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Kermansaravi M, Chiappetta S, Parmar C, Shikora SA, Prager G, LaMasters T, Ponce J, Kow L, Nimeri A, Kothari SN, Aarts E, Abbas SI, Aly A, Aminian A, Bashir A, Behrens E, Billy H, Carbajo MA, Clapp B, Chevallier JM, Cohen RV, Dargent J, Dillemans B, Faria SL, Neto MG, Garneau PY, Gawdat K, Haddad A, ElFawal MH, Higa K, Himpens J, Husain F, Hutter MM, Kasama K, Kassir R, Khan A, Khoursheed M, Kroh M, Kurian MS, Lee WJ, Loi K, Mahawar K, McBride CL, Almomani H, Melissas J, Miller K, Misra M, Musella M, Northup CJ, O'Kane M, Papasavas PK, Palermo M, Peterson RM, Peterli R, Poggi L, Pratt JSA, Alqahtani A, Ramos AC, Rheinwalt K, Ribeiro R, Rogers AM, Safadi B, Salminen P, Santoro S, Sann N, Scott JD, Shabbir A, Sogg S, Stenberg E, Suter M, Torres A, Ugale S, Vilallonga R, Wang C, Weiner R, Zundel N, Angrisani L, De Luca M. Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus. Sci Rep 2024; 14:3445. [PMID: 38341469 PMCID: PMC10858961 DOI: 10.1038/s41598-024-54141-6] [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: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-e Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Sonja Chiappetta
- Department of General and Laparoscopic Surgery, Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy.
| | | | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Teresa LaMasters
- Unitypoint Clinic Weight Loss Specialists, West Des Moines, IA, USA
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Abdelrahman Nimeri
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, VIC, Australia
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Helmuth Billy
- Ventura Advanced Surgical Associates, Ventura, CA, USA
| | - Miguel A Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | | | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Pierre Y Garneau
- Division of Bariatric Surgery, CIUSSS-NIM, Montreal, Canada
- Department of Surgery, Université de Montréal, Montréal, Canada
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | - Kelvin Higa
- Fresno Heart and Surgical Hospital, UCSF Fresno, Fresno, CA, USA
| | - Jaques Himpens
- Bariatric Surgery Unit, Delta Chirec Hospital, Brussels, Belgium
| | - Farah Husain
- University of Arizona College of Medicine, Phoenix, USA
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Amir Khan
- Walsall Healthcare NHS Trust, Walsall, UK
| | | | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marina S Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Shinchu Hospital, Zhubei City, Taiwan
| | - Ken Loi
- Director of St George Surgery, Sydney, Australia
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | | | | | - John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Karl Miller
- Diakonissen Wehrle Private Hospital, Salzburg, Austria
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, Federico II" University, Naples, Italy
| | | | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Mariano Palermo
- Department of Surgery, Centro CIEN-Diagnomed, University of Buenos Aires, Buenos Aires, Argentina
| | - Richard M Peterson
- Department of General and Minimally Invasive Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Luis Poggi
- Department of Surgery Clinica Anglo Americana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
| | - Aayad Alqahtani
- New You Medical Center, King Saud University, Obesity Chair, Riyadh, Saudi Arabia
| | - Almino C Ramos
- Medical Director of Gastro-Obeso-Center, Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - Karl Rheinwalt
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | - Rui Ribeiro
- Centro Multidisciplinar Do Tratamento da Obesidade, Hospital Lusíadas Amadora e Lisbon, Amadora, Portugal
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Sergio Santoro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-900, Brazil
| | - Nathaniel Sann
- Advanced Surgical Partners of Virginia, Richmond, VA, USA
| | - John D Scott
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, MA, USA
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Calle del Prof Martín Lagos, S/N, 28040, Madrid, Spain
| | - Surendra Ugale
- Kirloskar and Virinchi Hospitals, Hyderabad, Telangana, India
| | - Ramon Vilallonga
- Endocrine, Bariatric, and Metabolic Surgery Department, Universitary Hospital Vall Hebron, Barcelona, Spain
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rudolf Weiner
- Bariatric Surgery Unit, Sana Clinic Offenbach, Offenbach, Germany
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II University of Naples, Naples, Italy
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Affiliation(s)
- E. de Bree
- Department of Surgical Oncology, University Hospital Heraklion, Greece
| | - D. Tsiftsis
- Department of Surgical Oncology, University Hospital Heraklion, Greece
| | | | - G. Harocopos
- Department of Surgical Oncology, University Hospital Heraklion, Greece
| | - G. Schoretsanitis
- Department of Surgical Oncology, University Hospital Heraklion, Greece
| | - J. Melissas
- Department of Surgical Oncology, University Hospital Heraklion, Greece
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Charalampakis V, Seretis C, Daskalakis M, Fokoloros C, Karim A, Melissas J. The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up. Surg Obes Relat Dis 2018; 14:1652-1658. [PMID: 30072237 DOI: 10.1016/j.soard.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/25/2018] [Revised: 06/05/2018] [Accepted: 06/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up. OBJECTIVES To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome. SETTING Bariatric Unit, University Hospital of Heraklion, Greece. METHODS Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded. RESULTS A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study. CONCLUSIONS Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.
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Affiliation(s)
- Vasileios Charalampakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Department of General Surgery, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom.
| | - Charalampos Seretis
- Department of General Surgery, George Elliot Hospital, Nuneaton, United Kingdom
| | - Markos Daskalakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Upper GI Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christos Fokoloros
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Ahmed Karim
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
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Prokopakis EP, Kaprana A, Karatzanis A, Velegrakis GA, Melissas J, Chalkiadakis G. Association between the increase in incidence of papillary thyroid carcinoma in Crete and exposure to radioactive agents. Acta Otorhinolaryngol Ital 2018; 38:310-315. [PMID: 29498716 PMCID: PMC6146575 DOI: 10.14639/0392-100x-1642] [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] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022]
Abstract
The mean gamma-ray distribution in Crete during the years after the nuclear accident at Chernobyl and its correlation with the Papillary Thyroid Cancer (PTC) distribution was identified. A total of 4285 patients underwent total thyroidectomy in our centre between 1990 and 2012. Data of gamma-ray (nSv/h) distribution were selected from the Greek Statistical Authorisation. A geo-spatial statistical model was used to estimate the expected number of patients with PTC and Kriging interpolation prediction model to estimate their distribution. Geographical weighted regression was performed to estimate the risk of PTC in relation to gamma ray distribution. All factors that were examined were found to be statistically significant for PTC distribution in Crete. Gamma-ray was determined as a significant risk factor (OR = 2.89; 95% CI = 1.682-4.989; p value = 0.03). There is a significant correlation between gamma-ray exposure and the increased prevalence of the PTC suggesting that the former may have been a significant risk factor.
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Affiliation(s)
- E P Prokopakis
- Department of Otorhinolaryngology, University Hospital of Crete, Heraklion, Crete, Greece
| | - A Kaprana
- Department of Otorhinolaryngology, University Hospital of Crete, Heraklion, Crete, Greece
| | - A Karatzanis
- Department of Otorhinolaryngology, University Hospital of Crete, Heraklion, Crete, Greece
| | - G A Velegrakis
- Department of Otorhinolaryngology, University Hospital of Crete, Heraklion, Crete, Greece
| | - J Melissas
- Department of Surgical Oncology, University Hospital of Crete, Heraklion, Crete, Greece
| | - G Chalkiadakis
- Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece
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Melissas J. John Melissas, MD, PhD, FACS. Obes Surg 2017; 28:1-2. [PMID: 29214432 DOI: 10.1007/s11695-017-3043-5] [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: 11/30/2022]
Affiliation(s)
- John Melissas
- Department of Surgical Oncology, Bariatric Unit of Heraklion University Hospital, Voutes, 711 10, Heraklion, Crete, Greece.
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Abstract
Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, 164 Erythreas Street, 714 09, Heraklion, Crete, Greece.
| | - Italo Braghetto
- Department of Surgery, Hospital Clínico "Dr Jose J. Aguirre", Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Juan Carlos Molina
- Department of Surgery, Hospital Clínico "Dr Jose J. Aguirre", Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy.
| | - Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet, Pôle Digestif, Nice, F-06202, France. .,Faculté de Médecine, Université de Nice-Sophia Antipolis, Nice, F-06107, France.
| | - Mirto Foletto
- Week Surgery, Bariatric Unit, Padova University Hospital, Padova, Italy.
