SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "WFRF:(Sundbom Magnus) ;pers:(Hedberg Jakob 1972)"

Sökning: WFRF:(Sundbom Magnus) > Hedberg Jakob 1972

  • Resultat 1-10 av 19
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Bekhali, Zakaria, et al. (författare)
  • Large Buffering Effect of the Duodenal Bulb in Duodenal Switch : a Wireless pH-Metric Study
  • 2017
  • Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 27:7, s. 1867-1871
  • Tidskriftsartikel (refereegranskat)abstract
    • Bariatric procedures result in massive weight loss, however, not without side effects. Gastric acid is known to cause marginal ulcers, situated in the small bowel just distal to the upper anastomosis. We have used the wireless BRAVO (TM) system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a substantial amount of acid. We placed a pre- and a postpyloric pH capsule in 15 DS-patients (seven men, 44 years, BMI 33) under endoscopic guidance and verified the correct location by fluoroscopy. Patients were asked to eat and drink at their leisure, and to register their meals for the next 24 h. All capsules but one could be successfully placed, without complications. Total registration time was 17.2 (1.3-24) hours prepyloric and 23.1 (1.2-24) hours postpyloric, with a corresponding pH of 2.66 (1.74-5.81) and 5.79 (4.75-7.58), p < 0.01. The difference in pH between the two locations was reduced from 3.55 before meals to 1.82 during meals, p < 0.01. Percentage of time with pH < 4 was 70.0 (19.9-92.0) and 13.0 (0.0-34.6) pre and postpylorically, demonstrating a large buffering effect. By this wireless pH-metric technique, we could demonstrate that the duodenal bulb had a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. This physiologic effect could explain the low incidence of stomal ulcers.
  •  
2.
  • Edholm, David, et al. (författare)
  • Laparoscopy in Duodenal Switch : Safe and Halves Length of Stay in a Nationwide Cohort from the Scandinavian Obesity Registry
  • 2017
  • Ingår i: Scandinavian Journal of Surgery. - : SAGE Publications. - 1457-4969 .- 1799-7267. ; 106:3, s. 230-234
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND AIMS:Unsatisfactory weight loss after gastric bypass or sleeve gastrectomy in super-obese patients (body mass index > 50) is a growing concern. Biliopancreatic diversion with duodenal switch results in greater weight loss, but is technically challenging to perform, especially as a laparoscopic procedure (Lap-DS). The aim of this study was to compare perioperative outcomes of Lap-DS and the corresponding open procedure (O-DS) in Sweden.MATERIAL AND METHODS:The data source was a nationwide cohort from the Scandinavian Obesity Surgery Registry and 317 biliopancreatic diversion with duodenal switch patients (mean body mass index = 56.7 ± 6.6 kg/m2, 38.4 ± 10.2 years, and 57% females) were analyzed. Follow-up at 30 days was complete in 98% of patients.RESULTS:The 53 Lap-DS patients were younger than the 264 patients undergoing O-DS (35.0 vs 39.1 years, p = 0.01). Operative time was 163 ± 38 min for lap-DS and 150 ± 31 min for O-DS, p = 0.01, with less bleeding in Lap-DS (94 vs 216 mL, p < 0.001). There was one conversion to open surgery. Patients undergoing Lap-DS had a shorter length of stay than O-DS, 3.3 versus 6.6 days, p = 0.02. No significant differences in overall complications within 30 days were seen (12% and 17%, respectively). Interestingly, the two leaks in Lap-DS were located at the entero-enteric anastomosis, while three out of four leaks in O-DS occurred at the top of the gastric tube.CONCLUSION:Lap-DS can be performed by dedicated bariatric surgeons as a single-stage procedure. The use of laparoscopic approach halved the length of stay, without increasing the risk for complications significantly. Any difference in long-term weight result is pending.
  •  
3.
