John Griniatsos - Academia.edu (original) (raw)

Papers by John Griniatsos

Southern Medical Journal, 2007

A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for el... more A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a conventional open approach. Copious hemostasis was achieved using sutures, clips and diathermy, and no bile duct or vascular injuries were recognized intraoperatively. Because of severe right upper quadrant abdominal pain and significant deterioration of the liver function tests (LFTs) on the first postoperative day, the patient underwent a Doppler ultrasound scan which showed absence of blood flow at the level of porta hepatis. Urgent relaparotomy revealed an ischemic liver on the right, a transected common bile duct at the level of its confluence, a divided and ligated right hepatic artery and thrombosed portal vein down to its confluence. Thrombectomy and reconstruction of the portal vein were performed to salvage the left hemiliver, and after restoration of blood flow to the left hemiliver, a right hemihepatectomy and a Roux-en-Y hepaticojejunostomy on the left were performed.

Rural and remote health

It has been established that patients prefer receiving health information from primary care physi... more It has been established that patients prefer receiving health information from primary care physicians. In Greece, recent reforms supporting urban primary healthcare have not been enacted, and long waiting times in Athens' emergency departments are common. To evaluate cases treated in the emergency department of a Greek general hospital and explore the potential role of primary care in managing these cases. A total of 53,926 patients visited the emergency department studied during on-call days from February 2005 to February 2006. The cases were classified into 6 groups according to their main complaint: (1) internal medicine; (2) surgical; (3) orthopedic; (4) otorhinolaryngology (ENT); (5) eye disorders (ophthalmology); and (6) gynecology-obstetric. Of the 53,926 patients studied, 9167 (17%) came from a rural area. The internal medicine department was most commonly attended (15,373; 28.5%), followed by orthopedics (16.9%). In the surgical, ENT, ophthalmology and gynecology group...

International surgery

The appropriate treatment for extrahepatic hepatic artery aneurysms remains controversial, with a... more The appropriate treatment for extrahepatic hepatic artery aneurysms remains controversial, with arguments for and against embolization. We describe a case of a giant true aneurysm of the common hepatic artery associated with obstructive jaundice of nonhemobilia origin. The patient, a 49-year-old previously healthy man, presented with upper midepigastric pain, jaundice, and low-grade fever. The diagnosis of the aneurysm was mainly based on computed tomography scan findings. The aneurysm was successfully embolized using wire coils, and the patient was operated on for acute abdomen. Necrotizing acalculus cholecystitis was found, and cholecystectomy followed by aneurysmectomy without hepatic artery reconstruction was performed. The jaundice subsided spontaneously, and the patient was discharged in good condition. Giant common hepatic artery aneurysms can be managed by either surgery or embolization. In the absence of liver ischemia there is no need for common hepatic artery reconstruction unless a bilioenteric bypass has to be performed to resolve the issue of jaundice. If the latter is required, reconstruction of the hepatic artery might be justifiable to maximize the blood supply to the bile duct.

Journal of B.U.ON.: official journal of the Balkan Union of Oncology

In the present article we present the possible pathogenetic mechanisms as well as the appropriate... more In the present article we present the possible pathogenetic mechanisms as well as the appropriate clinical and laboratory investigations for the anemia, which is associated with gastrointestinal tract malignancies. Moreover, we conducted a MEDLINE database search between 1992-2003, focusing on the currently available methods for perioperative correction and treatment of anemia.

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES

Cerrahlar "k›smi intestinal obstrüksiyon" nozolojik antitesine aflinad›r. ‹ntussusepsiyon bu anti... more Cerrahlar "k›smi intestinal obstrüksiyon" nozolojik antitesine aflinad›r. ‹ntussusepsiyon bu antite için ender olarak rastlanan bir etyolojik faktördür, ancak genellikle ameliyat öncesi tan› koyulamamaktad›r. ‹ntussusepsiyon tan›s›na yönelik birçok görüntüleme tekni¤i önerilmifltir, fakat bunlardan hiçbiri belirgin bir duyarl›l›k ve özgüllük göstermemifltir. Bu yaz›da yer alan k›smi intestinal obstrüksiyon olgusunda, spiral kar›n BT tara-mas› yap›lm›flt›r. Kullan›lan yöntem, kusursuz bir do¤rulukla, k›smi intestinal obstrüksiyonun do¤as›n› (intussusepsiyon) ve yerleflimini (ç›kan kolon) ortaya koymufltur. Bu yöntemi, klasik BT taramas›na göre ekstra avantaj olarak daha k›sa bir inceleme süresi olmas›na dayanarak, spiral BT'yi k›smi intestinal obstrüksiyonu olan hastalar›n ameliyat öncesi de¤erlendirmesinde alternatif bir tan›sal modalite olarak önermekteyiz.