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Charalampakis V, Bertsias G, Lamprou V, de Bree E, Romanos J, Melissas J. Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study. Surg Obes Relat Dis 2015; 11:70-6. [DOI: 10.1016/j.soard.2014.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 12/19/2022]
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de Bree E, Dimitriadis E, Giannikaki E, Chryssou EG, Melissas J. A giant pregnancy-associated intra-abdominal desmoid tumour: not necessarily a contraindication for subsequent pregnancy. World J Surg Oncol 2013; 11:277. [PMID: 24131728 PMCID: PMC3852701 DOI: 10.1186/1477-7819-11-277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 06/24/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022] Open
Abstract
Desmoid tumours are rare mesenchymal tumours, often locally invasive and characteristically associated with a high local recurrence rate after resection. A potential aetiological role for female hormones is indicated. Pregnancy-associated desmoid tumours are almost exclusively located in the abdominal wall. An essential issue is how to counsel women who have had a pregnancy-associated desmoid tumour and subsequently wish to bear a child. A considerably rare case of a patient with a resection of a giant pregnancy-associated, 33 cm in diameter, intra-abdominal desmoid tumour is presented. After a subsequent pregnancy, the patient delivered healthy twins 26 months later. Fifty-four months after treatment, there are no signs of recurrent or second desmoid tumour. Although rarely located in the abdomen, pregnancy-associated desmoid tumours should be included in the differential diagnosis of intra-abdominal tumours detected during or shortly after pregnancy. Based on this case and a few others reported in the literature, subsequent pregnancy does not necessarily seem to be a risk factor for recurrent or new disease.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece.
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Laliotis A, Vrekoussis T, Kafousi M, Sanidas E, Askoxilakis J, Melissas J, Mavroudis D, Castanas E, Stathopoulos EN. Immunohistochemical study of pElk-1 expression in human breast cancer: association with breast cancer biologic profile and clinicopathologic features. Breast 2012; 22:89-95. [PMID: 23127278 DOI: 10.1016/j.breast.2012.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 09/10/2012] [Accepted: 09/23/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recently an increased interest on Elk1 protein and its role in breast cancer evolution has been noted. This protein is an element of the Ets family of transcription factors and it has been involved in a number of important cell processes through the activation of different genes, in a number of normal tissues as well as in many malignancies. METHODS One hundred and seventy (n = 170) cases of operable breast cancer (invasive ductal, lobular and mixed type breast carcinomas) were randomly selected and investigated for the expression of pElk-1, Ki-67 and Cyclin D1 using immunohistochemistry. Our findings were correlated with tumors' clinicopathologic data and biologic profile. RESULTS Activated Elk1 is positively associated with ER (p-value: 0.018) and also shows a positive association of with Cyclin D1 (p-value: <0.001). No relationship was noted between pElk1 and Ki67 (p-value: 0.213). Luminal A and B Her-2 negative breast cancer subtypes were showing greater pElk-1 immunoreactivity compared to Her-2 and Basal breast cancer subtypes, and also a higher staining intensity. No association of the molecule with other clinicopathologic characteristics (tumor size, stage, histological type or lymph node metastases) or disease adverse events (local recurrence, metastasis or death) was evidenced. CONCLUSIONS Our findings offer a new perspective for the role of pElk-1 in breast neoplasia suggesting a direct relation of this molecule to tumor biology and a putative target of personalized breast cancer therapies, although its prognostic/discriminant role is not supported.
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Affiliation(s)
- Aggelos Laliotis
- Department of Surgical Oncology, University of Crete, School of Medicine, Heraklion, Greece
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de Bree E, Romanos J, Tsogkas J, Askoxylakis J, Metaxari M, Michalakis J, Volakakis E, Melissas J, Tsiftsis DD. Complications and toxicity after abdominal and pelvic hypoxic stop-flow perfusion chemotherapy: incidence and assessment of risk factors. Ann Surg Oncol 2012; 19:3591-7. [PMID: 22576062 DOI: 10.1245/s10434-012-2383-6] [Citation(s) in RCA: 2] [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: 05/07/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Controversial results regarding the efficacy and toxicity of hypoxic abdominal and pelvic stop-flow perfusion chemotherapy (SFP) have been reported in relatively small series. Hence, because adequate assessment of its benefit in large homogenous cohorts is missing, acceptable morbidity should initially be assured in a series of adequate size. Additionally, risk factors should be assessed for eventual patient selection. METHODS The morbidity of abdominal and pelvic SFP performed on a miscellaneous group of patients in our institute was analyzed and potential risk factors for adverse events were evaluated. RESULTS Seventy abdominal (n = 42) and pelvic (n = 28) SFP were performed on 55 patients. In total, 28 adverse effects were observed after 30% of the procedures. Severe (grade 3) adverse events were recorded only after 4% of the procedures, while treatment-related life-threatening events and deaths were not present. Abdominal procedures when compared with pelvic ones were associated with increased systemic toxicity (36 vs. 7%, p = 0.005). Advanced age, gender, prior chemotherapy and/or radiotherapy, limited experience, repeated procedure, drug choice and omission of hemofiltration after SFP completion were not associated with statistically significant increase of procedures with overall or systemic adverse events. CONCLUSIONS In the present series, abdominal and pelvic SFP was associated with an acceptable morbidity, which was mostly mild or moderate. Abdominal procedures were associated with increased toxicity. This procedure seems to be repeatable and also well tolerated both by elderly patients and by patients who had undergone prior chemotherapy and/or radiotherapy, while hemofiltration does not appear to decrease the incidence of systemic toxicity.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Herakleion, Greece.
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Melissas J, Daskalakis M, Askoksilakis I. [Laparoscopic sleeve gastric resection: experience of Bariatric Department in University of Cyprus, Greece]. Klin Khir 2012:14-18. [PMID: 22888544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Experience of laparoscopic sleeve gastric resection performance for morbid obesity was summarized. Indications for the method application, the operation procedure details, its mechanism of action, securing the body mass reduction, are adduced. The efficacy and security of the intervention were estimated.
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Charalampakis V, Daskalakis M, Bertsias G, Papadakis JA, Melissas J. Validation of the Greek Translation of the Obesity-Specific Moorehead–Ardelt Quality-of-Life Questionnaire II. Obes Surg 2012; 22:690-6. [PMID: 22411571 DOI: 10.1007/s11695-012-0628-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vasileios Charalampakis
- Bariatric Unit, Department of Surgical Oncology, Heraklion University Hospital, University of Crete, 164 Erythreas St, 71409 Heraklion, Crete, Greece
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Sigala F, Kontis E, Hepp W, Filis K, Melissas J, Mirilas P. Long-term outcomes following 282 consecutive cases of infrapopliteal PTA and association of risk factors with primary patency and limb salvage. Vasc Endovascular Surg 2012; 46:123-30. [PMID: 22344984 DOI: 10.1177/1538574411432161] [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: 11/15/2022]
Abstract
We aimed to determine the long-term results after infrapopliteal PTA (primary patency, limb salvage, survival) and examine for association with risk factors (e.g. diabetes, infection, etc). We studied 268 patients with 282 critically ischemic limbs treated with PTA of at least one crural artery during a six-year period. Data included TASC II morphological classification of lesions and risk factors. Technical success rate was 97.2%, and overall mortality 0.7%. Patients with milder TASC lesions preserved primary patency longer than patients with more severe lesions. Similar results were obtained for limb salvage and survival. Fontaine stage, TASC class and postoperative infection of operated limb increased the risk for loss of primary patency and major amputation. Concomitant carotid stenosis was associated with loss of primary patency. Diabetes mellitus, preoperative ulcer or gangrene were associated with need of major amputation. PTA was a safe and effective treatment for CLI due to lesions of infrapopliteal vessels.
