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Bourdas DI, Travlos AK, Souglis A, Stavropoulou G, Zacharakis E, Gofas DC, Bakirtzoglou P. Effects of a Singular Dose of Mangiferin-Quercetin Supplementation on Basketball Performance: A Double-Blind Crossover Study of High-Level Male Players. Nutrients 2024; 16:170. [PMID: 38201999 PMCID: PMC10781150 DOI: 10.3390/nu16010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Pre-exercise mangiferin-quercetin may enhance athletic performance. This study investigated the effect of mangiferin-quercetin supplementation on high-level male basketball players during a basketball exercise simulation test (BEST) comprising 24 circuits of 30 s activities with various movement distances. The participants were divided into two groups (EXP = 19 and CON = 19) and given a placebo one hour before the BEST (PRE-condition). The following week, the EXP group received mangiferin-quercetin (84 mg/140 mg), while the CON group received a placebo (POST-condition) before the BEST in a double-blind, cross-over design. The mean heart rate (HR) and circuit and sprint times (CT and ST) during the BEST were measured, along with the capillary blood lactate levels (La-), the subjective rating of muscle soreness (RPMS), and the perceived exertion (RPE) during a resting state prior to and following the BEST. The results showed significant interactions for the mean CT (p = 0.013) and RPE (p = 0.004); a marginal interaction for La- (p = 0.054); and non-significant interactions for the mean HR, mean ST, and RPMS. Moreover, the EXP group had significantly lower values in the POST condition for the mean CT (18.17 ± 2.08 s) and RPE (12.42 ± 1.02) compared to the PRE condition (20.33 ± 1.96 s and 13.47 ± 1.22, respectively) and the POST condition of the CON group (20.31 ± 2.10 s and 13.32 ± 1.16, respectively) (p < 0.05). These findings highlight the potential of pre-game mangiferin-quercetin supplementation to enhance intermittent high-intensity efforts in sports such as basketball.
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Affiliation(s)
- Dimitrios I. Bourdas
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (A.S.); (E.Z.)
| | - Antonios K. Travlos
- Department of Sports Organization and Management, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Efstathiou and Stamatikis Valioti & Plataion Avenue, 23100 Sparta, Greece;
| | - Athanasios Souglis
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (A.S.); (E.Z.)
| | - Georgia Stavropoulou
- School of Philosophy and Education, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece;
| | - Emmanouil Zacharakis
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (A.S.); (E.Z.)
| | - Dimitrios C. Gofas
- Arsakeia-Tositseia Schools, Philekpaideftiki Etaireia, Mitilinis 26, 11256 Athens, Greece;
| | - Panteleimon Bakirtzoglou
- Faculty of Sport Sciences & Physical Education, Metropolitan College, Eleftheriou Venizelou 14, 54624 Thessaloniki, Greece
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Mitrousis I, Bourdas DI, Kounalakis S, Bekris E, Mitrotasios M, Kostopoulos Ν, Ktistakis IE, Zacharakis E. The Effect of a Balance Training Program on the Balance and Technical Skills of Adolescent Soccer Players. J Sports Sci Med 2023; 22:645-657. [PMID: 38045735 PMCID: PMC10690516 DOI: 10.52082/jssm.2023.645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023]
Abstract
Soccer is a complex sport, and balance appears to play a crucial role in the quality execution of technical skills, which are mostly performed while standing on one foot. Nevertheless, in younger ages, when learning still affects soccer performance, the effect of a balance-training program on the player's balance and technical skills remains unexplored. This research examined the effect of a balance-training program (BTP) on balance and technical skills of adolescent soccer players. Τhe participating volunteers were thirty-two soccer players (12-13 years old with 3.84 ± 0.95 years of practice), randomly separated into two groups: an experimental (EXP, n1 = 17) and a control group (CON, n2 = 15). Both groups were evaluated in static and dynamic balance and in technical skills (dribbling, passing, juggling, and shooting with dominant and non-dominant legs) before (Pre-condition) and after the intervention (Post-condition) which was an eight-week BTP for the EXP group and a placebo-training program for the CON group. Α 2 by 2 (groups×condition) mixed analysis of variance (ANOVA) with repeated measures on the condition factor was used to assess possible differences between groups. A significant groups × condition interaction effect was found in dynamic balance (p = 0.008), static (p = 0.042), and shooting (p = 0.022) with dominant leg performance. The EXP group improved (p = 0.007) its static balance by 37.82% and also significantly improved its dynamic balance and shooting accuracy with dominant leg in Post condition by 24.98% (p = 0.006) and 83.84% (p = 0.006) respectively. No significant improvement of other variables was detected in the EXP group Post condition. Dynamic and static balance, and shooting with dominant leg skills can be improved in adolescent soccer players through a specialized 8-week BTP. Balance-training program may contribute to technical skill improvement in soccer training.
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Affiliation(s)
- Ioannis Mitrousis
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | - Dimitrios I Bourdas
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | | | - Evangelos Bekris
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | - Michael Mitrotasios
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | - Νikolaos Kostopoulos
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | - Ioannis E Ktistakis
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
| | - Emmanouil Zacharakis
- School of Physical Education and Sports Science, National & Kapodistrian University of Athens, Greece
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Bourdas DI, Bakirtzoglou P, Travlos AK, Andrianopoulos V, Zacharakis E. Analysis of a comprehensive dataset: Influence of vaccination profile, types, and severe acute respiratory syndrome coronavirus 2 re-infections on changes in sports-related physical activity one month after infection. Data Brief 2023; 51:109723. [PMID: 37965614 PMCID: PMC10641141 DOI: 10.1016/j.dib.2023.109723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
This dataset was created with the primary objective of elucidating the intricate relationship between the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) re-infections and the pre-illness vaccination profile and types concerning alterations in sports-related physical activity (PA) after SARS-CoV-2 infection among adults. A secondary objective encompassed a comprehensive statistical analysis to explore the influence of three key factors-namely, Vaccination profile, Vaccination types, and Incidence of SARS-CoV-2 re-infections-on changes in PA related to exercise and sports, recorded at two distinct time points: one to two weeks prior to infection and one month after the last SARS-CoV-2 infection. The sample population (n = 5829), drawn from Hellenic territory, adhered to self-inclusion and exclusion criteria. Data collection spanned from February to March 2023 (a two-month period), involving the utilization of the Active-Q (an online, interactive questionnaire) to automatically assess weekly habitual sports-related PA among adults both before and after their last SARS-CoV-2 infection. The questionnaire also captured participant characteristics, pre-illness vaccination statuses (i.e., unvaccinated, partially vaccinated, fully vaccinated, and vaccine types), and occurrences of SARS-CoV-2 re-infections. The dataset sheds light on two noteworthy phenomena: (i) the intricate interplay between post-acute SARS-CoV-2 infection and a decline in sports-related physical activity (-27.6 ± 0.6%, 95%CI: -26.1 - -29.1), influenced by the pre-illness vaccination profile factor (p = 0.040); and (ii) the divergence in sports-related physical activity decline between partially vaccinated (-38.2 ± 0.7%, 95%CI: -35.3 - -41.1, p = 0.031) and fully vaccinated respondents (-19.2 ± 0.5%, 95%CI: -17.2 - -21.2). These phenomena underscore the imperative for tailored interventions and further investigation to promote the resumption of physical activity and mitigate long-term repercussions. Furthermore, this dataset enriches our understanding of the dynamics of sports-related physical activity and provides valuable insights for public health initiatives aiming to address the consequences of COVID-19 on sports-related physical activity levels. Consequently, this cross-sectional dataset is amenable to a diverse array of analytical methodologies, including univariate and multivariate analyses, and holds potential relevance for researchers, leaders in the sports and medical sectors, and policymakers, all of whom share a vested interest in fostering initiatives directed at reinstating physical activity and mitigating the enduring ramifications of post-acute SARS-CoV-2 infection.