  • Elias, Khalid, et al. (författare)
  • Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
  • 2018
  • Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 14:2, s. 144-149
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Bariatric procedures are increasingly being used, but data on bowel habits are scarce.Objectives: To assess changes in gastrointestinal function and patient-scored symptoms after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS).Setting: University hospital in Sweden.Methods: We recruited 268 adult patients (mean age of 42.5 yr, body mass index 44.8, 67.9% female) listed for RYGB and BPD/DS. Patients answered validated questionnaires prospectively concerning bowel function, the Fecal Incontinence Quality of Life Scale, and the 36-Item Short Form Health Survey before and after their operation.Results: Postoperatively, 208 patients (78.2% of 266 eligible patients) answered the questionnaires. RYGB patients had fewer bowel motions per week (8 versus 10) and more abdominal pain postoperatively (P<.001). Postoperatively, the 35 BPD/DS patients (69% versus 23%) needed to empty their bowel twice or more than twice daily, reported more flatus and urgency, and increased need for keeping a diet (P<.001). Concerning Fecal Incontinence Quality of Life Scale, coping and behavior was slightly reduced while depression and self-perception scores were improved after RYGB. Lifestyle, coping and behavior, and embarrassment were reduced after BPD/DS (P<.05). In the 36-Item Short Form Health Survey, physical scores were markedly improved, while mental scores were largely unaffected.Conclusion: RYGB resulted in a reduced number of bowel movements but increased problems with abdominal pain. In contrast, BPD/DS-patients reported higher frequency of bowel movements, more troubles with flatus and urgency, and increased need for keeping a diet. These symptoms affected quality of life negatively, however, general quality of life was markedly improved after both procedures. These results will be of great value for preoperative counseling.
  •  
4.
  • Elias, Khalid, et al. (författare)
  • Prevalence and impact of acid-related symptoms and diarrhea in patients undergoing Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch
  • 2020
  • Ingår i: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 16:4, s. 520-527
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Gastrointestinal symptoms are common in the obese population. Objectives: To determine the prevalence and importance of acid-related symptoms and diarrhea in 3 different types of bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD/DS). Setting: National data from Sweden. Methods: A total of 58,823 primary bariatric procedures (RYGB: 87.5%, SG: 11.7%, and BPD/DS: .7%) performed from 2007 to 2017 were identified in the Scandinavian Obesity Surgery Registry. Associations between acid-related symptoms and diarrhea, both defined by continuous use of pharmacologic treatment, and predefined outcomes were studied in a multivariate model, adjusted for age, sex, body mass index, and year of surgery. Results: At baseline, acid-related symptoms were most common in RYGB (9.9%), while diarrhea was rare. In general, symptomatic patients were older, had more co-morbidities, and scored lower on quality of life compared with the remaining patients. In the multivariate analysis, RYGB patients with acid-related symptoms had reduced risk of prolonged operative time and length of stay, while postoperative complications and reoperations increased by 24% and 36%, respectively. In SG, both symptoms were associated with prolonged operative time and a doubled risk for complications. Symptomatic patients had reduced improvement in quality of life, while no association with the weight result was seen. Postoperatively, acid-related symptoms decreased in RYGB, while doubling in SG. Diarrhea increased 2- and 6-fold in RYGB and BPD/DS, respectively. Conclusion: The 2 gastrointestinal symptoms were associated with increased operative risks and reduced improvement in quality of life. Postoperatively, the respective anatomic alternations affected both gastrointestinal symptoms. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
  •  
5.
  • Hedberg, Jakob, 1972- (författare)
  • Gastrointestinal Physiology and Results following Bariatric Surgery
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery. The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI>48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results. Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH<4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p<0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus. This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI>48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.  
  •  
6.
