| 1. |
- Acosta, Stefan, et al.
(författare)
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Extended score interval in the assessment of basic surgical skills.
- 2015
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Ingår i: Medical Education Online. - : Informa UK Limited. - 1087-2981. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- The Basic Surgical Skills course uses an assessment score interval of 0-3. An extended score interval, 1-6, was proposed by the Swedish steering committee of the course. The aim of this study was to analyze the trainee scores in the current 0-3 scored version compared to a proposed 1-6 scored version.
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| 2. |
- Berndsen, F, et al.
(författare)
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Changing the path of inguinal hernia surgery decreased the recurrence rate ten-fold. Report from a county hospital
- 2002
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Ingår i: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151. ; 168:11, s. 592-596
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To audit the effect of changes in treatment of inguinal hernias on recurrence rate. Design: Retrospective analysis of consecutive patients operated on in 1990 and prospective analysis of consecutive patients operated on in 1996. Follow up with questionnaire followed by selective clinical examination. Setting: County hospital, Sweden. Subjects: 144 patients with 147 inguinal hernias operated on in 1990 and 154 patients with 165 inguinal hernias operated on in 1996. Interventions: In 1993, we changed many aspects of the treatment of inguinal hernia. We introduced new techniques such as Shouldice, Lichtenstein, and laparoscopic hernia repair. Non-absorbable polypropylene sutures replaced the braided absorbable sutures previously used. Inguinal herniorrhaphy went from a "low status" operation to a high status operation and became a primary teaching operation for surgical residents. Main outcome measures: Recurrence rate at 5 year follow up. Results: The 5 year recurrence rate decreased from 28% in 1990 to 3% in 1996 (p < 0.001). The median operating time increased from 35 minutes in 1990 to 78 minutes in 1996 (p < 0.001). Conclusion: Changing the strategy of inguinal hernia surgery by introducing uniform operating techniques and new materials dramatically improved the results and allowed us to achieve recurrence rates comparable to those seen in specialised hernia centres.
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| 3. |
- Hagelsteen, Kristine, et al.
(författare)
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Simball Box for Laparoscopic Training With Advanced 4D Motion Analysis of Skills.
- 2016
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Ingår i: Surgical Innovation. - : SAGE Publications. - 1553-3506 .- 1553-3514. ; 23:3, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic skills training and evaluation outside the operating room is important for all surgeons learning new skills. To study feasibility, a video box trainer tracking 4-dimensional (4D) metrics was evaluated as a laparoscopic training tool.
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| 4. |
- Hallén, Magnus, et al.
(författare)
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Low complication rate and an increasing incidence of surgical repair of primary indirect sliding inguinal hernia
- 2016
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 401:2, s. 215-222
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of the present study was to explore the risk for complications and reoperations following open repairs for sliding groin hernias.Method All primary indirect inguinal hernia repairs registered in the Swedish Hernia Register 1998–2011 were identified. Repeated and bilateral procedures were excluded. The epidemiology, the incidence of per- and postoperative complications, and the reoperation rate due to recurrences were analyzed.Results 100 240 non-repeated unilateral repairs were registered with sliding hernias in 13 132 (13.1 %) (male 14 %, female 5 %) procedures. The methods of repair for sliding and non-sliding hernias were Lichtenstein and other open anterior mesh repairs (N = 10865, 82.7 % and N = 60790, 69.8 %), endoscopic techniques (N = 136, 1.0 % and N= 4352, 5.0 %), and other techniques (N= 2131, 16.2 % and N= 21966, 25.2 %). In multivariate analyses with adjustment for gender, acute/planned surgery, reducibility, method of repair and age, sliding hernias were associated with a low but slightly increased risk for perioperative complications (hazard ratio 1.30, 95 % confidence interval 1.04–1.62, p = 0.023) and postoperative hematoma (hazard ratio 1.13, confidence interval 1.02–1.26, p =0.019). There was no increased risk of reoperation due to recurrences.Conclusion Compared to older reports, the incidence of repairs due to primary indirect sliding inguinal hernias has increased over time and it is not just a male disease. The overall results are good with low and comparable complication rates, and no increased risk of reoperations due to recurrences.