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Affiliation(s)
- Fragiska Sigala
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Athens, Greece
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14
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Daskalakis M, Mavroudis D, Sanidas E, Apostolaki S, Askoxylakis I, de Bree E, Georgoulias V, Melissas J. Assessment of the effect of surgery on the kinetics of circulating tumour cells in patients with operable breast cancer based on cytokeratin-19 mRNA detection. Eur J Surg Oncol 2011; 37:404-10. [DOI: 10.1016/j.ejso.2011.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/29/2011] [Accepted: 02/08/2011] [Indexed: 12/12/2022] Open
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de Bree E, Charalampakis V, Melissas J, Tsiftsis DD. The extent of lymph node dissection for gastric cancer: a critical appraisal. J Surg Oncol 2010; 102:552-62. [PMID: 20976727 DOI: 10.1002/jso.21646] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The extent of lymphadenectomy during therapeutic gastrectomy for gastric cancer remains a protracted and controversial issue. While traditionally extended lymphadenectomy is performed in Eastern Asia, limited lymphadenectomy is advocated by most western surgeons. Two large western randomized trials, meta-analyses and a recent systematic review were unable to demonstrate overall benefit from extended lymphadenectomy. In this review, the currently available data on this topic are critically evaluated, while ongoing studies and future perspective are discussed.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece.
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16
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Abstract
Basal cell carcinoma (BCC) is very common and usually encountered when it is small in size. Giant BCC (i.e. greater than 5 cm in diameter) is quite rare and comprises 0.5 percent of all BCC. Extremely rarely, tumors larger than 20 cm have been reported. Herein, a case with an enormous, vegetating BCC of the abdominal wall, 30 x 20 cm in size, is described. This report demonstrates that such a case can still be observed in the civilized world of the 21st century, which remains profoundly astonishing. A literature survey was performed and revealed only 7 cases with such super giant BCC (i.e. larger than 20 cm in diameter). Generally, this tumor attains these enormous proportions due to neglect on the patient's part, and is usually located at sites covered by clothes. Treatment is mainly surgical and generally curative, resulting also in an improved quality of life. Tumor size of more than 10 cm in diameter is associated with increased risk for metastatic disease, severe morbidity and consequently impaired prognosis.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete-University Hospital, Herakleion, Greece.
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17
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Abstract
Pregnancy after breast cancer treatment has become an important issue since many young breast cancer patients have not completed their family. Generally, these patients should not be discouraged to become pregnant when they want to, since published data suggest no adverse effect of pregnancy on survival. As fertility may be impaired by chemotherapy, different fertility preserving strategies have been developed. Births seem to sustain no adverse effects, while breastfeeding appears to be feasible and safe.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Herakleion, Greece.
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Taflampas P, Christodoulakis M, de Bree E, Melissas J, Tsiftsis DDA. Preoperative decision making for rectal cancer. Am J Surg 2010; 200:426-32. [PMID: 20223450 DOI: 10.1016/j.amjsurg.2009.09.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 09/02/2009] [Accepted: 09/15/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients. METHODS We searched the MEDLINE and PubMed databases using the following keywords: "rectal cancer," "total mesorectal excision," "multidisciplinary treatment/team," "radiotherapy," "chemotherapy," and their combinations. There were no language or publication year restrictions. References in published articles also were reviewed. RESULTS Total mesorectal excision surgery, high-resolution pelvic magnetic resonance imaging, preoperative chemoradiotherapy, and pathologic reports according to Quirke protocol are preconditions for the initiation of an effective multidisciplinary team. Common topics for discussion are the status of the circumferential margin, the type of radiotherapy and surgery required, and the chemotherapeutic agent to be used. CONCLUSIONS This review focuses on this issue based on two main principles. First, the status of the circumferential margin dictates the use of preoperative chemoradiotherapy. Second, preoperative chemoradiotherapy is superior in terms of free circumferential resection margin rate, local recurrence rate, and toxicity.
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Taflampas P, Christodoulakis M, Gourtsoyianni S, Leventi K, Melissas J, Tsiftsis DD. The effect of preoperative chemoradiotherapy on lymph node harvest after total mesorectal excision for rectal cancer. Dis Colon Rectum 2009; 52:1470-4. [PMID: 19617762 DOI: 10.1007/dcr.0b013e3181a0e6ac] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate whether preoperative chemoradiotherapy reduces the number of lymph nodes harvested after total mesorectal excision of rectal cancer. METHODS From January 1995 to December 2007, 168 consecutive patients with rectal cancer underwent total mesorectal excision in the Department of Surgical Oncology at the University of Crete. The patients were divided into three groups (Group A, no chemoradiotherapy; Group B, short course of chemoradiotherapy; Group C, long course of chemoradiotherapy). The primary end points were the number of lymph nodes examined and the percentage of patients with fewer than 12 lymph nodes removed. RESULTS The overall number of lymph nodes retrieved was not significantly reduced by the use of preoperative chemoradiotherapy. The percentage of patients with fewer than 12 lymph nodes examined, however, was significantly higher in Group C. The leakage rate and the duration of hospital stay were not affected. The rate of wound infections was higher in Group C. CONCLUSION Preoperative chemoradiotherapy did not significantly decrease the overall number of lymph nodes retrieved but did increase the percentage of patients with fewer than 12 lymph nodes examined.
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Abstract
Desmoid tumor, also known as aggressive fibromatosis or desmoid-type fibromatosis, is a rare monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. Although histologically benign, desmoids are often locally invasive and associated with a high local recurrence rate after resection. Since it is a heterogeneous disease, in particular regarding clinical presentation, anatomic location and biological behavior, treatment should be individualized to reduce local tumor control failure with concurrently acceptable morbidity and preservation of quality of life. Many issues regarding optimal treatment of desmoids remain controversial. However, wide surgical excision remains the treatment of choice, except when surgery is mutilating and is associated with considerable function loss or major morbidity. Involvement of surgical margins is probably associated with an increased risk of local recurrence. Postoperative radiotherapy results in a significant reduction of the local recurrence rate, but only in the case of involved surgical margins. Radiotherapy for gross disease is considerably effective, but is associated with a relatively high rate of complications, which are usually mild or moderate and radiation dose dependent. Radiotherapy should only be applied where anatomic constraints preclude complete resection and radiotherapy is not too toxic. Risk factors for local tumor control failure include young age, large size, presentation as recurrent disease, limb/girdle or intra-abdominal location, involved surgical margins, omission of radiotherapy, radiation dose less than 50 Gy and insufficient radiation field size. Increased comprehension of the pathogenesis and biological behavior of desmoids resulted in the emerging applicability of systemic therapies and a wait-and-see policy. Systemic treatment may be indicated in patients that have anatomic barriers to effective surgery or radiotherapy. Considering the significant morbidity of surgery and/or radiotherapy for certain locations, especially mutilation and loss of function, and the tumor's natural history, which is often characterized by prolonged periods of stability or even regression, a period of watchful waiting may compose the most appropriate management in selected asymptomatic patients. Attempts to complete eradication of the disease may be worse than the disease itself.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, PO Box 1352, 71110 Herakleion, Greece.
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Schoretsanitis G, Daskalakis M, Melissas J, Tsiftsis DD. Parathyroid carcinoma: clinical presentation and management. Am J Otolaryngol 2009; 30:277-80. [PMID: 19563942 DOI: 10.1016/j.amjoto.2008.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 04/01/2008] [Accepted: 05/03/2008] [Indexed: 11/28/2022]
Abstract
Parathyroid carcinoma constitutes a rare cause of hyperparathyroidism. Five patients, presenting with symptoms and clinical signs of parathyroid hyperfunction, were diagnosed with parathyroid carcinoma in our department over a 12-year period. The experience we gained in the management of these tumors is presented. The aim of this study is to elucidate the clinical features of the disease, the surgical treatment, and the sensitivity of the imaging modalities used to enhance the diagnostic ability. Preoperative recognition and intraoperative identification of this rare endocrine malignancy require a high index of clinical suspicion. Intraoperative awareness is needed of the malignant potential of the encountered lesion.
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Affiliation(s)
- George Schoretsanitis
- Department of Surgical Oncology, Medical School, University of Crete, University General Hospital, Herakleion, Greece.
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22
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Melissas J. Safety, quality and excellence in bariatric surgery. MINERVA CHIR 2009; 64:239-252. [PMID: 19536050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The prevalence of obesity has increased three-fold in the past two decades. In Europe, 150.000.000 adults and 15.000.000 children are currently affected and obesity epidemic is responsible for approximately 1,000,000 deaths annually. Bariatric surgery for the severely obese has resulted in an overall of 61% weight reduction, across all procedures and has been shown to ameliorate or significantly improve many of the obesity-related comorbidities. Surgery is a serious intervention with procedural risks. Safety, quality and efficacy of the service offered to the morbidly obese patients, from both surgeons and hospitals are therefore, of outmost importance, to ensure optimal outcome of the surgical intervention, with the lowest possible risk for complications and mortality. An institution that can be certified by an independent organization, as capable to undertake the management of morbidly obese patients with outstanding results, is a Centre of Excellence (COE) in Bariatric and Metabolic surgery. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has described the requirements for both surgeons and institutions in order to offer outstanding bariatric surgical management and, therefore, to become Centres of Excellence. European Accreditation Council for Bariatric Surgery (EAC-BS) is an independent organization, established by IFSO officials and leading bariatric surgeons in Europe, for quality control in bariatric surgery and data collection and analysis. Surgeons and institutions fulfilling the requirements and willing to become a Centre of Excellence in Bariatric Surgery may apply to the EAC-BS for evaluation. The creation of a European network of COEs will be of great value in promoting safety, quality and excellence in bariatric and metabolic surgery.
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Affiliation(s)
- J Melissas
- Department of Surgical Oncology, Heraklion University Hospital, Medical School, University of Crete, Crete, Greece.
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Melissas J, Daskalakis M, Koukouraki S, Askoxylakis I, Metaxari M, Dimitriadis E, Stathaki M, Papadakis JA. Sleeve gastrectomy-a "food limiting" operation. Obes Surg 2008; 18:1251-6. [PMID: 18663545 DOI: 10.1007/s11695-008-9634-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/30/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG. METHODS Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29-65), median body mass index (BMI) 49.46 kg/m(2) (range 41.14-55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation. RESULTS A significant reduction in patients' weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50-20.90) min, to 12.50 (range 9.20-18.00) min at 6 months and 12.16 (range 10.90-20.00) min at 24 months postoperatively (P < 0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50-104.60) min, to 62.50 (range 46.30-80.00) min at 6 months and 60.80 (range 54.80-100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43-58) % to 72 (range 57-97) % at 6 months and 74 (range 45-82) % at 24 months, following SG (P < 0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively. CONCLUSIONS Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this 'food limiting' operation results in weight loss.
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Affiliation(s)
- John Melissas
- Bariatric Unit Department of Surgical Oncology, Heraklion University Hospital, Medical School, University of Crete, 15 Delaporta St., Herarklion 71409, Crete, Greece.
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Markogiannakis H, Sanidas E, Michalakis I, Manouras A, Melissas J, Tsiftsis D. Predictive factors of operative or nonoperative management of blunt hepatic trauma. MINERVA CHIR 2008; 63:223-228. [PMID: 18577908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Nonoperative management (NOM) has revolutionized the care of blunt hepatic trauma patients. The aim of the present study was to identify and evaluate the predictors of NOM of these patients. METHODS The Trauma Registry data of 55 consecutive adult patients admitted with blunt hepatic trauma over a 4-year period was reviewed. Patients were divided into immediately operated (OP-group) and selected for NOM (NOM-group). Factors analyzed were: demographics, injury mechanism, initial vital signs, liver injury grade, concomitant injuries, and total injury severity scoring systems. RESULTS Concomitant abdominal trauma, high Injury Severity Score (ISS), low International Classification of Diseases 9(th) revision Injury Severity Score (ICISS), and low probability of survival (Ps) were predictors for operative management. Compared to NOM-patients (66%, N=36), OP-patients (34%, N=19) suffered more frequently concomitant abdominal injuries (84.2% vs 47.2%, P=0.004) and were more severely totally injured as expressed by higher ISS (25 vs 20, P=0.01), lower ICISS (0.51 vs 0.74, P=0.003), and lower Ps (0.81 vs 0.98, P=0.005). NOM resulted in lower intensive care unit admission and mortality rates (47.2% vs 78.9%, P=0.002 and 2.7% vs 15.8%, P=0.03, respectively). NOM-success rate was 92%. CONCLUSION NOM of blunt hepatic trauma is safe and efficient. Concomitant abdominal trauma, ISS, ICISS, and Ps are predictors for operative or nonoperative management.
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Affiliation(s)
- H Markogiannakis
- Department of Surgical Oncology, Herakleion University Hospital, Herakleion Medical School, University of Crete Herakleion, Crete, Greece.
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Abstract
BACKGROUND Diet and surgically-induced weight loss have been shown to lead to alterations in motor and sensory function of the stomach. We investigated the clinical outcome and gastric emptying of solid foods in morbidly obese (MO) patients following sleeve gastrectomy (SG). METHODS We studied 23 MO patients [(7 males, 16 females), mean age 38.9 +/- 11.0 years (range 20-64 years), mean weight 135.1 +/- 19.0 kg (range 97-167 kg), mean BMI 47.2 +/- 4.8 kg/m(2) (range 39.6-56.0 kg/m(2))] who each underwent a sleeve gastrectomy (SG) for weight reduction. At the monthly follow-up visits, variations in weight and BMI changes, postoperative meal size and frequency, and presence of gastrointestinal symptoms were recorded. 11 patients underwent scintigraphic measurement of the gastric emptying of a solid meal pre- and 6 months postoperatively. RESULTS A significant reduction in patients' weight was evidenced at 6 and 12 months postoperatively [98.6 +/- 11.8 kg and 87.0 +/- 10.7 kg respectively (P=0.001)]. BMI decreased to 35.2 +/- 4.3 kg/m(2) at 6 months and to 31.1 +/- 4.5 kg/m(2) at 12 months, respectively (P=0.001). Although meal size was drastically reduced, meal frequency increased postoperatively in 12 patients (52.2%). Only 5 patients (21.8 %) reported occasional vomiting after meals following SG. The gastric emptying half-time (T1/2) accelerated (47.6 +/- 23.2 vs 94.3 +/- 15.4, P<0.01) and the T-lag phase duration decreased (9.5 +/- 2 min vs 19.2 +/- 2 min, P<0.05) post-operatively. The percentage of the meal emptied from the stomach 90 min after consumption increased significantly after SG (75.4 +/- 14.9% vs 49.2 +/- 8.7%, P<0.01). CONCLUSIONS This study indicates that following SG, the stomach empties its contents rapidly into the small intestine and symptoms of vomiting after eating (characteristic of restrictive procedures) are either absent or very mild. Therefore, the term 'restrictive' is possibly ill-advised for this new bariatric operation. It remains for other mechanisms of energy intake reduction, such as intestinal distension and satiety signals through gut hormones to be investigated, to comprehensively explain precisely how this 'food limiting' procedure results in weight loss.
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Affiliation(s)
- John Melissas
- Bariatric Unit and Department of Surgical Oncology, Heraklion University Hospital, Faculty of Medicine, University of Crete, Greece.
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Kontakis GM, Pagkalos JE, Tosounidis TI, Melissas J, Katonis P. Bioabsorbable materials in orthopaedics. Acta Orthop Belg 2007; 73:159-69. [PMID: 17515225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from the need to eliminate implant removal operations. Although they have not gained widespread popularity among orthopaedic surgeons, they still represent an area of evolution. Considerable effort has been put into developing new bioabsorbable materials with fewer adverse effects. In this article an extensive review of the literature is presented emphasising on basic science and clinical applications of these materials. A review of the types of implants, the materials used, their biochemical properties, their adverse effects and some of the potential future applications is presented.