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Affiliation(s)
- Dimitrios I. Bourdas
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Panteleimon Bakirtzoglou
- School of Physical Education and Sport Science, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Antonios K. Travlos
- Department of Sports Organization and Management, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Efstathiou and Stamatikis Valioti & Plataion Avenue, 23100 Sparta, Greece
| | - Vasileios Andrianopoulos
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Emmanouil Zacharakis
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
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Bourdas DI, Bakirtzoglou P, Travlos AK, Andrianopoulos V, Zacharakis E. Exploring the Impact of COVID-19 on Physical Activity One Month after Infection and Its Potential Determinants: Re-Infections, Pre-Illness Vaccination Profiles/Types, and Beyond. Vaccines (Basel) 2023; 11:1431. [PMID: 37766108 PMCID: PMC10538036 DOI: 10.3390/vaccines11091431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
This study investigated changes in physical activity (PA) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection while considering age, PA level, underlying medical conditions (UMCs), vaccination profiles/types, re-infections, disease severity, and treatment. Data were collected from 5829 respondents by using a validated web-based questionnaire. The findings showed that there was a significant overall decrease in PA (-16.2%), including in daily occupation (-11.9%), transportation (-13.5%), leisure-time (-16.4%), and sporting (-27.6%) activities. Age, PA level, UMCs, vaccination profiles/types, disease severity, and treatment played a role in determining PA in individuals' post-acute SARS-CoV-2 infections. Re-infections did not impact the decline in PA. Unvaccinated individuals experienced a significant decline in PA (-13.7%). Younger (-22.4%) and older adults (-22.5%), those with higher PA levels (-20.6%), those with 2-5 UMCs (-23.1%), those who were vaccinated (-16.9%) or partially vaccinated (-19.1%), those with mRNA-type vaccines only (-17.1%), those with recurrent (-19.4%)-to-persistent (-54.2%) symptoms, and those that required hospital (-51.8%) or intensive care unit (-67.0%) admission during their infections had more pronounced declines in PA. These findings emphasize the complex relationship between post-acute SARS-CoV-2 infection and PA and highlight the need for targeted interventions, further research, and multidisciplinary care to promote PA resumption and mitigate long-term effects on global public health.
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Affiliation(s)
- Dimitrios I. Bourdas
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (V.A.); (E.Z.)
| | - Panteleimon Bakirtzoglou
- School of Physical Education and Sport Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Antonios K. Travlos
- Department of Sports Organization and Management, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Efstathiou and Stamatikis Valioti & Plataion Avenue, 23100 Sparta, Greece;
| | - Vasileios Andrianopoulos
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (V.A.); (E.Z.)
| | - Emmanouil Zacharakis
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece; (D.I.B.); (V.A.); (E.Z.)
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Souglis A, Bourdas DI, Gioldasis A, Ispirlidis I, Philippou A, Zacharakis E, Apostolidis A, Efthymiou G, Travlos AK. Time Course of Performance Indexes, Oxidative Stress, Inflammation, and Muscle Damage Markers after a Female Futsal Match. Sports (Basel) 2023; 11:127. [PMID: 37505614 PMCID: PMC10385326 DOI: 10.3390/sports11070127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Our aims were to investigate the time-course effects of a futsal match on performance, oxidative stress, and muscle damage markers, as well as inflammatory and antioxidant responses during a 6-day post-match period. METHODS Thirty-four female high-level futsal players were assessed on several oxidative stress, inflammation, subjective muscle soreness, subjective rate perceived exertion, and performance tests before a futsal match, immediately after, and 24 h to 144 h after. RESULTS Counter movement jump, 20 m, and 10 m sprints performance significantly decreased immediately after the match (p < 0.05) and returned to baseline 72 h post-match (p > 0.05). Delayed onset muscle soreness peaked 24 h post-match and rate perceived exertion peaked post-match (p < 0.05) and returned to baseline 96 h post-match (p > 0.05). Inflammatory biomarkers peaked at 24 h (p < 0.05) and remained significantly elevated for 72 h after the match (p < 0.05). Muscle damage biomarkers peaked at 24 h (p < 0.05) and remained significantly (p < 0.05) elevated for at least 72 h after the match. Oxidative stress markers peaked at 24 h-48 h (p < 0.05) and returned to baseline 120 h post-match (p > 0.05). In respect to antioxidant responses, these peaked at 24 h-48 h post-match (p < 0.05) and returned to baseline 120 h after the match (p > 0.05). CONCLUSIONS A single futsal match induces short/mid-term changes in performance, inflammation, oxidative stress, and muscle damage markers for about 72 h-96 h post-match.
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Affiliation(s)
- Athanasios Souglis
- Section of Didactics and Coaching in Sport Games, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Dimitrios I Bourdas
- Section of Sport Medicine & Biology of Exercise, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Aristotelis Gioldasis
- Section of Didactics and Coaching in Sport Games, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Ioannis Ispirlidis
- School of Physical Education & Sport Science, Democritus University of Thrace, Panepistimioupoli, 69100 Komotini, Greece
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Emmanouil Zacharakis
- Section of Didactics and Coaching in Sport Games, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Alexandros Apostolidis
- Section of Didactics and Coaching in Sport Games, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, 41 Ethnikis Antistasis, 17237 Daphne, Greece
| | - Georgios Efthymiou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Papakiriazi 24, 41222 Larissa, Greece
| | - Antonios K Travlos
- Department of Sports Organization and Management, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Efstathiou and Stamatikis Valioti & Plataion Avenue, 23100 Sparta, Greece
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Theodorou AS, Rizou HP, Zacharakis E, Ktistakis I, Bekris E, Panoutsakopoulos V, Strouzas P, Bourdas DI, Kostopoulos N. Pivot Step Jump: A New Test for Evaluating Jumping Ability in Young Basketball Players. J Funct Morphol Kinesiol 2022; 7:jfmk7040116. [PMID: 36547662 PMCID: PMC9783850 DOI: 10.3390/jfmk7040116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Jumping ability in basketball is usually assessed using standardized vertical jump tests. However, they lack specificity and do not consider the player’s basketball skills. Several studies have suggested performing specific jump tests, which are tailored to the movement patterns and requirements of a basketball game. The pivot step jump test (PSJT) is a novel test designed to evaluate the specific jumping abilities of basketball players by combining a pivot step on one leg with a maximum bilateral vertical jump. This study had two aims: to determine the reliability and validity of the PSJT using typical jump tests as the criterion measure and to demonstrate the PSJT as a practical test to evaluate specific jumping ability in young male and female basketball players. Twenty female (EGA; 14.0 ± 0.7 years, 59.3 ± 7.9 kg, 162.1 ± 5.5 cm) and fifteen male (EGB; 14.0 ± 0.7 years, 58.1 ± 7.7 kg, 170.3 ± 6.4 cm) basketball players participated in the study. The test−retest reliability of the PSJT within sessions (intrasession reliability) and across sessions (intersession reliability) was assessed within EGA. For the evaluation of validity, EGB performed the PSJT and a series of criterion jumping tests. For EGA, no changes (p > 0.05) were found in PSJT performance between test sessions and excellent intra- and intersession reliability was observed (ICCs > 0.75). Correlation coefficients indicated high factorial validity between the jumping tests and PSJT (r = 0.71−0.91, p < 0.001). The PSJT appears to offer a valid assessment of jumping ability in basketball and is a practical test for assessing sport-specific jumping skills in young basketball players.
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Affiliation(s)
- Apostolos S. Theodorou
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
- Correspondence: ; Tel.: +30-210-727-6175
| | - Hariklia-Parthenia Rizou
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Emmanouil Zacharakis
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Ioannis Ktistakis
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Evangelos Bekris
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Vassilios Panoutsakopoulos
- Biomechanics Laboratory, School of Physical Education and Sports Sciences at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Panagiotis Strouzas
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Dimitrios I. Bourdas
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
| | - Nikolaos Kostopoulos
- School of Physical Education & Sport Sciences (TEFAA), National and Kapodistrian University of Athens, Dafni, 17237 Athens, Greece
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Maridaki M, Papadopetraki A, Moustogiannis A, Dourida-Mitarachi M, Zacharakis E, Philippou A. Salivary Hormonal And Cytokine Responses To A High-level Basketball Match In Wheelchair Athletes. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876788.78436.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jiang H, Kruszewski A, Cherkashina E, Theodorou A, Zacharakis E, Cherkashin I, Konovalov I, Kruszewski M. Compensatory action of the index and middle finger in the kinematic chain of a basketball shot. Acta Bioeng Biomech 2022; 24:14-20. [PMID: 38314477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Performing effective actions requires the basketball player to balance factors such as motor variability, error minimalization and a complex sequence of coordination to determine the best action. PURPOSE The aim of the study was to differentiate the strength of the muscles of the index and middle fingers when performing a basketball shot. MATERIALS AND METHODS Study group consisted of 122 male college basketball league students. The study included psychophysiological tests to determine indices of individual and typological characterictics s of higher nervous activity, proprioceptive sensitivity tests of the fingers of the leading hand and field tests to assess participants' shooting skills. The touch-based finger pressure sensing system measured the different levels of pressure exerted by the participants' main index and middle finger during grasping. RESULTS For both the middle and index finger, the highest correlation with shot efficiency was found for a 120 g load g (p < 0.01 for 2PS; 2PS40 suc; FT; 3PSO and 3.5 mS). Furthermore, high reproducibility of proprioceptive sensitivity of the index and middle finger of the leading hand was found in basketball players. CONCLUSIONS The research indicates that it is possible to organize compensatory behavior between joints on the basis of proprioception, with the last compensatory movements of the kinematic chain being performed by the fingers of the hand. The demonstrated high proprioceptive sensitivity of the index and middle finger of the leading hand in basketball players at a weekly interval may indicate ability to maintain high repeatability of movements controlled by these fingers.