International surgery

The operative management of the pancreatic stump after pancreaticoduodenectomy has been shown to ... more The operative management of the pancreatic stump after pancreaticoduodenectomy has been shown to be an important factor influencing the postoperative development of pancreatic fistula. Thus far, there is no ideal technique for reconstruction, and end-to-end pancreaticojejunostomy (PJS) represents the preferable method. Comparative analysis of early postoperative outcome was done between two groups of patients who underwent either end-to-end PJS or pancreatic remnant ligation (PRL) after pancreaticoduodenectomy. Between January 1997 and December 2001, 39 consecutive patients underwent pancreaticoduodenectomy at the 1st Department of Surgery, University of Athens Medical School. All operations were performed or supervised by two senior surgeons, and all patients underwent a Whipple's procedure. After pancreaticoduodenectomy, 23 patients underwent end-to-end PJS (PJS group), whereas the remaining 16 patients underwent PRL without pancreatic reconstruction (PRL group). We compared the two groups in terms of patients' characteristics, clinical presentation, serum laboratory values on admission, operative details, and postoperative course. The morbidity and mortality rates were 15.4% and 5.1%, respectively, for the whole series. In the PJS group, the morbidity rate was 8.7%, the pancreatic fistula formation rate was 4.3%, and the mortality rate was 4.3%. In the PRL group, the morbidity rate was 25%, the pancreatic fistula formation rate was 12.5%, and the mortality rate was 6.25%. These differences were not statistically significant. There were two deaths in the whole series (one in each group); however, none of the deaths were related to pancreatic fistula formation. Hospital stay was similar in both groups. Both PJS and PRL are valid surgical options that correlate with acceptable postoperative incidence of pancreatic fistula formation, morbidity, and mortality rates. Although PRL avoids the construction of the most risky anastomosis, the results of this study show that early postoperative results after PRL are not superior to PJS; therefore, the method should not be considered as the treatment of choice for the pancreatic stump after a Whipple's procedure. Meticulous surgical technique, surgical experience, and close postoperative care are essential for a successful outcome after this major abdominal operation.

The West Indian medical journal

Acta gastro-enterologica Belgica

Background and aim of the study : Although anal cancer represents a relatively uncommon malignanc... more Background and aim of the study : Although anal cancer represents a relatively uncommon malignancy, its incidence over the last five decades, has been reported as increased for both sexes, worldwide. Human papillomavirus (HPV) infection has been shown to be a major cause for its development. The aim of the present study is to report on clinical, epidemiological and virological data of squamous anal cancer in Greek patients.

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU... more To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU) biologically modulated by folinic acid (FA) plus a somatostatin analogue (octreotide acetate-long acting formulation-LAR) that can both inhibit the action of several growth factors and angiogenesis, in patients with advanced pancreatic cancer. Thirty-two patients with advanced symptomatic pancreatic cancer with measurable disease and median age 64 years (range 50-72) received the following combination: 5-FU, given at 350 mg/m(2) i.v. bolus, biologically modulated by FA 350 mg/m(2) on days 1, 2, 8 and 9; and gemcitabine, given by short i.v. infusion at 1000 mg/m(2) on days 1 and 8. The regimen was administered every 3 weeks. LAR 30 mg was given intramuscularly every 4 weeks. Objective tumor response was documented in 7 out of 32 evaluable patients (all partial responses-PR), yielding a 22% response rate (RR) (95% CI 10.5-35). Sixteen (50%) patients (95% CI 31.4-60.8) remained with stabl...

International urology and nephrology, 2003

We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a... more We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming so...