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| 5. |
- Hallén, Magnus, et al.
(författare)
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Risk factors for reoperation due to chronic groin postherniorrhaphy pain
- 2015
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 19:6, s. 863-869
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Tidskriftsartikel (refereegranskat)abstract
- Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP. All 195,707 repairs registered in the Swedish Hernia Register between 1999 and 2011 were included in the study. Out of these, 28,947 repairs were excluded since they were registered as procedures on the same patient after a previous repair. Age, gender, hernia anatomy (indirect reference), method of repair (anterior sutured repair reference) and postoperative complications were included in a multivariate Cox analysis with reoperation due to CGPP as endpoint. Of the patients included in the study cohort, 218 (0.13 %) later underwent reoperation due to CGPP, including 31 (14 %) women. Median age at the primary repair was 61.5 years. Risk factors for being reoperated were age < median [hazard ratio (HR) 3.03, 95 % confidence interval (CI) 2.22-4.12], female gender (HR 2.13, CI 1.41-3.21), direct hernia (HR 1.35, CI 1.003-1.81), other hernia (HR 6.03, CI 3.08-11.79), Lichtenstein repair (HR 2.22, CI 1.16-4.25), plug repair (HR 3.93, CI 1.96-7.89), other repair (HR 2.58, CI 1.08-6.19), bilateral repair (HR 2.58, CI 1.43-4.66) and postoperative complication (HR 4.40, CI 3.25-5.96). Risk factors for being reoperated due to CGPP in this cohort included low age, female gender, a direct hernia, a previous Lichtenstein or plug repair, bilateral repair and postoperative complications. Further research on how to avoid CGPP and explore the effectiveness of surgery for CGPP is necessary.
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| 6. |
- Ihse, Ingemar, et al.
(författare)
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Practicum-Lund Clinical Skills Center.
- 2010
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Ingår i: Journal of Surgical Education. - : Elsevier BV. - 1878-7452 .- 1931-7204. ; 67:6, s. 468-469
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Tidskriftsartikel (refereegranskat)
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| 7. |
- Rogmark, Peder, et al.
(författare)
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Short-term outcomes for open and laparoscopic midline incisional hernia repair : a randomized multicenter controlled trial
- 2013
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Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 258:1, s. 37-45
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: : The aim of the trial was to compare laparoscopic technique with open technique regarding short-term pain, quality of life (QoL), recovery, and complications.BACKGROUND: : Laparoscopic and open techniques for incisional hernia repair are recognized treatment options with pros and cons.METHODS: : Patients from 7 centers with a midline incisional hernia of a maximum width of 10 cm were randomized to either laparoscopic (LR) or open sublay (OR) mesh repair. Primary end point was pain at 3 weeks, measured as the bodily pain subscale of Short Form-36 (SF-36). Secondary end points were complications registered by type and severity (the Clavien-Dindo classification), movement restrictions, fatigue, time to full recovery, and QoL up to 8 weeks.RESULTS: : Patients were recruited between October 2005 and November 2009. Of 157 randomized patients, 133 received intervention: 64 LR and 69 OR. Measurements of pain did not differ, nor did movement restriction and postoperative fatigue. SF-36 subscales favored the LR group: physical function (P < 0.001), role physical (P < 0.012), mental health (P < 0.022), and physical composite score (P < 0.009). Surgical site infections were 17 in the OR group compared with 1 in the LR group (P < 0.001). The severity of complications did not differ between the groups (P < 0.213).CONCLUSIONS: : Postoperative pain or recovery at 3 weeks after repair of midline incisional hernias does not differ between LR and OR, but the LR results in better physical function and less surgical site infections than the OR does. (ClinicalTrials.gov Identifier: NCT00472537).
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| 8. |
- Sandblom, G., et al.