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Affiliation(s)
- Han Jiang
- Department of Sports Training, Wuhan Sports University, Wuhan, China
| | - Artur Kruszewski
- Department of Individual Sports, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | | | - Apostolos Theodorou
- National and Kapodistrian University of Athens, School of Physical Education and Sport Sciences, Athens, Greece
| | - Emmanouil Zacharakis
- National and Kapodistrian University of Athens, School of Physical Education and Sport Sciences, Athens, Greece
| | | | - Igor Konovalov
- Theory and Methodology of Volleyball and Basketball Institute of Sports, Volga State University of Physical Culture, Sports and Tourism, Kazan
| | - Marek Kruszewski
- Department of Individual Sports, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
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Han Jiang, Kruszewski A, Cherkashina E, Theodorou A, Zacharakis E, Cherkashin I, Konovalov I, Kruszewski M. Compensatory action of the index and middle finger in the kinematic chain of a basketball shot. Acta Bioeng Biomech 2022. [DOI: 10.37190/abb-02092-2022-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose
Performing effective actions requires the basketball player to balance factors such as motor variability, error minimalization and a complex sequence of coordination to determine the best action.
Aim of study. The aim of the study was to differentiate the strength of the muscles of the index and middle fingers when performing a basketball shot.
Methods
Material and method. Study group enrolled 122 male college basketball league students. The study included psychophysiological tests to determine indices of individual and typological characteristics of higher nervous activity, proprioceptive sensitivity tests of the fingers of the leading hand, and field tests to assess participants' shooting skills. The touch-based finger pressure sensing system measured the different levels of pressure exerted by the participants' main index and middle finger during grasping.
Results
For both the middle and index finger, the highest correlation with shot efficiency was found for a 120 g load g (p < 0,01 for 2PS; 2PS40 suc; FT; 3PSO and 3,5mS). Furthermore, high reproducibility of proprioceptive sensitivity of the index and middle finger of the leading hand was found in basketball players.
Conclusions
The research indicates that it is possible to organize compensatory behavior between joints on the basis of proprioception, with the last compensatory movements of the kinematic chain being performed by the fingers of the hand. The demonstrated high proprioceptive sensitivity of the index and middle finger of the leading hand in basketball players at a weekly interval may indicate ability to maintain high repeatability of movements controlled by these fingers.
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Rois S, Zacharakis E, Kounalakis S, Soultanakis HN. Thermoregulatory responses during prolonged swimming with a Wetsuit at 25 °C. INT J PERF ANAL SPOR 2021. [DOI: 10.1080/24748668.2021.1947018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Spyridon Rois
- Aquatics Division, School of Physical Education and Sports Science, Kapodistrian University of Athens, Dafni, Greece
| | - Emmanouil Zacharakis
- Athletic Division, School of Physical Education and Sports Science, Kapodistrian University of Athens, Dafni, Greece
| | - Stylianos Kounalakis
- Department of Physical and Cultural Education, Hellenic Army Academy, Vari, Attiki, Greece
| | - Helen N. Soultanakis
- Aquatics Division, School of Physical Education and Sports Science, Kapodistrian University of Athens, Dafni, Greece
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Kostopoulos N, Zacharakis E, Bolatoglou T, Kostopoulos P, Ktistakis I, Xirouchaki CE. Nutritional habits and knowledge in elite and professional basketball players. Gazz Med Ital - Arch Sci Med 2020. [DOI: 10.23736/s0393-3660.19.04068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tsalis K, Zacharakis E, Vasiliadis K, Kalfadis S, Vergos O, Christoforidis E, Betsis D. Bile Duct Injuries during Laparoscopic Cholecystectomy: Management and Outcome. Am Surg 2020. [DOI: 10.1177/000313480507101216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to analyze our experience with the management of bile duct injuries (BDIs) following laparoscopic cholecystectomy (LC). From 1996 to 2004, 21 patients with BDI after LC were treated in our department. The BDIs were graded according to the classification of Strasberg. Ten patients had minor BDI. Minor injuries were classified as A in six and D in four patients. In three patients, endoscopic retrograde cholangiopancreatography sphincterotomy and stent placement was adequate treatment. Six patients required laparotomy and bile duct ligation or suturing, and one patient underwent laparoscopy with additional ligation of a duct of Luschka. Eleven patients had major BDIs. These injuries were classified as E1 in two, E2 in three, E3 in four, and E4 in two patients. Among the patients with a major BDI, Roux- en-Y hepaticojejunostomy was performed. After a median follow-up of 69.45 months, no evidence of biliary disease has been detected among our patients. BDIs should be managed in a specialist unit where surgeons skilled to perform such repairs should undertake definitive treatment. Roux- en-Y hepaticojejunostomy is the procedure of choice in the management of major BDIs as it is accompanied by satisfactory results.
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Affiliation(s)
- Kostas Tsalis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Emmanouil Zacharakis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Konstantinos Vasiliadis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Stavros Kalfadis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Orestis Vergos
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Emmanouil Christoforidis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
| | - Dimitrios Betsis
- 4th Surgical Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Regional Hospital, Exohi, Thessaloniki, Greece
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Bundred JR, Kamarajah SK, Siaw‐Acheampong K, Nepogodiev D, Jefferies B, Singh P, Evans R, Griffiths EA, Alderson D, Gossage J, McKay S, Mohamed I, van Hillegersberg R, Vohra R, Wanigsooriya K, Whitehouse T, Bagajevas A, Bekele A, Blanco‐Colino R, Da Roit A, El Kafsi‐Mawley J, Gjata A, Gockel I, Castro RG, Harustiak T, Hsu P, Isik A, Kechagias A, Kennedy A, Kidane B, Mahendran HA, Mejia L, Moreno JI, Negoi I, Santiago AJ, Sayyed R, Schneider P, Soares AS, Sousa M, Takeda FR, Vanstraten S, Wallner B, Wijnhoven B, Achiam M, Agustin T, Akbar A, Al‐Bahrani A, Al‐Khyatt W, Albertsmeier M, Alghunaim E, Alkhaffaf B, Allum W, Am F, Andreollo N, Arndt A, Babor R, Barbosa J, Bardini R, Beardsmore D, Beban G, Bernardes A, Berrisford R, Bianchi A, Bjelovic M, Boddy A, Bolca C, Bonavina L, Bryce G, Byrom R, Casaca R, Chan D, Charalabopoulos A, Cheong E, Ciotola F, Colak E, Collins C, Constantinoiu S, Costa R, Dahlke M, Darling G, Dawas K, de Manzoni G, Denewer A, Devadas M, Dexter S, Dikinis S, Dimitrios T, Dolan J, Duong C, Egberts J, Elgharably Y, Elhadi M, Elmahi S, Farias FA, Fekaj E, Fernández J, Forshaw M, Freire J, French D, Gacevski G, Gaedcke J, Gananadha S, Gijon MM, Gokhale J, Gordon A, Grimminger P, Guevara R, Guner A, Gutknecht S, Mahmoodzadeh H, Halldestam I, Hedberg J, Heisterkamp J, Higgs S, Hii M, Hindmarsh A, Hoppner J, Isaza A, Izbicki J, Jacobs R, Jain P, Johansson J, Johnston B, Kafsi J, Kassa S, Kelty C, Khan I, Khoo D, Khyatt S, Kjaer D, Korkolis D, Kreuser N, Larsen M, Lau P, Leite J, Lewis W, Liakakos T, Loureiro C, Mahendran A, Maynard N, Mcgregor R, Mcnally S, Medina‐Franco H, Meguid R, Melhado R, Mercer S, Migliore M, Mingol F, Mogoanta S, Mohri Y, Mönig S, Moreno J, Motas N, Murphy T, Naqi S, Ni R, Niazi S, Oglesby S, Okonta K, Ortiz SR, Pal K, Palazzo F, Pascher A, Pascual M, Pata G, Pera M, Puig S, Ramirez J, Raptis D, Räsänen J, Reim D, Reynolds J, Robb W, Robertson K, Rosero G, Rosman C, Rossaak J, Saarnio J, Santiago A, Schiesser M, Scurtu R, Sekhniaidze D, Sevinç B, Skipworth R, So J, Trugeda MS, Syed A, Takahashi AML, Takeda F, Talbot M, Tareen M, Terashima M, Testini M, Tewari N, Tez M, Thomas M, Tirnaksiz M, Tonini V, Tu C, Turner P, Underwood T, Uzair A, Vallve‐Bernal M, Valmasoni M, Vicente C, Videira JF, Viswanath YKS, Weindelmayer J, White R, Wigle D, Wilkerson P, Wills V, Zacharakis E, Zuluaga M. International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA). World J Surg 2019; 43:2874-2884. [PMID: 31332491 DOI: 10.1007/s00268-019-05080-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy. METHOD The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit. RESULTS Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001). CONCLUSIONS This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.
