+30 6974 185 742

Dr Nikiforos Ballian

General Surgeons

About this Doctor


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Hemorrhoid surgery
Hemorrhoids affect 30-40% of the population in western countries. They are engorged blood vessels of the perianal area covered by bowel lining or skin and are caused by chronic constipation and low-fiber diets. Internal hemorrhoids usually cause painless bleeding. External hemorrhoids can cause pain and, less frequently, bleeding or itching. Internal and external hemorrhoids can coexist and result in mixed symptoms. Hemorrhoids are diagnosed on clinical examination and proctoscopy. Patients with bleeding may require colonoscopy to exclude colorectal cancer. All patients with hemorrhoids should increase fiber intake and avoid constipation. This will alleviate acute symptoms and also prevent recurrence after treatment. Laser hemorrhoid coagulation Early-stage internal hemorrhoids that bleed and will not respond to conservative measures can be treated with the use of laser energy to destroy hemorrhoidal feeding blood vessels. Large hemorrhoids are removed surgically (hemorrhoidectomy) using the harmonic scalpel, a device that divides tissue in a bloodless fashion and avoids the use of sutures. This technique has the lowest recurrence rate.
Cholecystectomy refers to surgical removal of the gallbladder. This is most commonly required for symptoms related to gallstones but additional indications include gallbladder polyps and dyskinesia. Cholecystectomy is almost always performed laparoscopically, under general anesthesia with the use of four small upper abdominal incisions. Patients ambulate few hours after surgery and are discharged home the same day or after an overnight hospital stay. There are no postoperative dietary or activity restrictions and mild analgesics are required for a few days only. Laparoscopic surgery offers ideal cosmetic results while avoiding wound complications such as infection and hernia formation.
Removal of the appendix is indicated when it becomes inflamed. This is performed laparoscopically using three small abdominal incisions. Laparoscopic surgery offers ideal cosmetic results while avoiding wound complications such as infection and hernia formation. Patients can be discharged on the day of surgery without any dietary or activity restrictions.
Pilonidal cyst
Pilonidal disease usually affects young men and is caused by hair and bacteria forming a blind-ending tract (sinus) underneath the skin at the natal cleft (tailbone) area. This tract can become infected, creating a collection of pus (abscess). Over time, the blind-ending tract can develop a second skin opening and create a ‘tunnel’ (fistula). A pilonidal abscess will cause pain, swelling, redness and drainage of foul-smelling purulent fluid from the affected area. Fever can occur as well. When an abscess is not present, a fistula or sinus can cause minimal symptoms, such as a skin dimple with occasional fluid discharge. Pilonidal disease is treated surgically, usually under general anesthesia. An abscess requires drainage and sometimes antibiotics. The patient returns to his usual activities including showering, exercise, etc within days after abscess drainage. Chronic fistulas are removed surgically. In these cases infection (pus) is absent and the wound can be closed with sutures over a drain which is left in place for a few days. The midline at the natal cleft is moved laterally to prevent recurrence. Most patients do not require hospitalization and are seen as outpatients for drain and suture removal. In some cases of chronic pilonidal fistula, the tract can be cauterized from within using a laser-emitting probe.This technique does not require a surgical incision but has a higher rate of recurrence. In all cases, laser hair removal of the affected area and attention to local hygiene are recommended to minimize recurrence.
Lateral internal sphincterotomy (anal fissure)
Anal fissure is a painful linear ulcer of the anus, usually at the midline. It is caused by a vicious cycle of constipation and local injury by hard stool, which then leads to pain at defecation and anal sphincter spasm, followed by more severe constipation and so on. The main symptom is acute and very severe perianal pain at the time of defecation that can last for a few hours after. Diagnosis requires physical examination only. Treatment is initially non-surgical and aims at (1) relieving constipation using fiber supplements and laxatives and (2) topical preparations that relax the internal anal sphincter. This strategy can be successful in 70-80% of patients when tolerated, the main reason for failure being drug-induced headache. Surgical treatment of anal fissure is indicated when the above therapy fails or is not tolerated and involves an outpatient operation under general anesthesia to partially divide the internal anal sphincter. The fissure itself is not removed and will heal spontaneously within a few weeks. Fiber supplements are continued. Surgical therapy is curative in more than 90% of patients.
Perianal fistula and abscess
A perianal abscess is a collection of pus in the connective tissues around the anus. Abscess formation causes pain, swelling, redness and occasionally fever. A perianal fistula is a communication between the perianal skin (external opening) and the lumen of the anus or rectum (internal opening). It is a complication of perianal abscess formation in approximately 25% of cases. A perianal fistula can lead to abscess recurrence. Perianal abscesses and fistulas are usually diagnosed on clinical examination of the affected area. Imaging studies (e.g. MR scanning) are occasionally required. A perianal abscess requires surgical drainage under general or regional anesthesia as it will not respond to antibiotics alone. The abscess cavity is left open after drainage and will heal spontaneously from the bottom up. Immunocompromised or diabetic patients will require antibiotic therapy. Drainage results in immediate symptom relief and most patients are discharged within less than 24 hours. Depending on its anatomy in relation to the anal sphincters, a perianal fistula is either incised open (low internal opening) or cauterized using laser energy (high opening, Fistula Laser Closure, FiLaC™). Fistula laser closure involves insertion of a laser-emitting catheter within the fistula tract and cauterization of the tract from the inside. Rates of successful closure are upwards of 70% and hospitalization is not required. Alternatively, seton treatment is sometimes used in fistulas with a high internal opening to gradually divide the fistula tract open.