  • Hedberg, Jakob, 1972-, et al. (författare)
  • Peri-anastomotic microdialysis lactate assessment after esophagectomy
  • 2021
  • Ingår i: Esophagus. - : Springer. - 1612-9059 .- 1612-9067. ; 18:4, s. 783-789
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Esophagectomy is the cornerstone in curative treatment for esophageal and gastroesophageal junctional cancer. Esophageal resection is an advanced procedure with many complications, whereof anastomotic leak is the most dreaded. This study aimed to monitor the microcirculation with microdialysis analysis of local lactate levels in real-time on both sides of the esophagogastric anastomosis in totally minimally invasive Ivor-Lewis esophagectomy. Materials and Methods Twenty-five patients planned for esophageal resection with gastric conduit reconstruction and intrathoracic anastomosis were recruited. A sampling device, the OnZurf(R) Probe, along with the CliniSenz(R) Analyser (Senzime AB, Uppsala Sweden) was utilized for measurements. Lactate levels from both sides of the anastomosis were analysed in real time, on site, by a transportable analyser device. Measurements were made every 30 min during the first 24 h, and thereafter every 2 hours for up to 4 days. Results All probes could be positioned as planned and on the third postoperative day 19/25 and 15/25 of the esophageal and gastric probes, respectively, continued to deliver measurements. In total, 89.6% (1539/1718) and 72.4% (1098/1516) of the measurements were deemed successful. The average lactate level on the esophageal side of the anastomosis and the gastric conduit ranged between 1.1-11.5 and 0.8-7.0 mM, respectively. Two anastomotic leaks occurred, one of which had persisting high lactate levels on the gastric side of the anastomosis. Conclusion Application and use of the novel CliniSenz(R) analyser system, in combination with the OnZurf(R) Probe was feasible and safe. Continuous monitoring of analytes from the perianastomotic area has the potential to improve care after esophageal resection.
  •  
7.
  • Hedberg, Jakob, 1972-, et al. (författare)
  • Wire-less pH-metry at the gastrojejunostomy after Roux-en-Y Gastric Bypass : a novel use of the BRAVO™-system
  • 2011
  • Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 25:7, s. 2302-2307
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe number of gastric bypass operations being preformed is increasing rapidly due to good weight loss and alleviation of co-morbidities in combination with low mortality and morbidity. Stomal ulcers are, however, a clinical problem after gastric bypass, giving patients discomfort, risk of bleeding or even perforation. To measure the acidity in the proximal jejunum, we adopted the wire-less pH-metry (BRAVO™-system) developed for evaluating reflux esophagitis.Methods25 patients (4 men, median age 44 years, BMI 29.3) who had undergone RYGBP 4 years earlier were recruited. Twenty-one asymptomatic, non-PPI users and in addition, four symtomatic patients (ongoing or stopped PPI-treatment) were studied. The wire-less BRAVO™-capsule was positioned at the level of the gastrojejunal anastomosis under visual control with the endoscope. pH was registered for up to 48 hours. Time with pH<4 was calculated. Two patients were studied with two capsules.ResultsOf the 25 recruited patients capsule placement was successful in all but 2 patients, and in 3 patients a constant neutral environment was seen before a premature loss of signal, indicating early loss of position, thus 20 successful measurements were made. The mean time of registration was 25.7 hours (6.1-47.4, n=20). In the 16 asymtomatic patients, median percentage of time with pH<4 at the gastrojejunostomy was 10.6% (range 0.4 -37.7%). When dividing the registration time in day (08.00-22.00) and night (22.00-06.00), the median percentage of time with pH<4 was 8.4 and 6.3, respectively, (p=0.08). The two double measurements gave similar results indicating consistency. No complications occurred.ConclusionWire-less pH-measurements in the proximal jejunum after gastric bypass are feasible and safe. The acidity was significant (10.5% of the registration time) even in asymptomatic patients with small gastric pouches. The described method could be useful in evaluation of epigastralgia after gastric bypass and in appraisal of PPI treatment of stomal ulcer. 
  •  
8.