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Garas G, Markar SR, Malietzis G, Ashrafian H, Hanna GB, Zacharakis E, Jiao LR, Argiris A, Darzi A, Athanasiou T. Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer. Ann Surg Oncol 2017; 25:221-230. [PMID: 29110271 PMCID: PMC5740197 DOI: 10.1245/s10434-017-6210-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) inform clinical practice and have provided the evidence base for introducing minimally invasive surgery (MIS) in surgical oncology. Crossover (unplanned intraoperative conversion of MIS to open surgery) may affect clinical outcomes and the effect size generated from RCTs with homogenization of randomized groups. OBJECTIVES Our aims were to identify modifiable factors associated with crossover and assess the impact of crossover on clinical endpoints. METHODS A systematic review was performed to identify all RCTs comparing MIS with open surgery for gastrointestinal cancer (1990-2017). Meta-regression analysis was performed to analyze factors associated with crossover and the influence of crossover on endpoints, including 30-day mortality, anastomotic leak rate, and early complications. RESULTS Forty RCTs were included, reporting on 11,625 patients from 320 centers. Crossover was shown to affect one in eight patients (mean 12.6%, range 0-45%) and increased with American Society of Anesthesiologists score (β = + 0.895; p = 0.050). Pretrial surgeon volume (β = - 2.344; p = 0.037), composite RCT quality score (β = - 7.594; p = 0.014), and site of tumor (β = - 12.031; p = 0.021, favoring lower over upper gastrointestinal tumors) showed an inverse relationship with crossover. Importantly, multivariate weighted linear regression revealed a statistically significant positive correlation between crossover and 30-day mortality (β = + 0.125; p = 0.033), anastomotic leak rate (β = + 0.550; p = 0.004), and early complications (β = + 1.255; p = 0.001), based on intention-to-treat analysis. CONCLUSIONS Crossover in trials was associated with an increase in 30-day mortality, anastomotic leak rate, and early complications within the MIS group based on intention-to-treat analysis, although our analysis did not assess causation. Credentialing surgeons by procedural volume and excluding high comorbidity patients from initial trials are important in minimizing crossover and optimizing RCT validity.
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Affiliation(s)
- George Garas
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK. .,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK.
| | - Sheraz R Markar
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - George Malietzis
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Hutan Ashrafian
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - George B Hanna
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Emmanouil Zacharakis
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Long R Jiao
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ara Darzi
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK
| | - Thanos Athanasiou
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK.,Health Technology Assessment Committee, National Institute of Health and Care Excellence, London, UK
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15
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De Luca F, Raheem A, Zacharakis E, Shabbir M, Spilotros M, Holden F, Akers C, Garaffa G, Christopher N, Ralph D. HP-05-002 Functional outcomes following penile fracture repair: a tertiary referral centre experience. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Garas G, Poulasouchidou M, Dimoulas A, Hytiroglou P, Kita M, Zacharakis E. Radiological considerations and surgical planning in the treatment of giant parathyroid adenomas. Ann R Coll Surg Engl 2015; 97:e64-6. [PMID: 26263956 DOI: 10.1308/003588415x14181254789682] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Giant parathyroid adenomas constitute a rare clinical entity, particularly in the developed world. We report the case of a 53-year-old woman where the initial ultrasonography significantly underestimated the size of the lesion. The subsequent size and weight of the adenoma (7 cm diameter, 27 g) combined with the severity of the hypercalcaemia raised the suspicion for the presence of a parathyroid carcinoma. This was later disproven by the surgical and histological findings. Giant parathyroid adenomas are encountered infrequently among patients with primary hyperparathyroidism, and appear to have distinct clinical and biochemical features related to specific genomic alterations. Cross-sectional imaging is mandated in the investigation of parathyroid adenomas presenting with severe hypercalcaemia as ultrasonography alone can underestimate their size and extent. This is important since it can impact on preoperative preparation and planning as well as the consent process as a thoracic approach may prove necessary for certain cases.
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Affiliation(s)
- G Garas
- St. Mary's Hospital, Imperial College London , UK
| | | | - A Dimoulas
- St Luke's Hospital, Thessaloniki , Greece
| | | | - M Kita
- Hippokration Hospital, Thessaloniki , Greece
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Brousil P, Shabbir M, Zacharakis E, Sahai A. PDE-5 Inhibitors for BPH-Associated LUTS. Curr Drug Targets 2015; 16:1180-6. [DOI: 10.2174/138945011611151013164756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 02/22/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022]
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18
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Markar SR, Wiggins T, Antonowicz S, Zacharakis E, Hanna GB. Minimally invasive esophagectomy: Lateral decubitus vs. prone positioning; systematic review and pooled analysis. Surg Oncol 2015; 24:212-9. [PMID: 26096374 DOI: 10.1016/j.suronc.2015.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/08/2015] [Accepted: 06/07/2015] [Indexed: 12/12/2022]
Abstract
The uptake of minimally invasive esophagectomy (MIE) has increased vastly over the last decade, with proven short-term benefits over an open approach. The aim of this pooled analysis was to compare clinical outcomes of Minimally Invasive Esophagectomy (MIE) performed in the prone and lateral decubitus positions. A systematic literature search (2000-2015) was undertaken for publications that compared patients who underwent MIE in the lateral decubitus (LD) or prone (PR) positions. Weighted mean difference (WMD) was calculated for the effect size of LD positioning on continuous variables and Pooled odds ratios (POR) for discrete variables. Ten relevant publications comprising 723 patients who underwent minimally invasive esophagectomy were included; 387 in the LD group and 336 in the PR group. There was no significant difference between the groups in terms of in-hospital mortality, total morbidity, anastomotic leak, chylothorax, laryngeal nerve palsy, average operative time, and length hospital stay. LD MIE was associated with a non-significant increase in pulmonary complications (POR = 1.65; 95% C.I. 0.93 to 2.92; P = 0.09), and significant increases in estimated blood loss (WMD = 36.03; 95% 14.37 to 57.69; P = 0.001) and a reduced average mediastinal lymph node harvest (WMD = -2.17; 95% C.I. -3.82 to -0.52; P = 0.01) when compared to prone MIE. Pooled analysis suggests that prone MIE is superior to lateral decubitus MIE with reduced pulmonary complications, estimated blood loss and increased mediastinal lymph node harvest. Further studies are needed to explain performance-shaping factors and their influence on oncological clearance and short-term outcomes.
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Affiliation(s)
- Sheraz R Markar
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Tom Wiggins
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Stefan Antonowicz
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Emmanouil Zacharakis
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - George B Hanna
- Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
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Garas G, Zarogoulidis P, Efthymiou A, Athanasiou T, Tsakiridis K, Mpaka S, Zacharakis E. Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial. J Thorac Dis 2015; 6:1655-8. [PMID: 25589955 DOI: 10.3978/j.issn.2072-1439.2014.12.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 11/14/2022]
Abstract
Boerhaave's syndrome (BS), also known as "spontaneous rupture of the esophagus", constitutes an emergency that requires early diagnosis if death or serious morbidity are to be prevented. First described in 1724, BS is thought to be more common than once thought. Its true incidence remains unknown. Mortality ranges between 20-40% with timely treatment but this rises to virtually 100% if treatment is delayed by more than 48 hours. This is unfortunately a common occurrence due to delayed diagnosis. The commonest precipitating factor is vomiting but BS can be truly "spontaneous". The classical clinical presentation described consists of vomiting, chest pain, and subcutaneous emphysema. However, and contrary to popular belief, this triad is actually uncommon accounting for the frequently delayed diagnosis. A less recognised presenting feature of BS is with pneumothorax due to associated rupture of the parietal pleura. Pneumothorax has been shown to be present in more than 20% of cases of BS-sometimes with a coexistent pleural effusion (hydropneumothorax). This article aims to raise awareness about pneumothorax as the sole initial presenting feature of BS and alert clinicians to consider BS in the differential diagnosis of any patient with respiratory symptoms and a recent history of vomiting.
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Affiliation(s)
- George Garas
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Alkiviadis Efthymiou
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Thanos Athanasiou
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Sofia Mpaka
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Emmanouil Zacharakis
- 1 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Gastroenterology, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Department of Cardiothoracic Surgery, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece
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20
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Efthymiou A, Podas T, Zacharakis E. Endoscopic ultrasound in the diagnosis of pancreatic intraductal papillary mucinous neoplasms. World J Gastroenterol 2014; 20:7785-7793. [PMID: 24976716 PMCID: PMC4069307 DOI: 10.3748/wjg.v20.i24.7785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/29/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cystic lesions are increasingly recognised due to the widespread use of different imaging modalities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a common, but also heterogeneous group of cystic tumors with a significant malignant potential. These neoplasms must be differentiated from other cystic tumors and properly classified into their different types, main-duct IPMNs vs branch-duct IPMNs. These types have a different malignant potential and therefore, different treatment strategies need to be implemented. Endoscopic ultrasound (EUS) offers the highest resolution of the pancreas and can aid in the differential diagnosis, classification and differentiation between benign and malignant tumors. The addition of EUS fine-needle aspiration can supply further information by obtaining fluid for cytology, measurement of tumor markers and perhaps DNA analysis. Novel techniques, such as the use of contrast and sophisticated equipment, like intraductal probes can provide information regarding malignant features and extent of these neoplasms. Thus, EUS is a valuable tool in the diagnosis and appropriate management of these tumors.
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MESH Headings
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/diagnostic imaging
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Endoscopic Ultrasound-Guided Fine Needle Aspiration
- Endosonography
- Humans
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/epidemiology
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Predictive Value of Tests
- Prognosis
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21
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Sridhar AN, Zacharakis E, Dudderidge T, Kelly JD, Nathan S. Robot-assisted management of Zinner's syndrome: report of seminal vesicle sparing technique and review of literature. J Robot Surg 2014; 8:185-7. [PMID: 27637531 DOI: 10.1007/s11701-013-0430-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
Abstract
The range of urological procedures performed with robotic assistance has widened with increasing experience with the da Vinci robotic system. We describe the use of the da Vinci SI Surgical System for excision of a seminal vesicle cyst in a patient who had associated ipsilateral renal agenesis (Zinner's syndrome). The robotic platform afforded a minimally invasive procedure with precise dissection and no collateral damage to neighbouring vital anatomy.
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Affiliation(s)
- A N Sridhar
- Institute of Urology, University College London Hospital NHS Trust, London, UK.
| | - E Zacharakis
- Institute of Urology, University College London Hospital NHS Trust, London, UK
| | - T Dudderidge
- Institute of Urology, University College London Hospital NHS Trust, London, UK
| | - J D Kelly
- Institute of Urology, University College London Hospital NHS Trust, London, UK
| | - S Nathan
- Institute of Urology, University College London Hospital NHS Trust, London, UK
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22
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Aziz O, Ashrafian H, Jones C, Harling L, Kumar S, Garas G, Holme T, Darzi A, Zacharakis E, Athanasiou T. Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: a meta-analysis of diagnostic accuracy. Int J Surg 2014; 12:712-9. [PMID: 24861544 DOI: 10.1016/j.ijsu.2014.05.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/13/2014] [Accepted: 05/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Routine intra-operative cholangiography (IOC) during laparoscopic cholecystectomy is often not performed because of increased operative time, radiation, and failure rate. Laparoscopic ultrasound (LUS) is a less invasive alternative but studies comparing it to IOC have been of small sample size. This study aims to assess the diagnostic accuracy of LUS in detecting common bile duct (CBD) stones compared to IOC. METHODS This meta-analysis was executed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. 11 comparative studies (1994-2013) reporting on 12 patient groups were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity for IOC and LUS, and their relationship assessed using a hierarchical summary receiver operating characteristic model with meta-regression. RESULTS IOC had a pooled sensitivity of 0.87 (95% CI 0.77-0.93) and a pooled specificity of 0.99 (95% CI 0.98-0.99) with no significant heterogeneity. The diagnostic Odds Ratio (OR) was 442 (95% CI 196-997) and pooled weighted Area Under the Curve (AUC) was 0.99 (95% CI: 0.98-1.0). LUS had a pooled sensitivity of 0.87 (95% CI 0.80-0.92) and a specificity of 1.00 (95% CI 0.99-1.00). Heterogeneity was significant for specificity results. The diagnostic Odds Ratio (OR) was 1171 (95% CI 372-3689) and the pooled, weighted AUC was 1 (95% CI: 0.99-1). Meta-regression did not identify factors that significantly predict diagnostic accuracy. CONCLUSIONS LUS is a potentially useful imaging modality to confirm the absence of CBD stones without needing to cannulate the biliary system.
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Affiliation(s)
- Omer Aziz
- Minimal Access Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - Catherine Jones
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - Sacheen Kumar
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - George Garas
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - Thomas Holme
- Department of General Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
| | - Emmanouil Zacharakis
- Department of Hepatobiliary Surgery, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK
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Kayani B, Garas G, Arshad M, Athanasiou T, Darzi A, Zacharakis E. Is hand-sewn anastomosis superior to stapled anastomosis following oesophagectomy? Int J Surg 2013; 12:7-15. [PMID: 24239928 DOI: 10.1016/j.ijsu.2013.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 10/17/2013] [Accepted: 11/02/2013] [Indexed: 12/19/2022]
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was: In patients undergoing oesophagectomy is stapled anastomosis (STA) superior to hand-sewn anastomosis (HSA) with respect to post-operative outcomes. In total, 82 papers were found suitable using the reported search and 14 of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing evidence shows that STA is associated with reduced time to anastomotic construction and decreased intra-operative blood loss but increased risk of benign stricture formation compared to HSA. There is no difference between HSA and STA with respect to cardiac or respiratory complications, anastomotic leakage, duration of hospital admission or 30-day mortality. In HSA, increasing surgical experience and intra-operative air leakage testing after anastomotic creation are associated with reduced risk of anastomotic leakage. Further adequately powered studies will enable identification of other local and systemic factors influencing anastomotic healing, which will lead to improved patient and anastomotic technique selection for optimal surgical outcomes.
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Affiliation(s)
- Babar Kayani
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
| | - George Garas
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK
| | - Mubarik Arshad
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK
| | - Emmanouil Zacharakis
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
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Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, Darzi A, Athanasiou T, Zacharakis E. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid 2013; 23:1138-50. [PMID: 23470035 DOI: 10.1089/thy.2012.0588] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. METHODS Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the "clamp-and-tie" technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds ratios were calculated by a Bayesian network meta-analysis, and metaregression was used for pair-wise comparisons. Indirect and direct comparisons were performed and inconsistency was assessed. RESULTS Thirty-five randomized controlled trials with 2856 patients were included. Ultrasonic coagulation ranked first (followed by Ligasure and then clamp-and-tie) with the lowest risk of postoperative hypoparathyroidism (odds ratio 1.43 [95% confidence interval (CI) 0.77-2.67] and 0.70 [CI 0.43-1.13], ultrasonic coagulation vs. Ligasure and ultrasonic coagulation vs. clamp-and-tie, respectively), least blood loss (-0.25 [CI -0.84 to -0.35] and -1.22 [CI -1.85 to -0.59]), and drain output (0.28 [CI -0.35 to -0.91] and -0.36 [CI -0.70 to -0.03]). From a health technology viewpoint, ultrasonic coagulation was associated with the shortest operative time (-0.66 [CI -1.17 to -0.14] and -1.29 [CI -1.59 to -1.00]) and hospital stay (-0.28 [CI -0.78 to 0.22] and -0.56 [CI -1.28 to 0.15]). The only exception occurs with the clinically important complication of recurrent laryngeal nerve paralysis, where the reverse trend applies (1.36 [CI 0.25-7.46] and 1.74 [CI 0.94-3.26]). CONCLUSIONS The comparative effectiveness of ultrasonic coagulation in thyroid surgery outcomes seems superior to other techniques with the exception of recurrent laryngeal nerve injury. This network meta-analysis, one of a handful in a surgical field, offers preliminary and robust evidence to guide clinical decisions and policy makers to adopt safer thyroid operations.
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Affiliation(s)
- George Garas
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College London , London, United Kingdom
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25
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Deeba S, Purkayastha S, Darzi A, Zacharakis E. Obturator hernias: A review of the laparoscopic approach. J Minim Access Surg 2013; 7:201-4. [PMID: 22022108 PMCID: PMC3193689 DOI: 10.4103/0972-9941.85642] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/05/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND: Obturator hernias (OH) account for a rare presentation to the surgical unit usually associated with bowel obstruction and strangulation. The treatment of this condition is classical laparotomy with repair of the hernia and bowel resection, if deemed necessary; recently, the laparoscopic approach has been reported in literature. This review examines the existing evidence of the safety and effectiveness of the laparoscopic approach for the management of OH. MATERIALS AND METHODS: We have conducted a systematic review of the cases reported in the literature between 1991 and 2009, using Medline with PubMed as the search engine, as well as Ovid, Embase, Cochrane Collaboration and Google Scholar databases to identify articles in English language reporting on laparoscopic management for the treatment of this condition. RESULTS: A total of 17 articles reporting on 28 cases were found. We describe the pooled data for demographics, operative time, hospital stay, morbidities and method of repair. We also compare to the results of the laparoscopic repair of other types of hernias in the literature. CONCLUSION: This approach was found to be a safe and effective approach for the repair of OH as compared to the classical open approach; however, its adoption as the gold standard needs further multicenter trials.
