| 1. |
- Bringman, S, et al.
(författare)
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Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study
- 2001
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Ingår i: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. - 1051-7200 .- 2331-2254. ; 11:5, s. 322-326
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon, There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups, Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.
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| 2. |
- Bringman, S., et al.
(författare)
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Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study
- 2001
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 15:3, s. 266-270
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. Methods: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. Results: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). Conclusion: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.
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| 3. |
- Frisén, Angelica, 1970-, et al.
(författare)
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Better outcome for female groin hernia patients when using preperitoneal techniques
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: It is not known why women have higher frequencies of postoperative complications and reoperation than men after groin hernia repair. This study analyses postoperative results for female hernia in order to identify the appropriate techniques to attain adequate repair and improve operative outcome. Method: A registry-based retrospective cohort study analysing data from 10 971 groin hernia repairs on women from the Swedish Hernia Register, 1992-2006. Results: Our data showed that the risk for reoperation was significantly reduced (RR 0.6 95% CI 0.4-0.8) by using a preperitoneal repair, and three times as many femoral hernias were diagnosed in elective repairs. Time to reoperation was increased from a median of 1 year to 3.5 years (p=0.002) when using a preperitoneal repair, and time to reoperation for femoral recurrence after an inguinal primary hernia was increased from 1 year to 5.2 years (p=0.025). Conclusions: Operative outcome for groin hernia repair in women was improved and risk for recurrence reduced by the utilisation of a preperitoneal approach. More femoral hernias were diagnosed in elective repairs and time to reoperation for femoral recurrence after an inguinal primary hernia was increased. We believe it is necessary to use a preperitoneal technique that visualizes all three locations for groin hernia in order to identify and adequately repair the hernia.
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| 4. |
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| 5. |
- Kald, Anders
(författare)
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Audit of groin hernia repair
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inguinal hernia repair is the most frequent procedure in general surgery. In the USA approximately 700,000 groin hernioplasties are carried out annually and accounts for almost US$ 3 billion in annual health care revenue. In Sweden approximately 20,000 hernia operations are performed annually and more than 3,000 of them are recurrent hernias. The renewed interest in cost-effectiveness and the introduction of new techniques, among them laparoscopic surgery, underlines the importance of quality assurance in hernia surgery. The aim of this thesis was to establish an audit of hernia surgery in a defined population allowing evaluation of management, riskfactors, outcome and economy. The method of control and definition of recurrence was studied. When recurrence was classified as "a weakness in the operated area necessitating a further operation or provision of a truss", the predictive value for postitive (recurrence) and negative (no recurrence) answers in the questionnaire was 38 and 99%, respectively. Thus, by using a questionnaire to identify symptomatic recurrences only a minority of the patients (10%) had to be examined at a follow-up . A study of eight Swedish hospitals showed that it is possible to include more than 99% in a medical audit of hernia operations within the frame-work of routine registration. In a three-year follow-up study of these hospitals, the total recurrence rate was 9.6% with an interhospital variation between 3.1 and 20.5%. Postoperative complications, direct hernia and recurrent hernia were factors associated with an increased risk for recurrence. The re-operation rate for recurrence may be an appropriate surrogate endpoint, although this underestimates the real recurrence rate by approximately 40%. An audit scheme based on prospective registration, annual analysis of outcome, regular use of questionnaire and selective follow-up, can identify significant inter hospital differences in outcome as well as variables associated with increased risk for recurrence, thereby raising quality awareness and facilitating the process of improvement. The introduction of a new technique, laparoscopic hernia repair, was studied in one of the units participating in the overall prospective registration. Two surgeons performed over 90% of the operations. After an initial period with 6 recurrences in the first 31 patients (recurrence rate 22.6%), the results improved and only one recurrence was diagnosed in the following 395 patients who underwent 360 transabdominal and 98 totally extraperitoneal repairs (recurrence rate 0.2%) with a mean (SD) follow-up of 19 (10) months. In the treatment of recurrent hernias a tenfold difference in recurrence rate was obtained by one unit using the laparoscopic approach with a preperitoneal mesh, compared to the three-year follow-up results from the eight hospitals studied. Laparoscopic hernia repair was cost-effective compared to the Shouldice operation among employed patients, due to faster recovery, provided that hoth direct and indirect costs were included. If laparoscopic herniarepair is considered the totally extraperitoneal operation should be used because of the risk for serious intraabdominal complications with the transabdominal technique.
