Athens Colorectal Laboratory Dr Apostolos Stamatiadis, Proctologist-Surgeon
Presentations at International Conferences
Surgical treatment of the local recurrence of rectal cancerP.Peveretos, A. STAMATIADIS, A. Fotopoulos, E. Leandros and B. Golematis Surgery in Europe, International Symposium. Rome, May 1988.
La contribution de la determination de CRP et CEA a la classification preoperatoire des tumeurs de l intestin grele P.PeveretosA. STAMATIADIS, N. Apostolidis et B, Golematis 90eme Congres Francais de Chirurgie, Septembre 1988.
Colorectal carcinoma evaluation with CT scanN. Apostolidis, A. STAMATIADIS, G. Triantos, B. Zombolas and B. Golematis 2nd Mediterranean Surgical Congress, Athens-Heraklion, June 1989.
The management of recurrent colorectal cancerP. Peveretos, G. Bonatsos, E. Leandros, A. STAMATIADIS and B. Golematis 33rd World Congress of Surgery, Toronto, September 1989.
Anal ultrasound in the evaluation of perianal abscesses and fistulasΑ. STAMATIADIS, P. Ioannidis, B. Mylonakis, B. Pararas and M. Filippakis Eurosurgery, Roma 1996.
Anal ultrasonography or computerized manometry for assessment of internal sphincter defects. A comparative studyΑ. STAMATIADIS, J Stavrakis, G. Kekos, N. Apostolidis and B. Pararas European Council for Coloproctology (ECCP) meeting. Edinburgh, June 17-19, 1997.
Ultrasonic evaluation of operative anal sphincter defectsSTAMATIADIS, A. Kavagia, N. Salametis and B. Pararas European Council for Coloproctology (ECCP) meeting. Edinburgh, June 17-19, 1997.
Perianal abscess after blunt trauma to the perineum. An ultrasonic studySTAMATIADIS, G. Nousis, G. Velimezis and B. Pararas European Council for Coloproctology (ECCP) meeting. Edinburgh , June 17-19, 1997.
The laboratory investigation of fecal incontinenceSTAMATIADIS, J. Stavrakis, G. Polymeneas and E. Kourias XXVth Balkan Medical Week, Ioannina 1-4 July 1998
Anal ultrasound- An useful diagnostic tool in the management of anorectal diseasesSTAMATIADIS, J. Stavrakis, G. Polymeneas and E. Kourias XXVth Balkan Medical Week, Ioannina 1-4 July 1998
The implication of endoanal ultrasound in the evaluation and management of perianal sepsisA. Stamatiadis, I. Karaitianos Meeting of Mediterranean Society of Coloproctology and Slovenian Section of Coloproctology 26.-28.09.2002 Otocek, Slovenia We studied the implication of endoanal ultrasound in the diagnostic investigation and management of perianal sepsis. Between 1995-2002, 339 patients with perianal sepsis (265 men and 74 women) with an age ranging between 10-85 years were examined endosonographically in the colorectal laboratory. 296 patients had no specific cause of perianal sepsis such as inflammatory bowel disease, HIV infection, postoperative infection, blunt perineal trauma, fissure-in-ano, suppurating anal neoplasm or hydradenitis. Endoanal ultrasound visualized the anatomy of perianal sphincters, the internal opening of fistula tracts, their mesosphincteric or extrasphincteric extensions. 48/296 patients were examined for acute perianal abscess and 202/296 patients for recurrent perianal sepsis (125 recurrent abscesses and 77 recurrent fistulas). Internal opening of perianal sepsis was visualized in 265/296 patients, 65/296 fistulas had extrasphinteric septic extensions and 47/296 fistulas were classified as high transphincteric. 41/77 patients with recurrent fistulas had internal anal sphincter defects and 28/77 external anal sphincter defects. Only 11/77 patients referred to symptoms of fecal incontinence. The endosonographic examination visualizes in detail the anatomy of perianal fistulas, their anatomic relation with sphinteric mechanism and any sphinter defects. This examination has a very significant contribution in the preoperative examination of difficult or recurrent cases of perianal sepsis and may help in the one-stage treatment of perianal abscesses.
Endosonographic findings in patients with fecal incontinenceA. Stamatiadis and B. Komborozos 9th Biennial Congress of the European Council of Coloproctology (ECCP Athens 2003) Between 1995-2003 105 patients with fecal incontinence (FI) were examined with endorectal ultrasound in our laboratory. There were 71 patients with a definite history of anatomic risk factors (congenital diseases, anorectal operation, difficult delivery, sexual abuse or other trauma). Most common risk factors in the patients history was anal dilatation in 21 patients, difficult delivery in 20 patients, internal sphincterotomy in 14 and fistula repair in 13 patients. 13 patients had evidence of internal or external rectal prolapse. In 26 patients, no risk factor was identified before the examination. Endoanal ultrasound revealed sphincter defects in 65 patients (56 internal anal sphincter defects and 49 external anal sphincter defects). Sphincter defects were found in 60/71 patients with a history of anorectal trauma and in 5/34 patients without a history of trauma. The etiology of FI was considered as non-traumatic after endoanal ultrasound examination in 44 patients (8 patients with endosonographic evidence of sphincter trauma). The results of endorectal ultrasound had a significant impact in the subsequent management of FI (sphincter repair, muscle transposition, biofeedback training or prolapse repair).