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Melissas J, Mouzas J, Filis D, Daskalakis M, Matrella E, Papadakis JA, Sevrisarianos N, Charalambides D. The intragastric balloon - smoothing the path to bariatric surgery. Obes Surg 2006; 16:897-902. [PMID: 16839490 DOI: 10.1381/096089206777822188] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intragastric balloon placement in association with diet for weight reduction is steadily gaining popularity. However, long-term follow-up studies on the effect of this method in maintaining weight loss are lacking. This study evaluated the long-term outcome following balloon removal in morbidly obese patients who had selected this method for weight loss. METHODS 140 morbidly obese patients who refused bariatric surgery because of fear of complications and mortality, underwent intragastric balloon placement and were followed over a 6- to 30-month period (mean 18.3 months) after balloon extraction. The 34 males and 106 females, with median age 38 years (range 16-62), median weight 122 kg (range 85-203), median BMI 42.3 kg/m(2) (range 35-61.3) and median excess weight (EW) 59 kg (range 29-132), received a Bioenterics Intragastric Balloon (BIB). Excess weight loss (EWL) > or =25% when the BIB was removed was considered a success. Weight fluctuations and any further interventional therapy requested by the patients after balloon removal were recorded. RESULTS 100 patients (71.4%) lost > or =25% of their EW on balloon extraction and were categorized as successes, while 40 patients (28.6%) did not achieve that weight loss and were categorized as failures of the method. During the follow-up period, 44 of the originally successful patients (31.4%) regained weight and were categorized as recurrences, while the remaining 56 patients (40%) maintained their EWL of > or =25% and were considered long-term successes. During follow-up, 45 patients (32.1%) requested and underwent bariatric surgery for their morbid obesity (21 Adjustable Gastric Band, 11 Laparoscopic Sleeve Gastrectomy, 13 Laparoscopic Gastric Bypass). Of these, 13 (32.5%) were from the group of 40 patients categorized as failures on BIB removal, 28 (63.6%) were from the group of 44 patients whose obesity recurred, and 4 (7.1%) were from the 56 patents who although they maintained successful weight loss requested further weight reduction. CONCLUSIONS The BIB served as a first step and a smooth introduction to bariatric surgery for morbidly obese patients who initially refused surgical intervention. The incidence of surgical intervention was double in patients who initially experienced the benefits of weight loss and then had obesity recurrence, compared with patients in whom the method failed. Indeed, a significant number of patients were assisted in their efforts to lose and maintain an acceptable weight loss over a 6- to 30-month follow-up period.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, Heraklion University Hospital, Crete, Greece.
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Markogiannakis H, Sanidas E, Messaris E, Michalakis I, Kasotakis G, Melissas J, Tsiftsis D. Management of blunt hepatic and splenic trauma in a Greek level I trauma centre. Acta Chir Belg 2006; 106:566-71. [PMID: 17168271 DOI: 10.1080/00015458.2006.11679953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSES Non-operative management (NOM) has revolutionized the care of blunt hepatic and splenic trauma patients. The objective of this study is to evaluate treatment of such patients in a Greek level I trauma centre, to identify factors that are important for selecting them for NOM and to investigate for predictors of NOM failure. MATERIAL AND METHODS We reviewed the Trauma Registry data of 96 consecutive adult patients admitted with blunt liver and/or splenic injuries over a 4-year period. RESULTS Immediately operated patients (32.3%) had lower diastolic arterial pressure (p = 0.02), lower International Classification of Diseases -9th revision Injury Severity Score (ICISS) (p = 0.01), and a higher grade of splenic injury (p = 0.002) than NOM patients. NOM success rate was 80%. No predictors of NOM failure were found ; however, isolated splenic trauma patients failed NOM more frequently than hepatic patients (p = 0.02). CONCLUSIONS NOM of adult blunt hepatic and splenic trauma patients is safe and efficient. Haemodynamic stability, ICISS and the grade of splenic injury are important for selecting these patients for NOM while splenic trauma patients need more intense observation.
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Affiliation(s)
- H Markogiannakis
- Department of Surgical Oncology, Herakleion University Hospital, Herakleion Medical School, University of Crete, Herakleion, Crete, Greece.
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Abstract
Rhabdomyolysis is a rare complication of serious surgical procedures, and constitutes a clinical and biochemical syndrome, caused by injury and destruction of skeletal muscles. It is accompanied by pain in the region of the referred muscle group, increase in creatine phosphokinase levels, myoglobinuria, often with severe renal failure, and finally multi-organ system failure and death, if not treated in time. The main risk factor in the development of postoperative rhabdomyolysis is prolonged intraoperative immobilization of the patient. Morbidly obese patients who undergo laparoscopic bariatric operations should be considered high-risk for rhabdomyolysis, from extended immobilization and pressure phenomena in the lumbar region and gluteal muscles. We report a 20-year-old woman with BMI 51, who underwent a prolonged laparoscopic Roux-en-Y gastric bypass. Postoperatively, she presented severe myalgia in the gluteal muscles and lumbar region, oliguria and creatine phosphokinase levels that reached 38,700 U/L. She was treated with intensive hydration and analgesics, and did not develop acute renal failure because diagnosis and treatment were attained immediately.
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Affiliation(s)
- D Filis
- Bariatric Unit, Department of Surgical Oncology, Medical School, University of Crete, Heraklion, Crete, Greece
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31
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Melissas J, Malliaraki N, Papadakis JA, Taflampas P, Kampa M, Castanas E. Plasma antioxidant capacity in morbidly obese patients before and after weight loss. Obes Surg 2006; 16:314-20. [PMID: 16545163 DOI: 10.1381/096089206776116444] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Oxidative stress may play a critical role in the pathogenesis and development of obesity-associated co-morbidities. Reactive oxygen and nitrogen species are produced as a consequence of normal aerobic metabolism and removed and/or inactivated in vivo by both endogenous (uric acid, bilirubin, thiols) and diet-derived (exogenous) antioxidants. The purpose of this study is to measure the total plasma antioxidant capacity (TAC), as well as the corrected TAC (cTAC, an index of exogenous provided antioxidants) in morbidly obese patients before and after surgical weight reduction. METHODS 16 morbidly obese (5 male and 11 female) candidates for surgical intervention, median age 34 (range 22-56) years, median weight 128 (range 96-186) kg, median excess weight 62 (range 28-115) kg and median BMI 44.4 (range 33.7-60.1) kg/m2 were evaluated before and 6 months after implantation of an intragastric balloon. 15 healthy blood donors (4 male and 11 female) on a normal diet, median age 35 (range 21-52) years, median weight 64.3 (range 46-78) kg and median BMI 24.2 (range 23.7-25.2) kg/m2 were also evaluated. Blood samples for routine clinical chemistry, TAC and cTAC determination were drawn, and weight and BMI calculation were performed once in the control group, and in the morbidly obese patients (MO) before and 6 months after the balloon implantation. RESULTS 6 months after balloon placement, weight and BMI of the MO patients were statistically significantly reduced from the preoperative values (P<0.001). Plasma TAC and cTAC values in the MO group were significantly lower preoperatively, compared to the control group (P<0.05 and P<0.001 respectively). cTAC values in the MO patients increased significantly following weight loss (P<0.001) and were restored to normal. However, the postoperative TAC values in the MO group did not change significantly and remained lower than in the normal controls. A significant decrease (P<0.001) in uric acid values was also noticed in the MO group after weight loss. CONCLUSION Plasma TAC and cTAC values are impaired in morbidly obese patients. Weight loss from an intragastric balloon is associated with significant increase in plasma cTAC values. Plasma TAC values, after the weight loss remain unchanged, possibly due to a decrease in uric acid, an important endogenous antioxidant.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, University of Crete, Heraklion, Crete, Greece.
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Alexopoulou C, Mitrouska I, Arvanitis D, Tzanakis N, Chalkiadakis G, Melissas J, Zervou M, Siafakas N. Vascular-specific growth factor mRNA levels in the human diaphragm. Respiration 2006; 72:636-41. [PMID: 16355005 DOI: 10.1159/000089580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 09/21/2004] [Accepted: 05/04/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Angiogenesis is an adaptation mechanism of skeletal muscles to increased load. Animal data have shown increased vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor-beta(1) (TGF-beta(1)) mRNA levels in the diaphragm as a result of increased minute ventilation, but there are no data concerning the human diaphragm. OBJECTIVES The purpose of this study was to investigate the VEGF, bFGF, TGF-beta(1) mRNA levels in the human diaphragm of normal subjects and patients with altered respiratory mechanics. METHODS We studied 9 patients with chronic obstructive pulmonary disease (COPD), 4 obese patients and 12 controls. We performed multiplex semiquantitative reverse transcription polymerase chain reaction to determine the VEGF, bFGF and TGF-beta(1) mRNA levels in specimens taken from their diaphragm. RESULTS VEGF mRNA levels were 18% higher in COPD patients compared with controls (p = 0.04), while for the obese patients, these levels were not statistically significantly different. bFGF and TGF-beta(1) mRNA levels in COPD patients or obese individuals compared with controls did not differ significantly either. CONCLUSIONS The results of our study showed that TGF-beta(1), VEGF and bFGF mRNA was detected in the human diaphragm. The VEGF levels were higher in COPD patients than in normal subjects. This upregulation of VEGF may suggest an enhancement of angiogenesis in the diaphragm in COPD patients.