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| 6. |
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| 7. |
- Kald, Anders, et al.
(författare)
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Laparoscopic hernia repair in patients with bilateral groin hernias
- 2000
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 166:3, s. 210-212
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare outcome of unilateral and bilateral laparoscopic hernia repair. Design: Prospective consecutive trial. Setting: University hospital, Sweden. Subjects: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. Main outcome measures: Operating time, hospital stay, complications, and time to recovery. Results: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. Conclusion: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.
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| 8. |
- Kald, Anders, et al.
(författare)
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Mesh repair of parastomal hernias : New aspects of the Onlay technique
- 2001
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Ingår i: Techniques in Coloproctology. - : Springer Science and Business Media LLC. - 1123-6337 .- 1128-045X. ; 5:3, s. 169-171
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Tidskriftsartikel (refereegranskat)abstract
- When a hernia becomes symptomatic with pain, obstruction, or mechanical distortion, need for a repair is likely. In this short note are new aspects on the Onlay mesh repair technique of parastomal hernias presented. The satisfactory results achieved in 5 patients are reported. One recurrence required a further successful repair.
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| 9. |
- Kald, Anders, et al.
(författare)
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Outcome of repair of bilateral groin hernias : A prospective evaluation of 1487 patients
- 2002
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Ingår i: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151 .- 1741-9271. ; 168:3, s. 150-153
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To find out whether simultaneous repair of bilateral hernias increases the risk of recurrence compared with unilateral repair. Design: Prospective study. Setting: Swedish hospitals participating in the Swedish Hernia Register (SHR). Interventions: Prospective collection of data from the SHR, 1992-1999 inclusive. The Cox proportional hazard test was used for calculating odds ratio (OR). Main outcome measures: Hernia repairs were followed up in a life table fashion until re-operation for recurrence or death of the patient. Results: 33416 unilateral and 1487 bilateral operations on 2974 groin hernias were found. Direct hernias were more common in the bilateral than in the unilateral group, 1825, 61% compared with 13 336, 40%, (p < 0.0001). A laparoscopic method was used for 1774 (60%) of bilateral and 3285 (10%) unilateral repairs, and 455 bilateral operations (31%) were done as day cases compared with 18 376 (55%) unilateral ones (p < 0.0001 for both comparisons). The cumulative incidence of reoperation at three years for groin hernias after bilateral and unilateral repair was 4.1% (95% confidence interval 3.1% to 5.1%) and 3.4% (95% CI 3.1% to 3.7%, respectively. After adjustment for other risk factors, the OR for reoperation for recurrence after bilateral repair was 1.2 (95% C1 0.9 to 1.5) with unilateral repair as reference. The OR for reoperation after laparoscopic bilateral repair compared with open bilateral repair was 0.9 (95% CI 0.6 to 1.4). Conclusions: Simultaneous repair of bilateral hernias does not increase the risk of reoperation for recurrence and there is no significant difference in the risk of reoperration after bilateral repair using open or laparoscopic techniques.
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| 10. |
- Kald, Anders, 1958-, et al.
(författare)
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Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy
- 2008
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 43:5, s. 627-633
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Peristomal bulging caused by hernia or prolapse is common in patients with a sigmoidostomy. It is not known whether and to what extent peristomal bulging influences various daily activities. The purpose of this study was to evaluate the effects of bulging by using a general and disease-specific health scale (Short Health Scale, SHS) and a stoma-specific quality of life (Stoma-QoL) questionnaire in patients with and without peristomal bulging. Material and methods. Seventy patients with sigmoidostomies were examined to identify peristomal bulging. The mean (SD) age was 71.7 (13.7) years and the patients had had their sigmoidostomies for a mean of 8.1 (7.9) years. Bulging was noticed in 46 patients (66%) while 24 had no bulging. Results. It was found that patients with bulging were at a disadvantage. In the SHS, patients with bulging reported significantly impaired QoL in 3 out of 4 scales regarding symptom load, worry and general sense of well-being. Also, in the Stoma-QoL questionnaire there was a significant difference between patients with and those without bulging. Conclusions. QoL evaluated with a general and disease-specific instrument (SHS) was significantly impaired in patients with bulging around a sigmoidostomy. The Stoma-QoL questionnaire showed a small but statistically significant difference between patients with and those without bulging but the clinical significance is uncertain. Further studies are required to evaluate the role of some of the individual items in the Stoma-QoL questionnaire. © 2008 Taylor & Francis.
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