thyroidectomies (LATE) and transoral thyroidectomies (TOT). In order to sustain a safe and high quality surgical practice, the indications and limitations of MIVAT/LATE are to be considered. Most authors agree that reoperation and previous irradiation of the neck are factors rendering MIIVAT/LATE impossible to perform. With regard to the size of the predominant nodule, everybody seems to concur that nodules less than 3cm are eligible for MIVAT/LATE, whereas in terms of the total volume of the excised gland, most authors would agree that any gland with a volume less than 20ml is eligible. Finally, during the last decade MIVAT/LATE have become accepted techniques for treating thyroid cancer. Where experienced surgeons are involved, MIVAT/LATE can be performed for tumours up to T4aN1a. However, most authors seem to suggest to less experienced surgeons that oncologic thyroidectomies be performed up to T1N0.