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Affiliation(s)
- Christina Alexopoulou
- Department of General Surgery, Medical School, University Hospital of Crete, GR-71110 Heraklion, Greece
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Mamplekou E, Komesidou V, Bissias C, Papakonstantinou A, Melissas J. Psychological Condition and Quality of Life in Patients with Morbid Obesity Before and After Surgical Weight Loss. Obes Surg 2005; 15:1177-84. [PMID: 16197793 DOI: 10.1381/0960892055002356] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bariatric surgery results in significant weight loss, improvement or cure of accompanying illnesses, and may lead to important changes in psychological conditions. The aim of this paper is to study the changes in the psychological and emotional lives of patients as well as quality of life during the first 2 years after vertical banded gastroplasty (VBG). METHODS The study population comprised 59 patients, 45 women (76.3%) and 14 men, between 18 and 64 years old. Patients were asked to complete an SCL-90R questionnaire before VBG. 2 years after VBG, patients were again asked to complete an SCL-90R as well as a BAROS questionnaire. Comparisons were made between loss of weight, alteration in the psychological condition and quality of life postoperatively, within the parameters of sex, age, marital status, level of education, duration of obesity and family history of obesity. RESULTS Women had a greater degree of depression from obesity than their male counterparts before the procedure (P=0.001), while their postoperative emotional improvement was more marked (P=0.008). The General Mental Health Index was higher in female than male patients (P=0.008). At 2 years after VBG, BMI was significantly reduced (P<0.001). Oversensitivity in personal relationships and anxiety affected patients more both pre- and postoperatively. The averages of all the indexes of the subgroups of the SCL-90R, which relates to psychological condition of patients, showed a statistically significant reduction at 2 years following VBG, indicative of the improvement of the patients' psychosomatic condition. The more weight patients lost, the more their quality of life improved, as evaluated by the BAROS (P<0.001). CONCLUSIONS The bariatric surgery most satisfactorily improved the patients' psychosomatic condition, as well as their quality of life, during the first 2 years after VBG.
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Affiliation(s)
- E Mamplekou
- Bariatric Unit, Department of Surgical Oncology, University Hospital, Heraklion, Crete, Greece
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Melissas J. Laparoscopic adjustable band combined with duodenal switch article. Obes Surg 2005; 15:1086-7; author reply 1087. [PMID: 16105415 DOI: 10.1381/0960892054621297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Our field is "bariatric" surgery. Bari means weight or pressure in ancient and modern Greek. However, bari denotes obese in biblical Hebrew and healthy in modern Hebrew. The Greek language and the Hebrew language (spoken by many ancient Northwest Semitic peoples) come from different language roots. We surveyed interactions between the two languages, to determine historically how bari could have become a "loanword". Ample mingling of the peoples was found.
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Melissas J, Kontakis G, Volakakis E, Tsepetis T, Alegakis A, Hadjipavlou A. The Effect of Surgical Weight Reduction on Functional Status in Morbidly Obese Patients with Low Back Pain. Obes Surg 2005; 15:378-81. [PMID: 15826473 DOI: 10.1381/0960892053576703] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although low back (LBP) pain is not a life-threatening disease, it is a source of significant discomfort and disability and accounts for work absences. It has been shown previously that morbid obesity is associated with increased frequency of LBP and that surgical weight loss improves the symptomatology. However, there are no studies to quantitatively assess the exact degree of functional disability caused by severe obesity and the degree of improvement of LBP that follows weight loss from bariatric surgery. METHODS 29 morbidly obese candidates for bariatric surgery with LBP, weight 132.5+/-27 (mean+/-SD) kg and BMI 47.2+/-8.8 kg/m2 were examined for their functional status using psychometric instruments specifically designed to objectively assess the patients' complaints. The preoperative scores were measured by a) visual analogue scales (VAS1, VAS2, VAS3), b) Roland-Morris disability questionnaire, c) Oswestry LBP disability questionnaire, and d) Waddell disability index, and were compared with the scores obtained by the same instruments 2 years after vertical banded gastroplasty. RESULTS The postoperative weight (92.3+/-19 kg) and BMI (32.9+/-6.3 kg/m2) of the 29 patients were significantly reduced (P<0.001). The improved functional disability scores were statistically significant: a) VAS1 1.59+/-1.86 (mean+/-SD) vs 0.32+/-0.64, P<0.001; b) VAS2 5.5+/-1.97 vs 2.14+/-1.88, P<0.001; c) VAS3 0.77+/-1.11 vs 0.09+/-0.29, P=0.006, d) Roland-Morris 7.89+/-5.11 vs 1.89+/-2.13, P<0.001; e) Oswestry 21.22+/-15.63 vs 5.61+/-7.51, P<0.001; f) Waddell 2.81+/-1.37 vs 0.56+/-0.72, P<0.001. CONCLUSIONS Surgical weight loss significantly improves the degree of functional disability of morbidly obese patients suffering from LBP.
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Affiliation(s)
- John Melissas
- Department of Surgical Oncology, Faculty of Medicine, University of Crete, Greece.
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de Bree E, Melissas J, Schoretsanitis G, Sanidas E, Tsiftsis DD. Pylorus-preserving pancreaticoduodenectomy with external pancreatic remnant drainage. Acta Chir Belg 2004; 104:668-72. [PMID: 15663272 DOI: 10.1080/00015458.2004.11679640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy is the mainstay of surgical treatment for various benign and malignant diseases of the head of the pancreas and the periampullar region. The incidence of postoperative morbidity remains significantly high. Various modifications have been advocated for the restoration of the digestive continuity and drainage of bile and pancreatic ducts in order to diminish this high morbidity rate. METHODS A new modification with the combination of an end-to-end duodenojejunal anastomosis and creation of an external pancreatic fistula following pylorus-preserving pancreaticoduodenectomy is described. Our initial experience with this modification in seven patients is reported and its advantages are discussed. RESULTS There was no mortality, while morbidity was 29%, including postoperative pneumonia and psychosis in one patient, and intra-abdominal abscess in another patient. No significantly delayed gastric emptying was observed and no patient developed diabetes, anastomotic ulcer or reflux cholangitis postoperatively. CONCLUSIONS The reported technique seems to be a safe modification of restoration after pancreaticoduodenectomy, with maintenance of anatomical gastrointestinal continuity, avoidance of complications from anastomosis with the pancreatic remnant, as well as maintenance of endocrine pancreatic function. However, long-term follow-up and larger comparative studies are needed to evaluate the impact of this modification on morbidity and mortality, including long-term nutritional complications.
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Affiliation(s)
- E de Bree
- Department of Surgical Oncology, University Hospital, Medical School of Crete, Herakleion, Greece.
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Melissas J, de Bree E, Schoretsanitis G, Tsiftsis DD. Experience with benign splenic disease. Acta Chir Belg 2004; 104:559-63. [PMID: 15571023 DOI: 10.1080/00015458.2004.11679614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In the ongoing effort to improve patient treatment, a deeper understanding of the symptomatology, physical signs and management options of rare splenic, non-traumatic, benign diseases is extremely important. PATIENTS AND METHODS The records of eight consecutive patients with benign splenic conditions, other than injury and abscess, were reviewed retrospectively in order to analyse the clinical presentation, diagnostic methodology and therapeutic procedures applied in these rare conditions. Of the eight patients, three were diagnosed with splenic hydatid cyst, two with pseudocysts, one with splenic epidermoid cyst, one with wandering spleen and one with infraction of an ectopic spleen with situs inversus of other intra-abdominal organs. RESULTS Upper abdominal pain was the most common presenting symptom and a tender palpable mass in the left upper abdominal quadrant, the predominant clinical finding. Pre-operative CT scanning confirmed the diagnosis in six patients, but failed to reveal the splenic pathology in the remaining two cases. Seven patients underwent splenectomy while saving splenic parenchyma was feasible in only one patient (12,5%). CONCLUSIONS Splenic, non-traumatic, benign diseases have vague clinical presentation and may create diagnostic difficulties. Although spleen saving intervention can be applied in selected cases, splenectomy would be required in most patients.