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Affiliation(s)
- Samer Deeba
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Praed Street, W2 1NY, UK
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26
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Abbassi-Ghadi N, Kumar S, Cheung B, McDermott A, Knaggs A, Zacharakis E, Moorthy K, Carby M, Hanna GB. Anti-reflux surgery for lung transplant recipients in the presence of impedance-detected duodenogastroesophageal reflux and bronchiolitis obliterans syndrome: A study of efficacy and safety. J Heart Lung Transplant 2013; 32:588-95. [DOI: 10.1016/j.healun.2013.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/08/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022] Open
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Howell AM, Jarral OA, Faiz O, Ziprin P, Darzi A, Zacharakis E. How should perineal wounds be closed following abdominoperineal resection in patients post radiotherapy--primary closure or flap repair? Best evidence topic (BET). Int J Surg 2013; 11:514-7. [PMID: 23707627 DOI: 10.1016/j.ijsu.2013.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/03/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022]
Abstract
This best evidence topic was investigated according to a described protocol. The question posed was: should the irradiated perineal wound following abdominoperineal resection (APR) be closed with primary repair or a myocutaneous flap. Using the reported search 364 papers were found of which eight represented the best evidence to answer the clinical question. The conclusion drawn is that there is some limited evidence for recommending flap closure in abdominoperineal resection post radiotherapy. The best evidence available was from a systematic review of cohort studies and case series. Although no meta-analysis was performed, overall wound healing was improved using flap closure with a low frequency of flap necrosis. Other studies providing evidence were case-control series or cohort studies. Three papers prospectively compared vertical rectus abdominus muscle (VRAM) flap with primary closure; two of which demonstrated statistically significant improvement in complication rates with flap closure. Two retrospective case control series showed significant improvement in major wound complication rates in the flap group. Two studies retrospectively compared gracilis flap repair with primary closure and showed significantly lower incidence of major perineal complications. Most studies suffered from significant limitations, small sample sizes and no direct comparisons between matched groups with respect to type of anatomic flap, wound size, tumour recurrence or radiation dose. Whilst there is evidence that myocutaneous flap closure following APR in radiotherapy patients can reduce wound related complications, prospective randomized controlled trials are warranted.
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Affiliation(s)
- A M Howell
- Department of Surgery and Cancer, Imperial College London, United Kingdom
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Kolinioti A, Kayani B, Skouras C, Fovos A, Aziz O, Zacharakis E. Does laparoscopic Heller’s myotomy provide superior results compared to endoscopic dilatation for oesophageal achalasia? Int J Surg 2013; 11:238-43. [PMID: 23416536 DOI: 10.1016/j.ijsu.2012.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 01/26/2023]
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Elliott JA, Patel VM, Kirresh A, Ashrafian H, Le Roux CW, Olbers T, Athanasiou T, Zacharakis E. Fast-track laparoscopic bariatric surgery: a systematic review. Updates Surg 2013; 65:85-94. [PMID: 23371325 DOI: 10.1007/s13304-012-0195-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023]
Abstract
This study aimed to systematically evaluate the evidence-based literature on fast-track laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to determine the feasibility and safety of fast-track laparoscopic bariatric surgery. A literature search of PubMed, EMBASE and Cochrane Library using the MeSH terms "bariatric surgery", "ambulatory surgical procedures" and related terms as keywords was performed. The study included articles that reported on intended next-day discharge for LRYGB and same-day discharge for LAGB. Data were extracted on study design and size, patient demographics, patient-selection criteria, patient preparation, perioperative management, operative details, clinical outcomes, and follow-up. The review included 13 studies classified as level 3b or 4 evidence. There were seven studies that investigated LAGB, five studies investigated LRYGB and one study detailed outcomes from both LRYGB and LAGB. Next-day discharge rate ranged from 81 to 100 % for LRYGB. Same-day discharge rate ranged from 76 to 98 % for LAGB. In LRYGB and LAGB complication, re-admission and mortality rates (≤10.5, ≤7.5, ≤0.1 %, respectively) were comparable with the conventional perioperative care. From our results, the fast-track management of patients undergoing LRYGB and LAGB is feasible. With careful patient selection and preparation within high-volume centres, and application of care pathways including close outpatient follow-up, outcomes for fast-track bariatric procedures can compare favourably with those reported in the literature for standard management, but with decreased cost. However, further studies from independent researchers are required to determine the safety of a generalised adoption of this approach outside of dedicated bariatric units, and to formally demonstrate the cost-benefit of fast-track bariatric surgery.
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Qureishi A, Garas G, Tolley N, Palazzo F, Athanasiou T, Zacharakis E. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg 2013; 11:203-8. [PMID: 23352847 DOI: 10.1016/j.ijsu.2013.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/01/2013] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether in patients with retrosternal goitre the need for a thoracic approach can be predicted using pre-operative CT. A total of 381 papers were identified using the reported search protocol of which 7 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results are tabulated. The evidence on this subject is poor, none of the studies were randomised, only one used controls (historical) and all studies were retrospective. Despite these limitations, CT represents the gold-standard imaging modality in the pre-operative evaluation of patients with retrosternal goitre. CT is essential to define the extent and position of a retrosternal goitre. The literature suggests that CT is the single most valuable pre-operative investigation predicting whether a sternotomy or lateral thoracotomy will be necessary for removal of the retrosternal goitre. Although pre-operative CT does not have the precision to predict whether a thoracic approach is required in all cases, the presence of certain radiological features such as extension of the goitre below the aortic arch or into the posterior mediastinum, a dumbbell shape and a thoracic component that is wider than the thoracic inlet are all associated with the need for a thoracic approach. In some cases a pre-operative CT will not only determine that a thoracic approach is mandatory but it will also guide the surgeon upon the type of thoracic approach.
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Affiliation(s)
- Ali Qureishi
- Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, United Kingdom
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31
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Garas G, Jarral O, Tolley N, Palazzo F, Athanasiou T, Zacharakis E. Is there survival benefit from life-long follow-up after treatment for differentiated thyroid cancer? Int J Surg 2012; 11:116-21. [PMID: 23253637 DOI: 10.1016/j.ijsu.2012.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/27/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether there is a survival benefit from life-long follow-up after treatment for thyroid cancer. A total of 137 papers were identified using the reported searches of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The existing guidelines for follow-up in thyroid cancer recommend life-long follow-up as recurrence may present after 5 years. However, the strategy of life-long follow-up for everyone (as advised by the British, European and American Thyroid Association guidelines) is not evidence-based. The issue is that some of the recurrences may present after 5 years and low volume recurrence may be more effectively treated. However, as in many other malignancies, there is no study that reliably shows a survival benefit conferred from life-long follow-up, especially in stage 1 disease. Moreover, the risk of recurrence only parallels the risk of disease-specific mortality in the older thyroid cancer patient group (>45 years at diagnosis). The evidence from the present review supports a risk stratified approach to follow-up for thyroid cancer since low-risk thyroid cancer is associated with low recurrence rates and mortality compared to the other groups. For young patients (<45 years at diagnosis) with stage 1 disease, there is no proven survival benefit from life-long follow-up following primary treatment. These patients could be safely discharged to primary care after 5 years for follow-up with yearly thyroglobulin measurements.
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Affiliation(s)
- George Garas
- Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, United Kingdom
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Zacharakis E, Kayani B, Athanasiou T, Ashrafian H. Context is paramount in the assessment of meta-analytical evidence: reply. World J Surg 2012. [PMID: 23203773 DOI: 10.1007/s00268-012-1841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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James DRC, Purkayastha S, Aziz O, Amygdalos I, Darzi AW, Hanna GB, Zacharakis E. The feasibility, safety and outcomes of laparoscopic re-operation for achalasia. MINIM INVASIV THER 2012; 21:161-7. [PMID: 22621381 DOI: 10.3109/13645706.2011.588798] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for achalasia in order to assess its feasibility and effectiveness. MATERIAL & METHODS A Medline, Embase, Ovid, Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic", "redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient demographics and details of primary procedure, operative details, intra- and post operative complications and symptom scores. RESULTS Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported. Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure. DISCUSSION This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric surgery and adequate experience in laparoscopic surgery for achalasia.