Chinese medical journal, 2010

Anticancer research, 2009

To examine existing evidence, trends and possible factors that may have affected the incidence of... more To examine existing evidence, trends and possible factors that may have affected the incidence of papillary thyroid cancer (PTC) among patients undergoing thyroidectomies in an iodine-sufficient population of Greece. All histology records from the patients who had undergone thyroid surgery at the Department of Surgery Laiko Hospital, Athens, Greece from January 1991 to December 2006 were retrospectively analyzed. Records were placed in a database which included patients' demographics, history, and medical condition, clinical and surgical parameters. One thousand four hundred and twenty-six patients (265 males and 1161 females) had undergone thyroidectomy during the above period of time. All surgeons favoured total thyroidectomy with resection of pro- and paratracheal lymph nodes. Thyroid tumors were classified according to the WHO classification system and were staged according to the TNM staging system. In 278 patients, PTC was histologically diagnosed. From 1999 onwards, thyro...

International surgery

Pancreatic tuberculosis is a rare clinical setting manifesting in various ways. Most often, enlar... more Pancreatic tuberculosis is a rare clinical setting manifesting in various ways. Most often, enlarged peripancreatic lymph nodes or growing tuberculomas compress adjacent organs, leading to biliary tract or gastrointestinal obstruction. Clinical examination, laboratory data, and imaging are all unspecific. Diagnosis is frequently misguided toward neoplasia requiring surgical intervention. However, the role of surgery in pancreatic tuberculosis ends in tissue sampling, abscess drainage, and bypassing obstruction. We present three cases of pancreatic tuberculosis: two caused by obstructive jaundice and the third caused by gastric outlet obstruction. All patients were operated on. Whipple's procedure was performed in one patient, and biliary and duodenal bypassing in the remaining patients. Diagnosis was decided by histopathology in all three cases. Medical treatment was effective in all patients. Although pancreatic tuberculosis is a medical disease, surgery is frequently used. Mai...

The American surgeon, 2005

Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP)... more Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) clearance, followed by interval laparoscopic cholecystectomy (two-stage approach), constitutes the most common practice in cases of uncomplicated mild acute biliary pancreatitis. Between June 1998 and December 2002, 44 patients (35 females and 9 males with a median age of 62 years) suffering from uncomplicated mild acute biliary pancreatitis were treated in our unit. All patients were electively submitted to surgery after subsidence of the acute symptoms, and for definitive treatment we favored the single-stage laparoscopic management, avoiding preoperative ERCP. All patients underwent laparoscopic cholecystectomy plus fluoroscopic intraoperative cholangiogram (IOC). If filling defect(s) were detected in the IOC, a finding suggestive of concomitant choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) was added in the same sitting. Twenty pati...

Hellenic Journal of Surgery, 2012

This review evaluates all the upto-date published data of the literature concerning single incisi... more This review evaluates all the upto-date published data of the literature concerning single incision laparoscopic hepatectomies (SILH) for malignant and benign conditions (colorectal liver metastasis, hepatocellular carcinoma, haemangiomas and liver adenomas).

Journal of Clinical Case Reports, 2013

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013

The emphasis for research in inguinal hernia repair has shifted from hernia recurrence to groin p... more The emphasis for research in inguinal hernia repair has shifted from hernia recurrence to groin pain, which is considered the most important factor for poor quality of life. : To evaluate hernia recurrences and pain at trocar site and at inguinal hernia site, in patients who underwent tacks-free transabdominal preperitoneal inguinal hernia repair, using a lightweight nonfixed 3-dimensional mesh with peritoneal suturing. Between 2009 and 2011, 32 patients (2 female) with mean age 51 years underwent hernia repair. The mean follow-up period was 12.4 months. The mean operative time was 84 minutes. There was minimal blood loss. No bowel or urinary bladder injury had occurred. Mean hospital stay was 1 day. One patient developed seroma 4 months postoperatively. There were no conversions to open repair, no hernia recurrence, and no deaths. The mean value of pain at trocar site and inguinal hernia site 12 hours postoperatively was 1.469 and 0.875, respectively. The pain was more intense bearing a peak at 12 hours postoperatively at the trocar site, compared with the inguinal site. It is demonstrated with this technique that there are no recurrences and the chronic pain is negligible. These findings call for confirmatory randomized trials in larger series with longer follow-up.