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Affiliation(s)
- J Melissas
- Department of Surgical Oncology, University General Hospital, Heraklion Crete, Greece.
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de Bree E, Michalakis J, Melissas J, Sanidas E, Tsiftsis DD. Spontaneous transanal bullet discharge following pelvic gunshot injury. ANZ J Surg 2004; 74:82. [PMID: 14986676 DOI: 10.1046/j.1445-1433.2003.02875.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Melissas J, Schoretsanitis G, Daskalakis M, Tsiftsis DD. Sigmoidoduodenal fistula as a rare complication of colonic carcinoma: report of a case. Surg Today 2003; 33:623-5. [PMID: 12884103 DOI: 10.1007/s00595-003-2547-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 04/02/2002] [Accepted: 11/19/2002] [Indexed: 10/26/2022]
Abstract
We report a very unusual case of malignant sigmoidoduodenal communication. To the best of our knowledge, this is the first documentation of this entity in the English language literature. A 76-year-old man presented with weakness, severe weight loss, foul-smelling eructations, anemia, constipation, and episodes of diarrhea. A sigmoidoduodenal fistula was found by barium enema, and a diagnosis of ulcerative colonic adenocarcinoma was made from the colonoscopy findings. Thus, we performed sigmoid colectomy with resection of the fistula and the involved anterior wall of the third duodenal part, followed by primary closure of the duodenal defect. Histological examination confirmed a Dukes' B (Stage II - T(4)N(0)M(0)) colonic adenocarcinoma, and the excision margins of the resected duodenal specimen were clear. We gave adjuvant chemotherapy with 5-fluorouracil and leucovorin. The patient is still alive and disease-free, 2 years postoperatively.
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Affiliation(s)
- John Melissas
- Department of Surgical Oncology, Heraklion University Hospital, Heraklion, Crete, Greece
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Papaioannou A, Michaloudis D, Fraidakis O, Petrou A, Chaniotaki F, Kanoupakis E, Stamatiou G, Melissas J, Askitopoulou H. Effects of Weight Loss on QT Interval in Morbidly Obese Patients. Obes Surg 2003; 13:869-73. [PMID: 14738673 DOI: 10.1381/096089203322618687] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obesity causes structural changes to the heart that may influence its function. Furthermore, morbid obesity is associated with an acquired prolongation of the QTc interval that may lead to potentially hazardous arrhythmias. The present study investigated the effect of body weight loss following vertical banded gastroplasty (VBG) on the QTc interval. METHODS 17 morbidly obese patients, scheduled for elective VBG, were studied before the operation and 8-10 months postoperatively, when each patient had achieved a weight loss of >/= 25% of the preoperative body weight. RESULTS 15 patients achieved significant body weight loss of >/= 25% within the first 8-10 postoperative months (P <0.001). This weight loss, corresponding to an excess weight loss of 48.7% and a mean body mass index (BMI) reduction from 49.7 kg/m2 to 36.6 kg/m2, was followed by significant shortening of the QTc interval from 428 msec to 393 msec (P <0.001). CONCLUSIONS The significant postoperative weight loss following VBG was accompanied by shortening of the QTc interval. This effect is expected to reduce the incidence of fatal conditions associated with the long QT syndrome, such as malignant ventricular arrhythmias and sudden death, and therefore improve morbidity and mortality.
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Affiliation(s)
- Alexandra Papaioannou
- Department of Anesthesiology, Cardiology and Surgical Oncology, University Hospital of Heraklion, Crete, Greece
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Ganotakis ES, Mandalaki K, Tampakaki M, Malliaraki N, Mandalakis E, Vrentzos G, Melissas J, Castanas E. Subclinical hypothyroidism and lipid abnormalities in older women attending a vascular disease prevention clinic: effect of thyroid replacement therapy. Angiology 2003; 54:569-76. [PMID: 14565632 DOI: 10.1177/000331970305400506] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors evaluated the frequency and type of lipid disorders associated with subclinical hypothyroidism (SH) in older women referred to their university vascular disease prevention clinic. They also assessed the results of thyroid replacement therapy. Fasting serum lipid profiles and thyroid function tests were measured in 333 apparently healthy women (mean age: 71.8 +/- 7 years). These women were divided into 3 groups: group I: 60-69 years old (n = 132); group II: 70-79 years old (n = 153); group III: 80-89 years old (n = 48). SH was defined as a serum thyrotropin concentration higher than 3.20 mlU/mL with a normal free thyroxine concentration. The prevalence of SH was 7.5%. Thyrotropin was higher than 3.20 mU/mL in 25 women; 7 (5.3%), 14 (9.2%), and 4 (8.3%) in groups I, II, and III, respectively. Low-density lipoprotein cholesterol (LDL-C) concentrations were higher in the women with SH (p = 0.037). The mean values of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C ratio, lipoprotein (a) (Lp[a]), apolipoprotein A-I (apo AI) apolipoprotein B100 (apo B) and apo B/apo A ratio were higher and triglycerides (TG) were lower, compared with those with normal levels of thyrotropin. However, none of these differences reached significance. Restoration of euthyroid status (thyroxine: 50-100 microg/day) in 17 SH women significantly improved TC (p = 0.017), LDL-C (p = 0.014), TC/HDL-C (p = 0.05), LDL-C/HDL-C (p = 0.03), apo B (p = 0.013), and Lp(a) (p = 0.0005) values. SH is relatively common in older women attending a vascular disease prevention clinic. Thyroid hormone replacement therapy significantly improved serum lipids. In particular, the reduction in LDL-C and Lp(a) concentrations may be of clinical benefit.
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Affiliation(s)
- Emmanouil S Ganotakis
- Department of Internal Medicine, University General Hospital, University of Crete, School of Medicine, Heraklion, Crete, Greece.
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Abstract
BACKGROUND Although low-back pain (LBP) is a common health problem and a source of significant discomfort, disability and work absences, its incidence, severity and outcome have not been extensively investigated in morbidly obese patients undergoing bariatric surgery. METHODS 50 morbidly obese candidates for vertical banded gastroplasty (VBG) were asked to fill in a questionnaire, to assess the incidence and severity of any existing LBP symptoms. 50 non-obese patients, admitted to our surgical unit for management of several benign conditions, were also asked to fill in the same questionnaire and served as controls. 24 months after VBG, the morbidly obese patients were again evaluated for their LBP symptoms. RESULTS LBP was identified in 29 morbidly obese patients (58%) preoperatively and in only 12 (24%) of the lean controls (P<0.01). 2 years after VBG, with a significant excess weight loss (P<0.0001), only 10 patients continued to have LBP but less frequently and requiring reduced doses of medications compared with the preoperative condition. In the remaining 19 patients with preoperative positive LBP history, the postoperative weight loss was associated with complete resolution of the symptoms. CONCLUSION The frequency of LBP is significantly higher in morbidly obese patients than in lean subjects. Surgical weight reduction results in significant improvement and even disappearance of this obesity co-morbidity.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, Medical School, University of Crete, Greece.