Inguinal hernia repair
Inguinal hernias are the commonest abdominal wall hernias in adults and require surgical treatment to prevent enlargement, resulting in symptoms and complications that might require emergency surgery. Diagnosis usually requires only physical examination. Inguinal hernias are repaired laparoscopically under general anesthesia using three small abdominal incisions. Non-absorbable mesh is used to reinforce the abdominal wall at the site of herniation. Laparoscopic surgery offers ideal cosmetic results while avoiding wound complications such as infection and hernia formation. This technique is ideal for patients with bilateral hernias. Patients are discharged on the same or following day without dietary restrictions. Non-prescription painkillers are required for the first 7-10 days after surgery. A gradual increase in physical activity is necessary for the first few weeks after surgery.
Repair of umbilical or incisional hernia
Umbilical and incisional hernias occur in areas of congenital or acquired abdominal wall weakness and can vary in size. The only treatment is surgical and is recommended for symptoms and to prevent hernia enlargement and complications such as bowel obstruction that require emergency surgery. Depending of the site and size of the hernia, umbilical and incisional hernias are repaired by open or laparoscopic surgery, usually with the use of non-absorbable mesh in order to minimize chances of recurrence. Duration of hospital stay and postoperative recovery depend on hernia size and type of repair.
Removal of part of the colon is commonly required for polyps, tumors, diverticulitis and other disorders. The use of laparoscopy reduces postoperative pain and length of hospital stay and minimizes risk of wound complications such as infection and incisional hernia. Hospital stay is typically 4-6 days and there are no dietary restrictions after discharge.
Sleeve gastrectomy
Obesity causes premature death and is a risk factor for multiple diseases that affect quality of life such as diabetes, hypertension, high cholesterol, heart disease, stroke, gastroesophageal reflux, osteoarthritis, sleep apnea and many types of cancer. Surgery has been shown by multiple studies to be the only reliable method of durable weight loss that increases survival and reverses obesity-related diseases. Sleeve gastrectomy is the most popular bariatric operation and leads to loss of about 60-70% of excess weight in the first 18-24 months after surgery. Sleeve gastrectomy is performed laparoscopically and removes most of the stomach in order to reduce appetite and lead to early satiety after eating small amounts of food. Hospital stay is typically 1-2 nights and patients are discharged from hospital on a clear liquid diet and with an abdominal drain that is removed 7-10 days later. Permanent dietary and lifestyle changes are necessary for optimal results and to avoid complications.
Laparoscopic hiatal hernia repair and anti-reflux surgery
Hiatal hernia refers to protrusion of part of the stomach into the chest. This commonly leads to dysfunction of the valve mechanism the prevents regugitation of food and stomach acid up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux can also occur in the absence of hiatal hernia and produces symptoms such as heartburn and regurgitation of food. Although lifestyle modification (e.g. avoiding large meals, smoking cessation etc) and medical therapy (medications that inhibit secretion of stomach acid) are the mainstay of treatment, surgery to repair hiatal hernia and recreate a valve mechanism to prevent reflux is very effective. Indications for surgery include failure of medical therapy (lack of efficacy, medication side-effects etc) or the desire to stop life-long medication in young patients. Surgery is performed laparoscopically using five small abdominal incisions. Relief of reflux is immediate and long-lasting without the need for anti-reflux medications. Studies show that 10% of patients or less require anti-reflux medications 5 years after surgery, more than 85% being symptom-free and off medical therapy. Patients stay in hospital overnight and are discharged home on a clear liquid diet for a few days, followed by pureed foods for a few more days. There are minimal long-term dietary restrictions.
Closure of ileostomy or colostomy
Regardless of the indication for creation, ileostomy and colostomy can be electively reversed when no longer necessary. This involves connecting the ileostomy or colostomy to the remaining non-functioning part of the intestinal tract to restore continuity. Bowel function typically returns in 2-3 days after which patients can resume a regular diet without restrictions.

Diplomas & Memberships

  • Fellow, American College of Surgeons (FACS)
  • Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, University of London
  • General Surgery Internship, Johns Hopkins Hospital
  • General Surgery Residency, University of Wisconsin Hospital
  • Fundamentals of Laparoscopic Surgery, Society of American Gastrointestinal and Endoscopic Surgeons
  • Certified, American Board of Surgery
  • English
  • Greek

Medical Office

The team consists of
  • 1 assistant
  • 1 anesthesiologist
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500 meters from Ampelokipi metro station - 32,1 km from Athens International Airport

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