Southern Medical Journal, 2007

A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for el... more A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a conventional open approach. Copious hemostasis was achieved using sutures, clips and diathermy, and no bile duct or vascular injuries were recognized intraoperatively. Because of severe right upper quadrant abdominal pain and significant deterioration of the liver function tests (LFTs) on the first postoperative day, the patient underwent a Doppler ultrasound scan which showed absence of blood flow at the level of porta hepatis. Urgent relaparotomy revealed an ischemic liver on the right, a transected common bile duct at the level of its confluence, a divided and ligated right hepatic artery and thrombosed portal vein down to its confluence. Thrombectomy and reconstruction of the portal vein were performed to salvage the left hemiliver, and after restoration of blood flow to the left hemiliver, a right hemihepatectomy and a Roux-en-Y hepaticojejunostomy on the left were performed.

Rural and remote health

It has been established that patients prefer receiving health information from primary care physi... more It has been established that patients prefer receiving health information from primary care physicians. In Greece, recent reforms supporting urban primary healthcare have not been enacted, and long waiting times in Athens' emergency departments are common. To evaluate cases treated in the emergency department of a Greek general hospital and explore the potential role of primary care in managing these cases. A total of 53,926 patients visited the emergency department studied during on-call days from February 2005 to February 2006. The cases were classified into 6 groups according to their main complaint: (1) internal medicine; (2) surgical; (3) orthopedic; (4) otorhinolaryngology (ENT); (5) eye disorders (ophthalmology); and (6) gynecology-obstetric. Of the 53,926 patients studied, 9167 (17%) came from a rural area. The internal medicine department was most commonly attended (15,373; 28.5%), followed by orthopedics (16.9%). In the surgical, ENT, ophthalmology and gynecology group...

International surgery

The appropriate treatment for extrahepatic hepatic artery aneurysms remains controversial, with a... more The appropriate treatment for extrahepatic hepatic artery aneurysms remains controversial, with arguments for and against embolization. We describe a case of a giant true aneurysm of the common hepatic artery associated with obstructive jaundice of nonhemobilia origin. The patient, a 49-year-old previously healthy man, presented with upper midepigastric pain, jaundice, and low-grade fever. The diagnosis of the aneurysm was mainly based on computed tomography scan findings. The aneurysm was successfully embolized using wire coils, and the patient was operated on for acute abdomen. Necrotizing acalculus cholecystitis was found, and cholecystectomy followed by aneurysmectomy without hepatic artery reconstruction was performed. The jaundice subsided spontaneously, and the patient was discharged in good condition. Giant common hepatic artery aneurysms can be managed by either surgery or embolization. In the absence of liver ischemia there is no need for common hepatic artery reconstruction unless a bilioenteric bypass has to be performed to resolve the issue of jaundice. If the latter is required, reconstruction of the hepatic artery might be justifiable to maximize the blood supply to the bile duct.

Journal of B.U.ON.: official journal of the Balkan Union of Oncology

In the present article we present the possible pathogenetic mechanisms as well as the appropriate... more In the present article we present the possible pathogenetic mechanisms as well as the appropriate clinical and laboratory investigations for the anemia, which is associated with gastrointestinal tract malignancies. Moreover, we conducted a MEDLINE database search between 1992-2003, focusing on the currently available methods for perioperative correction and treatment of anemia.

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES

Cerrahlar "k›smi intestinal obstrüksiyon" nozolojik antitesine aflinad›r. ‹ntussusepsiyon bu anti... more Cerrahlar "k›smi intestinal obstrüksiyon" nozolojik antitesine aflinad›r. ‹ntussusepsiyon bu antite için ender olarak rastlanan bir etyolojik faktördür, ancak genellikle ameliyat öncesi tan› koyulamamaktad›r. ‹ntussusepsiyon tan›s›na yönelik birçok görüntüleme tekni¤i önerilmifltir, fakat bunlardan hiçbiri belirgin bir duyarl›l›k ve özgüllük göstermemifltir. Bu yaz›da yer alan k›smi intestinal obstrüksiyon olgusunda, spiral kar›n BT tara-mas› yap›lm›flt›r. Kullan›lan yöntem, kusursuz bir do¤rulukla, k›smi intestinal obstrüksiyonun do¤as›n› (intussusepsiyon) ve yerleflimini (ç›kan kolon) ortaya koymufltur. Bu yöntemi, klasik BT taramas›na göre ekstra avantaj olarak daha k›sa bir inceleme süresi olmas›na dayanarak, spiral BT'yi k›smi intestinal obstrüksiyonu olan hastalar›n ameliyat öncesi de¤erlendirmesinde alternatif bir tan›sal modalite olarak önermekteyiz.