  • Jestin Hannan, Christine, et al. (författare)
  • Atelectasis formation and pleural effusion after esophagectomy : postoperative radiologic comparison of thoracoscopic versus open surgery
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Esophagectomy entails risk for postoperative pulmonary complications. In clinical practice, these might be reduced by minimal invasive esophagectomy (MIE). We tested the hypothesis that pulmonary findings on postoperative computed tomography (CT) differed between open esophagectomy and MIE. Secondarily, we present a suggestion for standardized CT-evaluation in these patients.Method: Postoperative (day 5) CT thorax from 40 patients (20 open and 20 MIE) who had undergone esophagectomy were reviewed. On an axial view, the areas of atelectasis and pleural effusion were measured at one and five centimetres above the right diaphragmatic dome and at the level of the carina. Additionally, the total distribution of atelectasis and pleural effusion was estimated on an ordinal scale (0-5), with ≥ 3 considered clinically important.Results: The groups were well-matched in terms of age, sex, and smoking status. There were no statistically significant differences in the areas of atelectasis or pleural effusion for open surgery compared with MIE. Neither did the groups differ in the proportion of patients subjective of clinically important atelectasis (dx: 30% vs. 25%, sin: 65% vs. 65%) or pleural effusion (dx: 15% vs. 15%, sin: 65% vs. 45%). More pleural effusion and atelectasis at the 1 cm level was present on the left side.Conclusion: Despite major differences in surgical access, there were no differences in postoperative atelectasis or pleural effusion between the two procedures. Less right-sided pleural effusion demonstrates the effect of surgical drains. The present measurements, performed at clear anatomical landmarks, can be of value in future studies.
  •  
9.
  • Jestin Hannan, Christine (författare)
  • Esophageal and Gastroesophageal Junctional Cancer : Improving Patient selection, Treatment and Care
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Esophageal cancer is the sixth most common cause of cancer-related death. Choice of surgical approach and individualized treatment is crucial. The aims of this thesis were to evaluate the introduction of minimally invasive esophagectomy (MIE) regarding oncological results and postoperative complications. To investigate radiological differences in pulmonary complications between MIE and open technique by studying computed tomography (CT). To evaluate geographical differences in intention for curative treatment and their association to survival. As well as to further explore these differences by comparing assessments of tumor stage (TNM) and treatment recommendations in anonymized cases at regional multidisciplinary cancer conferences (MCC).A comparison of 51 MIE (21 hybrid and 30 totally minimally invasive) and 65 open resections in 2007-2016, showed an increased lymph node yield in the MIE group, 18 (13–23) vs. 12 (8–16) median (IQR), p<0.001. The result was confirmed in a multivariate regression model (adjusted odds ratio 3.15 [1.11–8.98], p=0.03). Postoperative complications did not differ between the groups.When comparing CT after open esophagectomy (n=20) and MIE (n=20), no ipsilateral differences in the areas of atelectasis or pleural effusion were seen. Nor did the groups differ in the proportion of patients with clinically important atelectasis (dx: 30% vs. 25%, sin: 65% vs. 65%) or pleural effusion (dx: 15% vs. 15%, sin: 65% vs. 45%).A total of 5959 esophageal cancer patients, diagnosed 2006-2015 in Sweden, were identified from the National Register for Esophageal and Gastric Cancer (NREV). In a multivariable analysis, a higher rate of treatment with curative intent (time ratio 1.17 [1.05-1.30], p<0.001) and a higher resection rate (time ratio 1.24 [1.12-1.37], p<0.001) were associated with improved survival.Fifty anonymized esophageal cancer cases were distributed to five expert MCCs. In estimations of T-stage, the MCCs were in total agreement in eight of 50 cases (16%). For N-stage, total agreement was seen in 17 cases (34%) and for clinical M-stage in 34 cases (68%). The MCCs agreed on recommended treatment in 26/50 cases (52%). In conclusion, the introduction of MIE resulted in a larger lymph node yield, without increased risk for complications. No difference in postoperative pleural effusion and atelectasis was seen on computed tomography five days after open esophagectomy compared with MIE. Patients diagnosed in a county with a higher curative intention rate and a higher rate of surgery had better five-year survival and there are differences in assessment of esophageal cancer patients at different MCCs.
  •  
10.
  • Kamarajah, S. K., et al. (författare)
  • Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries : An international cohort study
  • 2021
  • Ingår i: European Journal of Surgical Oncology. - : Elsevier. - 0748-7983 .- 1532-2157. ; 47:6, s. 1481-1488
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-10 av 19

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy