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| 2. |
- Börner, Gabriel, et al.
(författare)
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Suture-TOOL : A suturing device for swift and standardized abdominal aponeurosis closure
- 2022
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Ingår i: Surgery in Practice and Science. - : Elsevier BV. - 2666-2620. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing. Method: Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15 cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-Tool user impressions was completed. Results: A SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p < 0.001). Suture time was shorter for Suture-TOOL (p < 0.001). Wound stitch count was higher for Needle-Driver (p = 0.013). The median SL/WL-ratio was similar between groups. The learning curve plateaued after three closures using Suture-TOOL. Two glove punctures were detected—all in the Needle-Driver group. Suture-TOOL received high VAS scores for all measured functionalities. Conclusion: Suture-TOOL is a promising device for clinical use. It is safe, easy, and fast resulting in a high-quality suture lines with a short learning curve and a high functionality ranking.
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| 3. |
- de la Croix, Hanna, et al.
(författare)
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Laparoscopic hernia surgery in Sweden 2010 to 2020 : scientifically highlights from the national Swedish Hernia Register
- 2021
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Ingår i: Laparoscopic Surgery. - : Ame Publishing Group. - 2616-4221. ; 5
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Forskningsöversikt (refereegranskat)abstract
- The Swedish Hernia Register (SHR) is a national quality register with more than 350,000 prospectively registered groin hernia repairs. Studies from the SHR have addressed important and clinically relevant issues within the field of laparoscopic groin hernia surgery and the aim of this paper is to present five of the most innovative patient-oriented publications including analysis of laparoscopic hernia repairs based on data retrieved from the SHR published between 2010 and 2020. After a Medline search was conducted, papers were graded and five papers were selected because of their specific nature, quality of methodology or international interest. The papers in our review studied a wide range of topics such as the risk of male infertility after mesh repair, risk of groin hernia surgery after open and minimally invasive prostatectomy, chronic pain after groin hernia surgery vs. method of repair, gender differences in risk of reoperation vs. method of repair and risk of reoperation vs. low and high molecular weight of the mesh. When gathering large amount of high-quality data, including almost total national coverage of all inguinal surgeries performed, it is possible to make valid conclusions and recommendation even on rare conditions and to sort out techniques that does not perform as intended, or does not apply to specific clinical situations. The studies above show that a laparoscopic repair is associated with a decreased risk of chronic pain for both gender to the price of a significantly higher risk of reoperation in men. The contrary is shown in women with a decreased risk of reoperation using laparoscopic repair compared to open repair.
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| 4. |
- Gutlic, Allan, et al.
(författare)
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Pain with sexual activity at 1 and 3 years : Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial)
- 2022
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 172:5, s. 1463-1470
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain at sexual activity induced by an inguinal hernia or as a cause of its repair is not thoroughly studied. Reported frequencies are between 25% and 30% preoperatively and 10% and 15% postoperatively. The primary aim was to analyze pain at sexual activity at 1 year comparing total extraperitoneal with Lichtenstein repair in a randomized setting. Methods: Men, 30 to 60 years old, with a primary inguinal hernia were randomized to total extraperitoneal without mesh fixation or Lichtenstein repair. A questionnaire on pain prevalence, frequency, intensity, and impairment of sexual functions caused by pain at sexual activity was introduced. Clinical examination, a questionnaire on sexual function, and the 36-Item Short Form Survey were performed preoperatively and at 1 and 3 years postoperatively. A risk factor analysis for pain at sexual activity as performed. Results: A total of 243 patients (111 total extraperitoneal and 132 Lichtenstein) were included between 2008 and 2014; 97% remained for 1-year and 90% for 3-year analysis. Preoperative pain at sexual activity was reported in 35%, with a reduction to 5.9% in total extraperitoneal and 12.5% in Lichtenstein (P = .098) at 1 year and 7.0% in total extraperitoneal and 9.3% in Lichtenstein (P = .566) at 3 years. Quality of life preoperatively was markedly reduced in patients with pain at sexual activity but restored almost to norm levels at 1 and 3 years. New pain at sexual activity (harm) was seen in 8 patients (3.6%) at 1 year. Risk factors for having postoperative pain at sexual activity were preoperative pain and Lichtenstein technique. Conclusion: Pain at sexual activity in inguinal hernia patients is more common than suspected and reduces quality of life. Repair will markedly reduce pain at sexual activity and restore quality of life in most patients without difference between techniques. Patients should be informed on a potential relation between having an inguinal hernia and sexual impairment.
