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Davakis S, Charalampopoulos G, Liakakos T, Charalabopoulos A. A rare cause of tracheopleural fistula following minimally invasive oesophagectomy. Ann R Coll Surg Engl 2023; 105:288-290. [PMID: 36239959 PMCID: PMC9974352 DOI: 10.1308/rcsann.2022.0104] [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] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
Totally minimally invasive oesophagectomy (TMIE) has been utilised to reduce respiratory and cardiac complications, offering favourable clinical and oncological outcomes. A 62-year-old male patient underwent two-stage TMIE for a Siewert type I tumour. During thoracoscopic oesophageal mobilisation and lymphadenectomy, a 10-mm bone-like mass was recognised and dissected along the subcarinal nodes, revealing a 2-3mm opening on the inferomedial aspect of the right main bronchus. The airway opening was repaired after conversion. This is the first report of an accessory cardiac bronchus encountered during oesophagectomy. Recognition of its characteristic position and features may result in early diagnosis and avoidance of a potentially lethal injury.
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Affiliation(s)
- S Davakis
- Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | | | - T Liakakos
- Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - A Charalabopoulos
- Laiko General Hospital, National and Kapodistrian University of Athens, Greece
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Sakarellos P, Papalois A, Gakiopoulou H, Zacharioudaki I, Katsimpoulas M, Belia M, Moris D, Aggelou K, Vagios I, Davakis S, Vailas M, Liakakos T, Diamantis T, Felekouras E, Kontos M. Growth of Intestinal Neomucosa on Pedicled Gastric Wall Flap, a Novel Technique in an Animal Model. J INVEST SURG 2022; 35:1329-1339. [PMID: 35196939 DOI: 10.1080/08941939.2022.2034196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Short bowel syndrome (SBS) remains an unsolved issue in modern medicine. Numerous experimental surgical techniques have been proposed in the attempt to increase the intestinal absorptive capacity.Materials and Methods: Ten female Landrace pigs, divided in two groups of 5 (A and B), were explored through a midline incision. A spindle-shaped vascularized full-thickness gastric wall flap (GWF) consisting of part of the major curvature with the gastroepiploic arch preserved was de-epithelialized and then placed as a "patch" to cover an antimesenteric border defect of either a nonfunctional blind intestinal loop (group A) or a functional intestinal loop of the gastrointestinal tract (group B). A spindle-shaped curved, rigid, low density polyethylene (LDPE) splint was sutured on the external surface of the patch in order to prevent shrinkage of GWF and collapse of the intestinal wall in group A.Results: There was a decrease of both dimensions of the patch. Microscopically a thin layer of columnar epithelial cells covered the center of the patch, evolving in shorter, blunt, poorly developed villi with increasing maturation laterally. The patch surface was covered by nearly 90%. In the three animals that died prematurely the coverage of GWF was negligent or suboptimal directly dependent on the length of survival.Conclusions: The hereby-described patching technique demonstrated the growth of intestinal neomucosa on the GWF. The capability of the stomach to provide large flaps and the advantages of the use of native tissues render this animal model valuable for the future research in the field.
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Affiliation(s)
- Panagiotis Sakarellos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Harikleia Gakiopoulou
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Iro Zacharioudaki
- Experimental, Educational and Research Centre, ELPEN, Athens, Greece
| | - Michalis Katsimpoulas
- Experimental Surgery Unit, Center of Clinical, Experimental Surgery and Translational Research, Βιοmedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Marina Belia
- Department of Haematology and Bone Marrow Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Dimitrios Moris
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Aggelou
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Vagios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiridon Davakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Liakakos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Diamantis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Kontos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Papalampros A, Davakis S, Syllaios A, Vagios I, Diamantopoulou P, Kyros E, Karydakis L, Goutas D, Nonni A, Felekouras E. Late onset metastasis from renal cell carcinoma masquerading as a gallbladder polyp. Ann R Coll Surg Engl 2021; 103:e13-e16. [PMID: 32969713 PMCID: PMC7705134 DOI: 10.1308/rcsann.2020.0193] [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] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. A third of people with RCC have metastatic lesions when diagnosed, and another third develop metachronous metastasis during follow-up or after surgical treatment. We report a case of gallbladder metastasis from clear-cell RCC in a 71-year-old woman 13 years after RCC of her right kidney. Preoperative imaging studies showed a suspicious, progressively enlarged gallbladder polyp. The patient underwent open cholecystectomy and lymph node dissection along the hepatoduodenal ligament. The pathology report was compatible with metastatic disease from the kidney that was previously resected. Gallbladder metastasis can occur from RCC several years after initial management. Physicians should be aware of this rare pathology, and intensive follow-up is essential after surgery for RCC.
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Affiliation(s)
- A Papalampros
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - S Davakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - A Syllaios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - I Vagios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - P Diamantopoulou
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - E Kyros
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - L Karydakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - D Goutas
- First Department of Pathology, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - A Nonni
- First Department of Pathology, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
| | - E Felekouras
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Greece
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Davakis S, Syllaios A, Meropouli A, Kyros E, Vagios I, Mpaili E, Sdralis E, Charalabopoulos A. Minimally invasive oesophagectomy for cancer in patients with HIV/AIDS: considerations and future directions. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32513017 PMCID: PMC7591628 DOI: 10.1308/rcsann.2020.0130] [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] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
The impact of HIV/AIDS on the treatment of oesophageal neoplasms remains undefined due to a lack of adequate data. We present our experience in treating patients with HIV/AIDS who have oesophageal cancer using minimally invasive techniques and discuss important key factors during perioperative management. Two men with HIV/AIDS underwent minimally invasive oesophagectomies in our department, with adequate clinical and oncological outcomes. Minimally invasive oesophagectomy can be safe and has the well-established benefits of minimally invasive techniques, offering good perioperative results and oncological outcomes in patients with HIV/AIDS. Multimodality therapy is crucial.
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Affiliation(s)
- S Davakis
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Syllaios
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Meropouli
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kyros
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - I Vagios
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Mpaili
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Sdralis
- Regional Oesophago-Gastric Cancer Centre, Broomfield Hospital, Chelmsford, Essex, UK
| | - A Charalabopoulos
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Regional Oesophago-Gastric Cancer Centre, Broomfield Hospital, Chelmsford, Essex, UK
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Davakis S, Syllaios A, Mpaili E, Sdralis E, Charalabopoulos A. Minimally invasive oesophagectomy and emerging complications: intercostal lung hernia. Ann R Coll Surg Engl 2020; 102:e73-e74. [PMID: 31845821 PMCID: PMC7027402 DOI: 10.1308/rcsann.2019.0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 08/31/2019] [Indexed: 11/22/2022] Open
Abstract
Lung herniation is a rare entity, defined as a protrusion of the lung above the normal confines of thorax; it is caused by increased intrathoracic pressure and defects or weakness of the chest wall. Intercostal lung hernia can occur spontaneously or following thoracic trauma or surgery. Postoperative hernias are more commonly associated with less extensive surgical procedures, such as thoracoscopic surgery or mini-thoracotomy incisions, rather than with major thoracic procedures. We describe the first reported case of postoperative intercostal lung hernia following two-stage totally minimally invasive oesophagectomy for cancer, together with its successful surgical repair.
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Affiliation(s)
- S Davakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Syllaios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Regional Oesophagogastric Centre, Department of Surgery, Broomfield Hospital, Chelmsford, UK
| | - E Mpaili
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Sdralis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Regional Oesophagogastric Centre, Department of Surgery, Broomfield Hospital, Chelmsford, UK
| | - A Charalabopoulos
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Regional Oesophagogastric Centre, Department of Surgery, Broomfield Hospital, Chelmsford, UK
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Davakis S, Syllaios A, Meropouli A, Mpaili E, Charalabopoulos A. Laparoscopic repair of late perforation following Heller myotomy due to overeating. Ann R Coll Surg Engl 2020; 102:e97-e99. [PMID: 32081032 DOI: 10.1308/rcsann.2020.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic Heller myotomy is the mainstay surgical treatment of oesophageal achalasia and has proven to be safe and effective over the course of time. Oesophageal perforation after myotomy can be a serious complication with devastating outcomes. Most commonly, mucosal perforation are detected intraoperatively or early postoperatively. We present an extremely rare case of late oesophageal perforation in a 28-year-old man treated with laparoscopic Heller myotomy for type II oesophageal achalasia, and its successful minimally invasive repair with laparoscopic primary suturing.
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Affiliation(s)
- S Davakis
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Syllaios
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Meropouli
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Mpaili
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Charalabopoulos
- Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Papalampros A, Vailas MG, Sotiropoulou M, Baili E, Davakis S, Moris D, Felekouras E, Deladetsima I. Report of a case combining solitary Peutz-Jeghers polyp, colitis cystica profunda, and high-grade dysplasia of the epithelium of the colon. World J Surg Oncol 2017; 15:188. [PMID: 29047391 PMCID: PMC5648433 DOI: 10.1186/s12957-017-1253-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colitis cystica profunda is a rare nonneoplastic disease defined by the presence of intramural cysts that contain mucus, usually situated in the rectosigmoid area, which can mimic various malignant lesions and polyps. Its etiology still remains not fully elucidated, and several mechanisms such as congenital, post-traumatic, and infectious have been implicated in the development of this rare entity. CASE PRESENTATION Herein, we describe a unique case of colitis cystica profunda in the setting of Peutz-Jeghers-type polyp of the sigmoid colon, associated with high-grade dysplasia of the overlying epithelium in a 48-year-old female patient, who presented to the emergency room with signs of intestinal obstruction. To the best of our insight, this is the first manifestation ever reported in the literature regarding the coexistence of solitary Peutz-Jeghers-type polyp, colitis cystica profunda, and high-grade dysplasia of the epithelium of the colon. CONCLUSIONS The purpose of this case report is to highlight colitis cystica profunda and its clinical significance. An uncommon nonneoplastic entity, many times masquerading as malignant lesion of the rectosigmoid area of the colon. Clinicians and pathologists should be aware of this benign condition that is found incidentally postoperatively in patients undergoing colectomies, leading to unnecessary increase of morbidity and mortality in these patients, who otherwise could have been cured with conservative treatment only.
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Affiliation(s)
- Alexandros Papalampros
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Michail G Vailas
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece.
| | - Maria Sotiropoulou
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Efstratia Baili
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Spiridon Davakis
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Demetrios Moris
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Evangelos Felekouras
- 1st Surgical Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Ioanna Deladetsima
- Pathology Department, Athens University School of Medicine, "Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
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Vailas MG, Moris D, Papalampros A, Sotiropoulou M, Schizas D, Davakis S, Vernadakis S. A "Trapped Heart" in an Octopus Pot: Takotsubo Cardiomyopathy; Review of a Rare Clinical Syndrome Following Solid-Organ Transplant. EXP CLIN TRANSPLANT 2017; 15:490-496. [PMID: 28967342] [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: 06/07/2023]
Abstract
OBJECTIVES Takotsubo cardiomyopathy, also known as "broken heart syndrome," "apical ballooning syndrome," and "stress-induced cardiomyopathy," was first des cribed in Japanese patients in 1990 by Sato and colleagues. Takotsubo cardiomyopathy is an increasingly recognized syndrome characterized by transient and reversible systolic dysfunction of the apical and middle segments of the left ventricle. This syndrome resembles acute myocardial infarction in the absence of evident coronary artery occlusion. Although the precise pathophysiology of takotsubo cardiomyopathy is still unknown, it seems that it is associated with excessive sympathetic stimulation, microvascular dysfunction, coronary artery vasospasm, and abnormal myocardial tissue metabolism. MATERIALS AND METHODS Herein, we sought to recognize and summarize the available literature data on Takotsubo cardiomyopathy regarding solid-organ transplant, in an attempt to provide the demographic and morphologic functional characteristics of patients with Takotsubo cardiomyopathy and related clinical implications. RESULTS AND CONCLUSIONS Transplant surgeons should maintain a high index of clinical suspicion and never underestimate takotsubo cardiomyopathy as a potential cause of heart failure following solid-organ transplant.
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Affiliation(s)
- Michail G Vailas
- First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Spyrou I, Davakis S, Moris D, Lakiotaki E, Dimitrokallis N, Papalampros A, Schizas D, Pikoulis E, Felekouras E. Inflammatory pseudotumour of the colon. Ann R Coll Surg Engl 2017; 99:e151-e153. [PMID: 28462661 DOI: 10.1308/rcsann.2017.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction A colorectal inflammatory myofibroblastic tumour (IMT) is a rare but benign entity masquerading as a malignant tumour. Although the lung is considered the most common site of occurrence, IMTs may arise in diverse extrapulmonary locations. We describe a case of a colonic IMT in a patient who presented in the emergency setting. Case History A 77-year-old man was admitted at our emergency department with acute abdominal pain. Physical examination revealed vague tenderness of the lower abdomen and non-palpable masses. Preoperative evaluation revealed a mass in the right lower quadrant of the abdomen, possibly originating from the terminal ileum, 1-2cm from the caecum. Owing to the clinical impression of a potentially malignant lesion, the patient underwent subtotal colectomy and omentectomy. The pathology report suggested the morphological and immunohistochemical features were more compatible with a colonic IMT. Conclusions A colorectal IMT is a rare clinical entity that can easily mimic a highly malignant tumour and cannot be distinguished clinically or radiologically. An accurate diagnosis is based on histological examination and surgical resection is therefore usually required.
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Affiliation(s)
- I Spyrou
- National and Kapodistrian University of Athens , Greece
| | - S Davakis
- National and Kapodistrian University of Athens , Greece
| | - D Moris
- National and Kapodistrian University of Athens , Greece
| | - E Lakiotaki
- National and Kapodistrian University of Athens , Greece
| | | | - A Papalampros
- National and Kapodistrian University of Athens , Greece
| | - D Schizas
- National and Kapodistrian University of Athens , Greece
| | - E Pikoulis
- National and Kapodistrian University of Athens , Greece
| | - E Felekouras
- National and Kapodistrian University of Athens , Greece
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