International surgery

The operative management of the pancreatic stump after pancreaticoduodenectomy has been shown to ... more The operative management of the pancreatic stump after pancreaticoduodenectomy has been shown to be an important factor influencing the postoperative development of pancreatic fistula. Thus far, there is no ideal technique for reconstruction, and end-to-end pancreaticojejunostomy (PJS) represents the preferable method. Comparative analysis of early postoperative outcome was done between two groups of patients who underwent either end-to-end PJS or pancreatic remnant ligation (PRL) after pancreaticoduodenectomy. Between January 1997 and December 2001, 39 consecutive patients underwent pancreaticoduodenectomy at the 1st Department of Surgery, University of Athens Medical School. All operations were performed or supervised by two senior surgeons, and all patients underwent a Whipple's procedure. After pancreaticoduodenectomy, 23 patients underwent end-to-end PJS (PJS group), whereas the remaining 16 patients underwent PRL without pancreatic reconstruction (PRL group). We compared the two groups in terms of patients' characteristics, clinical presentation, serum laboratory values on admission, operative details, and postoperative course. The morbidity and mortality rates were 15.4% and 5.1%, respectively, for the whole series. In the PJS group, the morbidity rate was 8.7%, the pancreatic fistula formation rate was 4.3%, and the mortality rate was 4.3%. In the PRL group, the morbidity rate was 25%, the pancreatic fistula formation rate was 12.5%, and the mortality rate was 6.25%. These differences were not statistically significant. There were two deaths in the whole series (one in each group); however, none of the deaths were related to pancreatic fistula formation. Hospital stay was similar in both groups. Both PJS and PRL are valid surgical options that correlate with acceptable postoperative incidence of pancreatic fistula formation, morbidity, and mortality rates. Although PRL avoids the construction of the most risky anastomosis, the results of this study show that early postoperative results after PRL are not superior to PJS; therefore, the method should not be considered as the treatment of choice for the pancreatic stump after a Whipple's procedure. Meticulous surgical technique, surgical experience, and close postoperative care are essential for a successful outcome after this major abdominal operation.

The West Indian medical journal

Acta gastro-enterologica Belgica

Background and aim of the study : Although anal cancer represents a relatively uncommon malignanc... more Background and aim of the study : Although anal cancer represents a relatively uncommon malignancy, its incidence over the last five decades, has been reported as increased for both sexes, worldwide. Human papillomavirus (HPV) infection has been shown to be a major cause for its development. The aim of the present study is to report on clinical, epidemiological and virological data of squamous anal cancer in Greek patients.

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU... more To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU) biologically modulated by folinic acid (FA) plus a somatostatin analogue (octreotide acetate-long acting formulation-LAR) that can both inhibit the action of several growth factors and angiogenesis, in patients with advanced pancreatic cancer. Thirty-two patients with advanced symptomatic pancreatic cancer with measurable disease and median age 64 years (range 50-72) received the following combination: 5-FU, given at 350 mg/m(2) i.v. bolus, biologically modulated by FA 350 mg/m(2) on days 1, 2, 8 and 9; and gemcitabine, given by short i.v. infusion at 1000 mg/m(2) on days 1 and 8. The regimen was administered every 3 weeks. LAR 30 mg was given intramuscularly every 4 weeks. Objective tumor response was documented in 7 out of 32 evaluable patients (all partial responses-PR), yielding a 22% response rate (RR) (95% CI 10.5-35). Sixteen (50%) patients (95% CI 31.4-60.8) remained with stabl...

International urology and nephrology, 2003

We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a... more We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming so...