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| 5. |
- Gutlic, Nihad, et al.
(författare)
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Impact of mesh fixation on chronic pain in total extraperitoneal inguinal hernia repair (TEP) : a nationwide register-based study
- 2016
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Ingår i: Annals of Surgery. - Philadelphia : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 263:6, s. 1199-1206
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mesh fixation is used to prevent recurrence at the potential risk for chronic pain in TEP. The aim was to compare the impact of permanent fixation (PF) with no fixation (NF)/nonpermanent fixation (NPF) of mesh on chronic pain after TEP repair for primary inguinal hernia.METHODS: Men, 30 to 75 years old, consecutively registered in the Swedish Hernia Register for a TEP primary repair in 2005 to 2009, were included in a mail survey using SF-36 and the Inguinal Pain Questionnaire (IPQ). Primary endpoint was IPQ question "Did you have pain during past week that could not be ignored." Risk factors for chronic pain and recurrent operations were analyzed.RESULTS: A total of 1110 patients were included (325 PF, 785 NF/NPF) with 7.7% reporting pain at median 33 months follow-up. No difference regarding primary endpoint pain (P < 0.462), IPQ and SF-36 subscales were seen. Recurrent operation was carried out in 1.4% during 7.5 years follow-up with no difference between PF- and NF-groups including subgroups of medial hernias. All SF-36 subscale-scores were equal to or better than the Swedish norm. A postoperative complication was a risk factor for chronic pain (OR 2.44, 95% CI 1.23-5.25, P < 0.023).CONCLUSIONS: The TEP procedure for primary inguinal hernia repair in men is associated with a low frequency of chronic pain and recurrent operations, with no difference between permanent fixation and no/nonpermanent fixation of mesh in a nationwide population-based study. TEP without fixation reduces costs and is safe for all patients.
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| 6. |
- Gutlic, Nihad, et al.
(författare)
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The Relevance of Sexual Dysfunction Related to Groin Pain After Inguinal Hernia Repair : The SexIHQ Short Form Questionnaire Assessment
- 2018
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Ingår i: Frontiers in surgery. - : Frontiers Media SA. - 2296-875X. ; 5, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic postoperative pain after inguinal hernia surgery can affect sexual function. A new short form questionnaire for inguinal hernia pain related sexual dysfunction (SexIHQ) was introduced and applied to a register based cohort of total extra-peritoneal hernioplasty (TEP) operated patients. Methods: Sexually active men, 30–60 years old, recorded in the Swedish Hernia Register for a primary inguinal hernia TEP operation were included. Two initial questions of the SexIHQ identify patients with pain at sexual activity. Only these patients proceeded to answer the specific questions on pain-induced impairment of sexual activity, pain frequency and intensity, physical functions (erection and ejaculation), and symptoms of depression. SexIHQ, the Short Form-36 (SF-36), the Inguinal Pain Questionnaire (IPQ) were mailed to participants for long term follow up. Results: In 538 included patients, 44 (8.2%) reported pain during sexual activity at mean 33 months after surgery. Sexual dysfunction was seen in 33 of these patients. A postoperative complication was a risk factor for pain during sexual activity; OR 4.89 (95% CI 1.92–12.43; p < 0.001). Quality-of-life was reduced in almost all SF-36 domains in patients with pain during sexual activity. Conclusions: A short form questionnaire, suitable for large cohorts, was developed to assess sexual dysfunction due to groin pain after inguinal hernia repair in male patients. Sexual dysfunction due to groin pain after hernia surgery by TEP is surprisingly common. Patients should preoperatively be informed of the risk of having pain during sexual activity following groin hernia surgery.
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| 7. |
- Johan Drott, Carl, et al.