Endosonographic investigation of complicated perianal sepsisA. Stamatiadis, B. Komborozos, I.G. Karaitianos. 9th Biennial Congress of the European Council of Coloproctology (ECCP Athens 2003) Background The aim of the study is to evaluate the role of endoanal ultrasound in the investigation and management of complicated perianal sepsis (recurrent, high transsphincteric, extrasphincteric fistulas or fistulas extending to the rectal ampulla). Methods Between 1995-2003 403 patients with perianal sepsis were investigated in the colorectal laboratory. There were 313 men and 90 women with their age ranging between 10-85 years. 57 patients had some specific cause of perianal sepsis such as inflammatory bowel disease, HIV infection, postoperative sepsis, blunt perineal trauma, fissure-in-ano, septic anal neoplasm or hydradenitis. 346 patients had no specific cause for perianal sepsis. 53/346 patients presented with acute perianal abscess and 239/346 patients with recurrent perianal inflammation (208 recurrent abscesses and 94 recurrent fistulas). In 312/346 patients an internal opening of perianal fistula was detected (anterior internal opening in 113 and posterior in 184/346 patients). Results There were 74/346 patients with extrasphincteric extension of perianal sepsis, 501346 patients with high transsphincteric fistulas and 43/346 patients with septic extension to the level of rectal ampulla. The internal opening was located posteriorly in 41/50 high transsphincteric fistulas, in 35/43 fistulas with septic extension to the level of rectal ampulla, in 57/74 fistulas with extrasphincteric extension and in 51/94 recurrent fistulas. 44/94 patients with recurrent fistulas had an internal anal sphincter trauma and 31/94 patients had an external anal sphincter trauma. Only 11/94 patients with recurrent fistulas had symptoms of fecal incontinence. The endosonographic investigation of perianal sepsis and fistulas helps significantly in the detection of internal opening, in the clarification of the anatomy and extensions of perianal sepsis, its relationship with anal sphincters and possible sphincter trauma. Conclusions This examination is mandatory in complicated or recurrent perianal sepsis in order to optimise surgical treatment.
Rigid transanal ultrasound: a modification of the technique for the imaging of rectal lesions, without a water-filled balloonApostolos Stamatiadis, Halikias loannis, Koborosos Vasilios, Karaitianos loannis 9th Biennial Congress of the European Council of Coloproctology (ECCP Athens 2003) AIM: We describe herein a modification of the standard rigid transanal ultrasonographic technique that allows for optimal imaging of the rectum. According to the standard technique, the intraluminal probe rotates around its longitudinal axis within a distilled water-filled elastic balloon to achieve acoustic contact with the rectal wall. However, the rectal lumen is not of spherical form, which results in a suboptimal acoustic contact. Moreover, the balloon tends to compress and alter the echomorphology of both the intraluminal and intramural lesions, and may even impair the free rotation of the probe, resulting in malfunction and breakdown of the apparatus. MATERIALS AND METHODS: We have modified the technique as follows: Following a standard enema, we introduce the rigid probe without a balloon, after having instilled a sufficient amount of degassed water to completely fill the rectal lumen. We thus achieve optimal acoustic contact with the rectal wall, which results in even more precise imaging of the rectosigmoid, without altering the form of the luminal or mural lesions. This technique can be further developed as an adjunct to the study of motility disorders of the rectum. It should be stressed that the rectum must be thoroughly prepped, as even minor particle or air contamination may interfere with the imaging. Obviously, this technique cannot be applied in case of moderate to severe incontinence. During the past 6 months, we successfully applied this technique for the imaging of rectal neoplasm (N=25), perianal fistula and abscess (N=15) and rectal prolapse (N=3). CONCLUSION: Our modification of the standard rigid .TRUS technique allows for optimal imaging of both intraluminal and intramural lesions of the rectum, in rectal neoplasms, sepsis and prolapse
ENDOSONOGRAPHIC DIAGNOSIS OF ACUTE PERIANAL SEPSIS COMPLICATING ANAL DILATATIONStamatiadis Apostolos , Halikias loannis, Danias Nikolaos 9th Biennial Congress of the European Council of Coloproctology (ECCP Athens 2003) AIM: Acute perianal sepsis is a rare complication of the anal dilatation. The pertinent bibliography on the subject is scarce. We present our experience in endosonographic diagnosis of perianal sepsis following manual dilatation of the anus. MATERIALS AND METHODS: Since 1999 we have examined 6 patients with perianal sepsis (4 male, 2 female, 36 to 67 years old) referred to our lab for rigid TRUS, following manual dilatation of the anus for the treatment of hemorrhoids. They were submitted to standard preparation of the anorectum (Fleet enema, one hour prior to the examination). A 7.5 MHz. rigid transducer was introduced, covered with a degassed water-filled balloon to achieve acoustic contact. All examinations were performed by a single colorectal surgeon (S.A.).RESULTS: Either perianal abscess or perianal fistula was demonstrated in all 6 patients referred to us with the clinical diagnosis of perianal sepsis. Presenting symptoms varied from overt sepsis (perianal pain, fever and malaise) to mild anal pain and purulent discharge. Referral time varied from 7 to 26 days following manual dilatation for the treatment of hemorrhoids. TRUS clearly demonstrated the presence of abscess and/or fistula, their anorectal topography in relation to the anal sphincters, and most interestingly the integrity of the sphincters, which should be taken into account prior to attempting any treatment. CONCLUSION: ‘Perianal sepsis is a rare, and perhaps underreported, complication of the manual dilatation of the anus. TRUS imaging is a safe and effective method for establishing the diagnosis of this complication and may be useful adjunct to the preoperative management of this rare but troublesome complication