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Affiliation(s)
- David R C James
- Department of Surgery and Cancer, St. Mary's Hospital, London, UK
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Kayani B, Spalding DR, Jiao LR, Habib NA, Zacharakis E. Does neostigmine improve time to resolution of symptoms in acute colonic pseudo-obstruction? Int J Surg 2012; 10:453-7. [PMID: 22985773 DOI: 10.1016/j.ijsu.2012.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 08/16/2012] [Accepted: 08/19/2012] [Indexed: 12/13/2022]
Abstract
A best evidence topic was written according to a structured protocol. In [patients with acute colonic pseudo-obstruction] is [neostigmine] superior to [conservative treatment] with respect to [duration of symptoms and complications]. In total 51 papers were found using the reported search, and ten of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that intravenous neostigmine is associated with significantly reduced duration of acute colonic pseudo-obstruction (ACPO) compared to conservative treatment alone. Neostigmine infusion should be administered with continuous cardiac monitoring for possible bradycardia, which may require treatment with atropine. Seven prospective analyses and one retrospective study showed that intravenous neostigmine reduces time to resolution of clinical and radiological features of ACPO. One prospective study showed that neostigmine is only effective in improving duration of ACPO when it is combined with proponalol. One prospective study showed no difference in time to resolution of ACPO between neostigmine and conservative treatment but this study was limited by small sample size, lack of radiological examinations and poor reporting of adverse effects. In four separate studies patients experienced bradycardia with intravenous neostigmine and this required treatment with atropine. No other significant adverse effects were reported. Overall, intravenous neostigmine is associated with a significant reduction in duration of ACPO. In addition to regularly reviewing patients for antic-cholinergic side effects, patients should undergo continuous cardiac monitoring for bradycardia. The wide variety in methodology and measurement of outcomes reinforce the need for higher power studies to improve patient selection and monitoring of outcomes.
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Affiliation(s)
- Babar Kayani
- Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
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Fovos A, Jarral O, Panagiotopoulos N, Podas T, Mikhail S, Zacharakis E. Does endoscopic treatment for early oesophageal cancers give equivalent oncological outcomes as compared with oesophagectomy? Best evidence topic (BET). Int J Surg 2012; 10:415-20. [PMID: 22771501 DOI: 10.1016/j.ijsu.2012.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/27/2012] [Accepted: 06/21/2012] [Indexed: 11/16/2022]
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether endoscopic mucosal resection (EMR) for early oesophageal cancer gives equivalent oncological outcomes as compared to oesophagectomy. A total of 340 papers were found using the reported searches of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Oesophagectomy with lymph node dissection for early oesophageal cancer is the standard to which every other treatment modality is compared to. However, the associated mortality and morbidity rates highlight the need for the development of effective, less invasive procedures. The evidence from the present review supports the use of EMR in this context as a first line treatment in T1a (mucosal) oesophageal cancer. The trade-off is a higher recurrence rate which can be dealt with successfully using a tight follow-up schedule and retreatment. The higher rates of lymph node involvement in T1b (submucosal) cancers preclude the use of endoscopic treatment in this setting except for patients unfit for surgery.
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Affiliation(s)
- Athanasios Fovos
- Department of Gastroenterology, Hammersmith Hospital, Imperial College London, United Kingdom
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Kanellos D, Pramateftakis MG, Mantzoros I, Zacharakis E, Raptis D, Despoudi K, Zaraboukas T, Koliakos G, Lazaridis H. The effects of the intraperitoneal administration of oxaliplatin and 5-FU on the healing of colonic anastomoses: an experimental study. Tech Coloproctol 2012; 15 Suppl 1:S111-5. [PMID: 21953242 DOI: 10.1007/s10151-011-0754-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The purpose of this experimental study was to assess the effects of the immediate postoperative intraperitoneal administration of oxaliplatin and 5-FU on the healing of colonic anastomoses in rats. METHODS Sixty rats were randomized into 4 groups of 15 rats each and were subjected to colonic anastomoses. To the 1st group, saline solution was administered immediately postoperatively, intraperitoneally. To the 2nd group, 5-FU was administered, to the 3rd group oxaliplatin and to the 4th group 5-FU and oxaliplatin were administered immediately postoperatively, intraperitoneally. After killing the rats on the 8th postoperative day, the anastomoses were examined macroscopically and the anastomotic bursting pressures were measured. The anastomoses were also examined histologically and the hydroxyproline contents were determined. RESULTS Rupture of the anastomosis was observed in no rats of the 1st group, in 3 rats of the 2nd group, in 4 rats of the 3rd group and in 7 rats of the 4th group (P = 0.016). The bursting pressure (P < 0.001), the hydroxyproline content (P < 0.001) and the concentration of collagen (P < 0.001) and fibroblasts (P < 0.001) were significantly lower in the 2nd, 3rd and 4th group in comparison with the 1st group. The formation of adhesions and the leukocytosis on the anastomoses were significantly higher in the 2nd, 3rd and 4th group than in the 1st group (P < 0.001). CONCLUSIONS The immediate postoperative, intraperitoneal administration of oxaliplatin, 5-FU or the combination of 5-FU and oxaliplatin impairs the healing of colonic anastomoses in rats.
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Affiliation(s)
- D Kanellos
- Fourth Surgical Department, Aristotle University of Thessaloniki, 1 Antheon str, Panorama, 55236 Thessaloniki, Greece
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Verma AR, Patel VM, Mikhail S, Zacharakis E. An unusual presentation of late oesophagojejunal anastomotic leak after total D2 gastrectomy. Ann R Coll Surg Engl 2012; 94:e106-8. [PMID: 22391379 DOI: 10.1308/003588412x13171221589450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oesophagojejunal anastomotic leak usually presents in the early post-operative period with abdominal pain and sepsis. We report a case of late anastomotic leak presenting as epigastric pain with hyperamylasaemia and discuss the differential diagnosis.
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Affiliation(s)
- A R Verma
- Imperial College Healthcare NHS Trust, UK
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Jarral OA, Purkayastha S, Athanasiou T, Darzi A, Hanna GB, Zacharakis E. Thoracoscopic esophagectomy in the prone position. Surg Endosc 2012; 26:2095-103. [PMID: 22395952 DOI: 10.1007/s00464-012-2172-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 01/13/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy. METHODS A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone," "thoracoscopic," and "esophagectomy" to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position. RESULTS Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits. CONCLUSION The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.
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Affiliation(s)
- Omar A Jarral
- Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
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Skouras C, Skouras T, Pai M, Zacharakis E, Spalding D. Inguinoscrotal extension of a pancreatic collection: a rare complication of pancreatitis-case report and review of the literature. Updates Surg 2012; 65:153-9. [PMID: 22392574 DOI: 10.1007/s13304-012-0138-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 02/21/2012] [Indexed: 02/05/2023]
Abstract
Pancreatitis associated with the extension of a pancreatic collection, pseudocyst or abscess into the groin is a rare phenomenon with few reports in the English literature. Nevertheless, it remains a clinically important differential diagnosis as it may be mistaken for more common pathologies in the groin and with a subsequent unnecessary surgical intervention. A case of this rare complication of pancreatitis is reported, together with a review of the literature.
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Affiliation(s)
- Christos Skouras
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Jarral OA, Athanasiou T, Hanna GB, Zacharakis E. Is an intra-oesophageal bougie of use during Nissen fundoplication? Interact Cardiovasc Thorac Surg 2012; 14:828-33. [PMID: 22392936 DOI: 10.1093/icvts/ivr140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best-evidence topic was written according to a structured protocol. The question addressed was whether the use of an intra-oesophageal bougie during Nissen fundoplication reduces post-operative dysphagia. A total of 34 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The popularity of bougie placement is likely to have been encouraged by an early study reported in this article in 1986 associating the use of a larger bougie with reduction of postoperative dysphagia. A more recent randomized study in 2000 also associated the use of bougie with significantly less long-term and severe dysphagia. Four retrospective studies showed no advantage from the use of a bougie, and the potential benefit are countered by the largest published series in the literature reporting the incidence of oesophageal perforation owing to bougie placement at 0.8%. Despite this risk, a survey of 393 German surgeons in 2005 revealed that 46% use a bougie. In summary, we conclude that there is some evidence to suggest that both the presence and size of bougie may have an impact on dysphagia. The evidence is not substantial enough to recommend change in clinical practice and its use must be weighed against the risk of oesophageal injury which patients should be consented for. These conclusions are in accordance with the 2010 Guidelines for Surgical Treatment of Gastroesophageal Reflux disease by the Society of American Gastrointestinal and Endoscopic Surgeons who give a Grade B recommendation for the placement of an oesophageal dilator. It is important that future studies are adequately powered and designed to measure longitudinal outcomes such as dysphagia severity with validated assessment tools at appropriate follow-up points. The measurement and usefulness of health-related quality of life needs to be investigated further in this patient population.