(författare)
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Fler akuta gallstensoperationer och färre elektiva under pandemin : [Swedish gallstone surgery during the covid-19 pandemic]
- 2022
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Ingår i: Läkartidningen. - : Läkartidningen. - 0023-7205 .- 1652-7518. ; 119
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Tidskriftsartikel (refereegranskat)abstract
- The covid-19 pandemic has necessitated reallocation of health care resources. This has raised concerns about the risks associated with postponing surgery for benign conditions that are given low priority. Data from the population-based Swedish National Register for Gallstone Surgery (GallRiks) show that the total number of procedures carried out during the initial months of each wave of the pandemic decreased. This was followed by a moderate increase in the number of procedures performed for acute cholecystitis, biliary pancreatitis, and obstructive jaundice. The consequences of the delayed surgery in the community at large and how this has affected health-related quality of life for patients having their procedure postponed remain to be evaluated, but so far it does not seem to have caused a major impact on public health.
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| 8. |
- Johan Drott, Carl, et al.
(författare)
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Fler akuta gallstensoperationer och färre elektiva under pandemin
- 2022
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Ingår i: Lakartidningen. - 0023-7205. ; 119
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Tidskriftsartikel (refereegranskat)abstract
- The covid-19 pandemic has necessitated reallocation of health care resources. This has raised concerns about the risks associated with postponing surgery for benign conditions that are given low priority. Data from the population-based Swedish National Register for Gallstone Surgery (GallRiks) show that the total number of procedures carried out during the initial months of each wave of the pandemic decreased. This was followed by a moderate increase in the number of procedures performed for acute cholecystitis, biliary pancreatitis, and obstructive jaundice. The consequences of the delayed surgery in the community at large and how this has affected health-related quality of life for patients having their procedure postponed remain to be evaluated, but so far it does not seem to have caused a major impact on public health.
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| 9. |
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| 10. |
- Rogmark, Peder
(författare)
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Implementation of Modern Incisional Hernia Repair Techniques
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Incisional hernia is one of the most common complications (5–20%) after abdominal surgery. Surgery is the only option to cure a hernia. Symptoms of an incisional hernia depend on the size of the abdominal wall defect and the protruding tissue. About 30% of the patients with an incisional hernia will have an operation performed. Traditional surgical sutured techniques have very high recurrence rate, whereas recurrence rates can be substantially reduced using modern mesh techniques. Mesh placement in a retromuscular position have excellent results in curing the hernia, but often involves large incisions and demands dissection of the retromuscular space of the rectus abdominis muscles. The mesh reinforces the repair of the abdominal wall. Alternatively, a mesh can be placed in the abdominal cavity on the posterior surface of the abdominal wall, fixed with sutures or tackers. To prepare the abdominal wall all adhesions must be dissected with a risk of bowel injury. A Swedish multicenter randomized controlled trial (RCT) PROLOVE has been performed on midline incisional hernia repair, comparing open (OHR) retromuscular mesh to laparoscopic (LHR) intraabdominal mesh techniques, focusing on pain and quality of life and a retrospective long term follow up for recurrence and QoL after the implementation of the retromuscular hernia repair at two specialist centers. Paper I covers the RCT with 133 included patients in a short term perspective. Elsewhere laparoscopic techniques had proved to cause less postoperative pain, have fewer complications and shorten recovery. LHR had fewer surgical site infections (SSI) (p<001). The operative techniques did not differ in pain and time to recovery. The preoperative quality of life (QoL) was low but restored to norm level at 3 weeks, with physical function being better after LHR. Paper II covers 124 patients remaining at 1 year follow up for complications, QoL, and predictors for an uneventful recovery. The reoperation rates were similar; wound complications were more common in OHR, contrary to recurrence in LHR. Recurrence rate did not differ. QoL was restored after 8 weeks and maintained at 1 year at norm level. The LHR technique was a predictor for an uneventful recovery. Paper III investigates the contraction behavior of a cohort of 36 meshes included in the PROLOVE trial. Patients with metal clip-marked meshes had x-ray exams within 2 days and 1 year after surgery. Mesh area change was in LHR –6% and in OHR +10%, probably within the limits of the technique used for measuring, and not regarded as clinically significant. No correlation was found between mesh area change and recorded pain levels. Paper IV covers a long-term follow up of 11 years on 301 patients with midline incisional retromuscular hernia repair performed 1998–2006. Over all recurrence rate was 8%, with no difference between primary or secondary hernia repairs. Long term QoL was lower than the norm, similar to patients with 2 chronic conditions. Satisfaction with surgery high was high. Conclusions Incisional hernia patients have low QoL which is restored by both LHR and OHR, but OHR has more SSIs. OHR has excellent long-term outcome. Mesh contraction at LHR and OHR is not a clinical problem.
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