(författare)
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Impact of operative time and surgeon satisfaction on the long-term outcome of hernia repair
- 2009
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Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1248-9204 .- 1265-4906. ; 13:6, s. 581-583
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the impact of the degree of difficulty and quality of hernia repair, as perceived by the surgeon, and operative time on the reoperation rate. All hernia repairs performed during the period 1994-1995 at the Department of Surgery, University Hospital of Lund, Sweden, were recorded prospectively. The degree of difficulty and the degree of difficulty in relation to the preoperative expectation of the surgeon were graded on a three-degree scale, the final outcome graded as optimal or suboptimal, and the time required to perform the hernia repair was recorded. Recurrence repairs prior to 1998 were traced in a retrospective review of the patient notes. The Swedish Hernia Register was checked for reoperations from 1998 and later. Altogether, 184 hernia repairs were recorded during the study period, including 14 repairs on women. The mean age of the patients was 58 years and the standard deviation was 15 years. Subsequent reoperation for recurrence was identified in 21 (11.4%) of these patients. The operative time correlated significantly with the surgeon's perception of the degree of difficulty (P < 0.05). Operative time less than 20 min (n = 4) was significantly associated with increased risk for reoperation (P < 0.05). The degree of difficulty, the degree of difficulty in relation to preoperative expectation, and the assessment of the final outcome were not associated with the risk for reoperation. Although neither the grade of difficulty nor the surgeon's perception of the quality of repair significantly predicted the final outcome, the risk for reoperation increased if the repair was performed rapidly.
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| 9. |
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| 10. |
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| 11. |
- Sevonius, Dan
(författare)
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Recurrent groin hernia - Outcome after surgery
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: According to the Swedish Hernia Register (SHR), the reoperation rate after recurrent groin hernia is more than twice that following primary hernia repair. Aims: To study the impact of method of mesh repair used in recurrent groin hernia surgery on re-recurrence as well as chronic pain and physical disability. Methods: Papers 1 and 2 were based on nationwide data from the SHR 1992-2008. In Paper 1 the cumulative risk for reoperation was studied after repeated surgery for recurrent hernia. In Paper 2 the risk for reoperation was analysed in relation to the mesh method used for recurrent hernia repair, taking the previous (index) repair into account. Papers 3 and 4 were based on a cohort of 1st and 2nd recurrent repairs performed at 5 hospitals in the south-west region of Sweden 1998-2007. A follow-up was performed 2009 using the Inguinal Pain Questionnaire (IPQ) and a selective clinical examination. In Paper 3 the risk for a 2nd recurrence was studied in relation to Anterior (AMR) and Posterior Mesh Repairs (PMR) and in Paper 4 the hazard ratio for chronic pain and physical disability was studied in relation to type of mesh repair and mean surgeon´s annual volume. Results: Paper 1 The risk for a further reoperation increased with the number of recurrent repairs (p<0.001). Paper 2 Endoscopic (E-PMR) and open PMR (O-PMR) were associated with the lowest risk for reoperation when the index repair was an anterior repair (p<0.001) Paper 3. PMR was associated with a decreased 2nd recurrence rate compared with AMR (p=0.025). An increased risk for a subsequent 2nd recurrence was seen an after anterior index repair followed by an AMR (HR 3.21 (CI 1.33-7.44), p=0.009)) and a decreased risk after posterior index repair followed by an AMR (HR 0.08 (CI 0.01-0.94), p=0.045). In the O-PMR group there was a lower 2nd recurrence rate after a Nyhus approach (2.5 %) compared to a trans inguinal approach (TIPP) (28 %) (p=0.001). A mean surgeon´s annual volume ≤ 5 O-PMR resulted in a higher risk for a 2nd recurrence (p<0.001). Paper 4 The E-PMR was associated with a lower risk for chronic pain and physical disability compared to AMR, after a previous anterior index repair (OR 0.54 (CI 0.30-0.97), p=0.039). A mean surgeon´s annual volume > 5 O-PMR correlated with a lower risk for chronic pain compared to an surgeon´s annual volume ≤ 5 (OR 0.42 (CI 0.19-0.94), p=0.034). Having a 2nd recurrent repair was associated with a higher risk for chronic pain compared to a 1st recurrent repair (OR 2.89 (CI 1.21-6.88), p=0.017). Conclusions: A posterior mesh repair for recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior mesh repair. A posterior mesh repair for the 1st recurrent operation is recommended after an anterior index repair and an anterior mesh repair after a posterior index operation. Endoscopic repairs have the lowest risk for both a 2nd recurrence and chronic groin pain and physical disability. An O-PMR performed trough a Nyhus incision is preferred and the TIPP procedure should be avoided. An surgeon´s annual volume > 5 O-PMR resulted in a lower 2nd recurrence rate and a lower risk for chronic pain. The risk for further recurrence increases with increasing number of groin hernia operations and the risk for chronic pain increases after a 2nd recurrent repair.