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Affiliation(s)
- Omar A Jarral
- Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK
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Kayani B, Jarral OA, Athanasiou T, Zacharakis E. Should oesophagectomy be performed with cervical or intrathoracic anastomosis? Interact Cardiovasc Thorac Surg 2012; 14:821-6. [PMID: 22368108 DOI: 10.1093/icvts/ivs036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was: In [patients undergoing oesophagectomy for oesophageal cancer] is a [cervical anastomosis or intrathoracic anastomosis] superior in terms of [post-operative outcomes]. In total, 47 papers were found suitable using the reported search, and nine of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that there is no convincing evidence that cervical anastomosis is superior to intrathoracic anastomosis with respect to post-operative outcomes. Only one prospective study showed significantly increased risk of anastomotic leak with cervical anastomosis, but this study was significantly limited due to patient selection and variations in surgical approach and technique. Cervical anastomosis was also shown to increase pharyngeal reflux on pH monitoring compared with intrathoracic anastomosis, but this did not influence symptoms or development of subsequent anastomotic complications. One randomized study showed intrathoracic anastomosis significantly increased risk of respiratory complications, but in this study patient treatment was variable and study design was limited. Intrathoracic anastomosis was also shown to correlate with anastomotic stricture formation and this was attributed to increased anastomotic stapling in this patient group compared with cervical anastomosis. Post-operative pain as measured by grouped symptom scales significantly increased with intrathoracic anastomosis compared with cervical anastomosis. This did not correlate with development of other cardiorespiratory complications and the difference between the two groups resolved within 24 months. Overall, there is currently insufficient evidence to show a significant difference between cervical and intrathoracic anastomosis with respect to post-operative complications and hospital mortality. The wide variety in methodology and outcomes reinforce the need for further randomized trials to more accurately establish significant differences in outcomes.
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Affiliation(s)
- Babar Kayani
- Department of Surgery and Cancer, Imperial College London, London, UK
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Fovos A, Jarral O, Patel V, Podas T, Spalding D, Zacharakis E. Does Heller's myotomy provide superior clinical outcome in comparison to botulinum toxin injection for treatment of achalasia?: Best evidence topic (BET). Int J Surg 2012; 10:120-3. [PMID: 22327009 DOI: 10.1016/j.ijsu.2012.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/23/2012] [Indexed: 10/14/2022]
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether Heller's myotomy provides superior results in comparison to botulinum toxin injection (BoTx) for treatment of achalasia. A total of 119 papers were retrieved using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results were tabulated. The highest level of evidence was one multicenter randomised controlled trial. We concluded that Heller's myotomy is superior to botulinum toxin injection for treatment of achalasia in terms of short and long term clinical outcome. Botulinum toxin injection may be considered in older patients and in patients for whom an operation or pneumatic dilation entails a higher risk, or as a bridge when these more effective modalities are not immediately available. It has an excellent safety profile and can be performed as a day case procedure.
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Affiliation(s)
- Athanasios Fovos
- Department of Gastroenterology, Hammersmith Hospital, Imperial College, London, United Kingdom
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43
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Shepherd AE, Gogalniceanu P, Kashef E, Purkayastha S, Zacharakis E, Paraskeva PA. Surgeon-performed ultrasound--a call for consensus and standardization. J Surg Educ 2012; 69:132-133. [PMID: 22208845 DOI: 10.1016/j.jsurg.2011.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 05/31/2023]
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Kayani B, Zacharakis E, Ahmed K, Hanna GB. Lymph node metastases and prognosis in oesophageal carcinoma--a systematic review. Eur J Surg Oncol 2011; 37:747-53. [PMID: 21839394 DOI: 10.1016/j.ejso.2011.06.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 02/09/2011] [Accepted: 06/28/2011] [Indexed: 12/27/2022] Open
Abstract
Oesophageal cancer is the 7th most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The 7th edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.
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Affiliation(s)
- B Kayani
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK
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45
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Symons NRA, Purkayastha S, Dillemans B, Athanasiou T, Hanna GB, Darzi A, Zacharakis E. Laparoscopic revision of failed antireflux surgery: a systematic review. Am J Surg 2011; 202:336-43. [PMID: 21788005 DOI: 10.1016/j.amjsurg.2011.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic antireflux surgery is an accepted treatment for persistent gastroesophageal reflux but about 4% of patients will eventually require revision surgery. METHODS We searched The Cochrane Collaboration, Medline, and EMBASE databases, augmented by Google Scholar and PubMed related articles from January 1, 1990, to November 22, 2010. Twenty studies met the inclusion criteria, reporting on 930 surgeries. RESULTS The mean surgical duration was 166 minutes and conversion to open revision fundoplication was required in 7% of cases. Complications were reported in 14% of cases and the mean length of stay varied between 1.2 and 6 days. A good to excellent result was reported for 84% of surgeries and 5% of patients required a further revisional procedure. CONCLUSIONS Laparoscopic revision antireflux surgery appears to be feasible and safe, but subject to somewhat greater risk of conversion, higher morbidity, longer hospital stay, and poorer outcomes than primary laparoscopic fundoplication.
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Affiliation(s)
- Nicholas R A Symons
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, Academic Surgical Unit, 10th Floor, QEQM Building, South Wharf Rd., London, W2 1NY UK
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46
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di Marco AN, Purkayastha S, Zacharakis E. Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum. Updates Surg 2011; 64:231-3. [PMID: 21785881 DOI: 10.1007/s13304-011-0092-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/20/2011] [Indexed: 12/12/2022]
Abstract
We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.
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Affiliation(s)
- Aimee N di Marco
- Department of BioSurgery and Surgical Technology, Imperial College, St Mary's Hospital, London, UK.
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Abstract
HYPOTHESIS Single-incision laparoscopic surgery (SILS) allows surgeons to perform laparoscopic procedures through a single umbilical incision, minimizing surgical trauma. DESIGN We describe herein our methods of SILS right hemicolectomy using a recent case as an example. SETTING SILS appendectomy and cholecystectomy have been performed by our surgical team for longer than 1 year among more than 80 patients. Patient SILS right hemicolectomy was performed in a 38-year-old woman with a history of B-cell lymphoma and ileocecal mass. INTERVENTIONS The operation was performed using a SILS port and an extracorporeal stapled anastomosis. MAIN OUTCOME MEASURES Length of stay and postoperative pain and complications. RESULTS SILS right hemicolectomy took 175 minutes to perform. The patient was discharged on postoperative day 6; a chest infection after surgery had prolonged the length of stay. CONCLUSIONS SILS is an attractive method to further minimize surgical trauma and can be applied in more complex cases, such as colectomy. Large trials are needed to determine the benefits of this new technique.
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Affiliation(s)
- Andre G Y Chow
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, England
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48
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Ahmed K, Ibrahim A, Anderson O, Patel VM, Zacharakis E, Darzi A, Paraskeva P, Athanasiou T. Development of a Surgical Educational Research Program—Fundamental Principles and Challenges. J Surg Res 2011; 167:298-305. [DOI: 10.1016/j.jss.2010.11.916] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/02/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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Gogalniceanu P, Jarral OA, Purkayastha S, Aggarwal R, Zacharakis E. Chest wall metastasis from oesophageal adenocarcinoma: a rare presentation. Updates Surg 2011; 63:223-6. [PMID: 21442344 DOI: 10.1007/s13304-011-0062-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
Body wall secondary deposits from visceral cancers represent a relatively rare form of metastasis. Oesophageal cancer is associated with poor survival outcomes, requiring careful staging and multidisciplinary therapeutic planning. The presence of skin and subcutaneous metastases in this patient group is rare and usually associated with squamous cell carcinomas. We present a case of subcutaneous metastasis from an oesophageal adenocarcinoma, discuss its impact on management and highlight the need for careful physical assessment in clinical practice in order to detect occult secondary deposits.
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Affiliation(s)
- Petrut Gogalniceanu
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
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50
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Jarral OA, Purkayastha S, Athanasiou T, Zacharakis E. Should thoracoscopic three-stage esophagectomy be performed in the prone or left lateral decubitus position? Interact Cardiovasc Thorac Surg 2011; 13:60-5. [PMID: 21441252 DOI: 10.1510/icvts.2010.255042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether the thoracoscopic phase of three-stage minimally-invasive esophagectomy is best performed in the prone or left lateral decubitus position. A total of 31 papers were found using the reported searches, of which seven represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that there is no convincing evidence that prone thoracoscopic esophagectomy is superior to left lateral decubitus positioning. Four papers retrospectively compared the prone and lateral techniques, and while the authors suggested that the prone position was associated with better surgical ergonomics due to the effects of gravity pooling blood outside the operative view and the reduced need for lung retraction, outcomes were not significantly different. All four studies had significant limitations, such as small patient populations and sequential operating with the possible effect of a learning curve. Two studies compared respiratory and haemodynamic changes associated with prone positioning and suggest that it is physiologically well tolerated and may offer better oxygenation, similar to that seen in the prone positioning of acute respiratory distress patients. The evidence for prone thoracoscopic esophagectomy is currently not mature enough to reach any significant conclusions, and randomized studies are required.
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Affiliation(s)
- Omar A Jarral
- Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, W2 1NY London, UK
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