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de Bree E, Romanos J, Michalakis J, Relakis K, Georgoulias V, Melissas J, Tsiftsis DD. Intraoperative hyperthermic intraperitoneal chemotherapy with docetaxel as second-line treatment for peritoneal carcinomatosis of gynaecological origin. Anticancer Res 2003; 23:3019-27. [PMID: 12926156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Cytoreductive surgery with continuous hyperthermic perfusion peritoneal chemotherapy (CHPPC) is a relatively new multimodality treatment for peritoneal malignancies. We studied the feasibility and outcome of CHPPC with docetaxel as second-line treatment for gynaecological peritoneal carcinomatosis. PATIENTS AND METHODS Twenty times CHPPC with docetaxel was performed in 19 patients, mean age of 65 years (47-80), who demonstrated early recurrent or persistent peritoneal carcinomatosis mainly of ovarian origin. RESULTS Treatment-related death was noted in 2 elderly patients with a high tumour load. Two other major complications, requiring re-operation, were recorded. Haematological docetaxel-induced toxicity was highly limited, while the wound complication rate was relatively high. Ascites disappeared in all patients. After a mean follow-up of 30 months, the actuarial overall 1- and 3-year survival rates after CHPPC were 79% and 63%. CONCLUSION CHPPC with docetaxel following cytoreductive surgery for early recurrent or persistent peritoneal carcinomatosis from gynaecological malignancies seems feasible and might have a positive impact on survival. The outcome seems to be superior to that of CHPPC with other drugs.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Phytogenic/administration & dosage
- Chemotherapy, Cancer, Regional Perfusion/methods
- Combined Modality Therapy
- Docetaxel
- Female
- Humans
- Hyperthermia, Induced/methods
- Infusions, Parenteral
- Intraoperative Care/methods
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Recurrence, Local/therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Paclitaxel/analogs & derivatives
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/secondary
- Peritoneal Neoplasms/surgery
- Peritoneal Neoplasms/therapy
- Taxoids
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Affiliation(s)
- Eelco de Bree
- Regional Cancer Treatment Unit, Department of Surgical Oncology, University Hospital-Medical School of Crete, Herakleion, Greece.
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Abstract
BACKGROUND Technical improvements of laparoscopic bariatric procedures are important to minimize operative time and increase safety and simplicity. METHODS A modification is described of the "classic" Mason-MacLean vertical banded gastroplasty (VBG), performed by laparoscopy, with wedge resection of the gastric fundus, thus avoiding the time-consuming and technically difficult gastro-gastrostomy window. RESULTS The technique used was simple and safe, and required less operative time than the "classic" method, without serious intra- or postoperative complications. Weight loss in 18 patients who underwent the modified laparoscopic VBG and were followed-up for 1 year was equal to that achieved in patients who underwent open VBG at our Institution. Gastro-gastric fistula was not observed in upper GI barium studies performed 12 months postoperatively. CONCLUSION The modified technique is preferable when lap-VBG is indicated for surgical treatment of morbidly obese patients.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, Medical School, University of Crete, Greece.
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Abstract
An extremely rare case of synchronous parathyroid and papillary thyroid carcinoma is reported for a patient presenting with hyperparathyroidism. This case is the first reported in the English literature of hyperfunctioning parathyroid carcinoma and concomitant thyroid carcinoma without a previous history of neck irradiation.
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Affiliation(s)
- George Schoretsanitis
- Departments of Surgical Oncology, Heraklion University Hospital, University of Crete Medical School, 42 Lefteraiou Street, Heraklion 71305, Crete, Greece
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Abstract
BACKGROUND Quality of life is poor in morbidly obese patients, because of impaired physical and psychosocial functioning. Surgical treatment offers long-term weight reduction and amelioration of most associated comorbidities. Studies of the effect of weight loss on patients' mental well-being are required, because discrimination and psychopathologic consequences represent a heavy burden. PATIENTS AND METHODS 53 patients were interviewed 48 hours before vertical banded gastroplasty (VBG) by the psychiatric team and completed the self-administered SCL-90-R questionnaire. Correlations of patients' age, educational level, employment, duration of obesity and family conditions were investigated and compared with the degree of obesity 10-12 months postoperatively. 35 patients returned to psychiatric follow-up and completed the same questionnaire, and the various psychopathologic characteristics were compared to the preoperative ones. RESULTS Females had statistically significant higher scores in all psychopathologic parameters studied; more obvious differences were seen in depression (P < 0.001), paranoid ideation (P < 0.001) and interpersonal sensitivity (P < 0.001). Correlations of several demographic characteristics with the patients' preoperative BMI were negative. 10-12 months following VBG, statistically significant improvement in the parameters of phobic anxiety, obsessions-compulsions, paranoid ideation and interpersonal sensitivity (P < 0.05) were found. CONCLUSION Pre-existing psychopathology was more obvious among females, and improved significantly following successful weight loss 1 year postoperatively.
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Affiliation(s)
- G M Papageorgiou
- Psychiatric Department EVANGELISMOS, General Hospital, Athens, Greece
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Melissas J, Kampitakis E, Schoretsanitis G, Mouzas J, Kouroumalis E, Tsiftsis DD. Does reduction in gastric acid secretion in bariatric surgery increase diet-induced thermogenesis? Obes Surg 2002; 12:399-403. [PMID: 12082896 DOI: 10.1381/096089202321088246] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients who have undergone gastrectomy for benign ulcer do not develop obesity. Furthermore, morbidly obese patients who undergo biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGBP) and vertical banded gastroplasty (VBG) plus truncal vagotomy, may lose more weight compared with patients who undergo VBG alone. A common characteristic of the above is the reduction of gastric hydrochloric acid secretion. We investigated whether reduction in gastric acid increases dietary-induced thermogenesis because of maldigestion of foods, and this may account for the greater weight loss in the above situations. MATERIALS AND METHODS 22 volunteers without symptoms from the upper gastrointestinal tract were studied. Gastric pH was measured and resting energy expenditure (MREE), using indirect calorimetry, was determined before and 8 hours after consumption of a standard meal. Parameters were measured again after 2 months administration of proton pump inhibitors in all volunteers. RESULTS Although significant reduction of gastric acid secretion occurred (p < 0.01), following administration of proton pump inhibitors, the fasting and postprandial MREE remained unchanged (p > 0.05). CONCLUSIONS The reduction in gastric acid secretion does not increase the energy requirements for digestion of foods and thus is neither the mechanism responsible for the increased weight loss observed after RYGBP or BPD, nor the explanation for the lean appearance of gastrectomized patients.
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Affiliation(s)
- John Melissas
- Department of Surgical Oncology, Heraklion University Hospital, University of Crete Medical School, Greece.
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Abstract
BACKGROUND Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. Early diagnosis and appropriate management are therefore challenging aspects for physicians. PATIENTS AND METHODS We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass. RESULTS The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. Staphylococcus aureus was the causative microorganism in the first two and Bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor. CONCLUSIONS A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses.
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Affiliation(s)
- J Melissas
- Department of Surgical Oncology, Heraklion, University Hospital, Greece.
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Melissas J, Kampitakis E, Schoretsanitis G, Mouzas J, Kouroumalis E, Tsiftsis DD. Does reduction in gastric acid secretion in bariatric surgery increase diet-induced thermogenesis? Obes Surg 2002; 12:236-40. [PMID: 11975219 DOI: 10.1381/096089202762552412] [Citation(s) in RCA: 2] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients who have undergone gastrectomy for benign ulcer do not develop obesity. Furthermore, morbidly obese patients who undergo biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGBP) and vertical banded gastroplasty (VBG) plus truncal vagotomy, may lose more weight compared with patients who undergo VBG alone. A common characteristic of the above is the reduction of gastric hydrochloric acid secretion. We investigated whether reduction in gastric acid increases dietary-induced thermogenesis because of maldigestion of foods, and this may account for the greater weight loss in the above situations. MATERIALS AND METHODS 22 volunteers without symptoms from the upper gastrointestinal tract were studied. Gastric pH was measured and resting energy expenditure (MREE), using indirect calorimetry, was determined before and 8 hours after consumption of a standard meal. Parameters were measured again after 2 months administration of proton pump inhibitors in all volunteers. RESULTS Although significant reduction of gastric acid secretion occurred (p < 0.01), following administration of proton pump inhibitors, the fasting and postprandial MREE remained unchanged (p > 0.05). CONCLUSIONS The reduction in gastric acid secretion does not increase the energy requirements for digestion of foods and thus is neither the mechanism responsible for the increased weight loss observed after RYGBP or BPD, nor the explanation for the lean appearance of gastrectomized patients.
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Affiliation(s)
- John Melissas
- Department of Surgical Oncology, Heraklion University Hospital, Greece.
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