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| 12. |
- Sevonius, Dan, et al.
(författare)
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Recurrent groin hernia surgery
- 2011
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Ingår i: British Journal of Surgery. - Bristol : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 98:10, s. 1489-1494
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Tidskriftsartikel (refereegranskat)abstract
- Background: The reoperation rate after recurrent groin hernia surgery is more than twice that recorded for primary groin hernia procedures. The aim was to define the outcome from routine redo hernia surgery by analysing a large population-based cohort from a national hernia register.Methods: All recurrent groin hernia operations registered in the Swedish Hernia Register from 1992 to 2008 were analysed using multivariable analysis with stratification for preceding repair.Results: Altogether 174 527 hernia operations were recorded in the Swedish Hernia Register between 1992 and 2008, including 19 582 reoperations. The preceding repair was included in the register for 5565 of these recurrent repairs. With laparoscopic repair as reference standard, the hazard ratio for recurrence was 2.55 (95 per cent confidence interval 1.66 to 3.93) after sutured repair, 1.53 (1.20 to 1.95) after Lichtenstein repair, 2.31 (1.76 to 3.03) after plug repair, 1.36 (0.95 to 1.94) after open preperitoneal mesh and 3.08 (2.22 to 4.29) after other repairs. Laparoscopic and open preperitoneal repair were associated with a lower risk of reoperation following a preceding open repair (P < 0.001), but no technique differed significantly from the others following a preceding preperitoneal repair.Conclusion: The laparoscopic and the open preperitoneal mesh methods of repair for recurrent groin hernias were associated with the lowest risk of reoperation. Although the method of repair in previous surgery must be considered, these techniques are the preferred methods for recurrent groin hernia surgery.
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| 13. |
- Sevonius, Dan, et al.
(författare)
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Repeated groin hernia recurrences.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:3, s. 516-518
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence. SUMMARY BACKGROUND DATA: Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group. METHODS: The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis. RESULTS: There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05). CONCLUSION: Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.
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| 14. |
- Sevonius, Dan, et al.
(författare)
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The Impact of Type of Mesh Repair on 2nd Recurrence After Recurrent Groin Hernia Surgery
- 2015
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 39:2, s. 315-322
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Tidskriftsartikel (refereegranskat)abstract
- According to the Swedish Hernia Register (SHR), the reoperation rate is more than doubled after recurrent groin hernia repair compared with primary repair. The aim was to study the impact of type of mesh repair used in recurrent groin hernia surgery on a 2nd recurrence in a population-based cohort derived from the SHR. All 1st recurrent hernia repairs in the south-west region of Sweden, registered in SHR between 1998 up to 2007 were included. A questionnaire was sent in 2009. Patients stating a new lump or persisting problems were examined. A 2nd recurrence was identified as a 2nd reoperation or at physical examination. The incidence was analysed comparing anterior mesh repair (AMR) and posterior mesh repairs (PMR) (endoscopic and open). Eight hundred and fifteen recurrent operations in 767 patents were analysed, 401 AMRs and 414 PMRs. PMR had a lower 2nd recurrence rate compared with AMR (5.6 vs. 11.0 %) (p = 0.025). An increased risk [3.21 (CI 1.33-7.44) (p = 0.009)] of a subsequent 2nd recurrence was seen after anterior index repair followed by AMR and a decreased risk [0.08 (CI 0.01-0.94) (p = 0.045)] after posterior index repair followed by AMR. PMR in recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior. A posterior approach for 1st recurrent operation is recommended after an anterior index repair and an anterior approach after a posterior index operation.
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