Chinese medical journal, 2010

Anticancer research, 2009

To examine existing evidence, trends and possible factors that may have affected the incidence of... more To examine existing evidence, trends and possible factors that may have affected the incidence of papillary thyroid cancer (PTC) among patients undergoing thyroidectomies in an iodine-sufficient population of Greece. All histology records from the patients who had undergone thyroid surgery at the Department of Surgery Laiko Hospital, Athens, Greece from January 1991 to December 2006 were retrospectively analyzed. Records were placed in a database which included patients' demographics, history, and medical condition, clinical and surgical parameters. One thousand four hundred and twenty-six patients (265 males and 1161 females) had undergone thyroidectomy during the above period of time. All surgeons favoured total thyroidectomy with resection of pro- and paratracheal lymph nodes. Thyroid tumors were classified according to the WHO classification system and were staged according to the TNM staging system. In 278 patients, PTC was histologically diagnosed. From 1999 onwards, thyro...

International surgery

Pancreatic tuberculosis is a rare clinical setting manifesting in various ways. Most often, enlar... more Pancreatic tuberculosis is a rare clinical setting manifesting in various ways. Most often, enlarged peripancreatic lymph nodes or growing tuberculomas compress adjacent organs, leading to biliary tract or gastrointestinal obstruction. Clinical examination, laboratory data, and imaging are all unspecific. Diagnosis is frequently misguided toward neoplasia requiring surgical intervention. However, the role of surgery in pancreatic tuberculosis ends in tissue sampling, abscess drainage, and bypassing obstruction. We present three cases of pancreatic tuberculosis: two caused by obstructive jaundice and the third caused by gastric outlet obstruction. All patients were operated on. Whipple's procedure was performed in one patient, and biliary and duodenal bypassing in the remaining patients. Diagnosis was decided by histopathology in all three cases. Medical treatment was effective in all patients. Although pancreatic tuberculosis is a medical disease, surgery is frequently used. Mai...

The American surgeon, 2005

Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP)... more Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) clearance, followed by interval laparoscopic cholecystectomy (two-stage approach), constitutes the most common practice in cases of uncomplicated mild acute biliary pancreatitis. Between June 1998 and December 2002, 44 patients (35 females and 9 males with a median age of 62 years) suffering from uncomplicated mild acute biliary pancreatitis were treated in our unit. All patients were electively submitted to surgery after subsidence of the acute symptoms, and for definitive treatment we favored the single-stage laparoscopic management, avoiding preoperative ERCP. All patients underwent laparoscopic cholecystectomy plus fluoroscopic intraoperative cholangiogram (IOC). If filling defect(s) were detected in the IOC, a finding suggestive of concomitant choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) was added in the same sitting. Twenty pati...

Hellenic Journal of Surgery, 2012

This review evaluates all the upto-date published data of the literature concerning single incisi... more This review evaluates all the upto-date published data of the literature concerning single incision laparoscopic hepatectomies (SILH) for malignant and benign conditions (colorectal liver metastasis, hepatocellular carcinoma, haemangiomas and liver adenomas).

Journal of Clinical Case Reports, 2013

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013

The emphasis for research in inguinal hernia repair has shifted from hernia recurrence to groin p... more The emphasis for research in inguinal hernia repair has shifted from hernia recurrence to groin pain, which is considered the most important factor for poor quality of life. : To evaluate hernia recurrences and pain at trocar site and at inguinal hernia site, in patients who underwent tacks-free transabdominal preperitoneal inguinal hernia repair, using a lightweight nonfixed 3-dimensional mesh with peritoneal suturing. Between 2009 and 2011, 32 patients (2 female) with mean age 51 years underwent hernia repair. The mean follow-up period was 12.4 months. The mean operative time was 84 minutes. There was minimal blood loss. No bowel or urinary bladder injury had occurred. Mean hospital stay was 1 day. One patient developed seroma 4 months postoperatively. There were no conversions to open repair, no hernia recurrence, and no deaths. The mean value of pain at trocar site and inguinal hernia site 12 hours postoperatively was 1.469 and 0.875, respectively. The pain was more intense bearing a peak at 12 hours postoperatively at the trocar site, compared with the inguinal site. It is demonstrated with this technique that there are no recurrences and the chronic pain is negligible. These findings call for confirmatory randomized trials in larger series with longer follow-up.