| 1. |
- Walther, B, et al.
(författare)
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Clinical outcome and long-term survival rates after esophagectomy are not determined by age over 70 years
- 2000
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Ingår i: Journal of Gastrointestinal Surgery. - 1091-255X. ; 4:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- Esophagectomy is considered a high-risk procedure in patients aged 70 years or older. This study evaluates the impact of two age groups (younger than 70 and 70 years or older) on clinical outcome and long-term survival rates following this procedure. This prospective study included survival analysis and clinical evaluations at 3, 6, and 12 months after esophagectomy. All esophagectomy patients undergoing gastric (n = 125), jejunal (n = 10), or colonic (n = 4) reconstructions at our institution from 1984 to 1996 were included. Fifty patients were older than 70 years, 89 were younger, and 120 of these 139 patients had tumors. The overall hospital mortality rate was 1.4% (2 of 139), both in the younger age group. All leaks from anastomoses and grafts were nonfatal, and these problems occurred in seven patients in the younger age group and two in the older group. The mean preoperative weight was 70 kg, and there was a mean weight loss of 5 kg during the first three postoperative months only but none thereafter (P <0.001). This was the same for patients with benign and malignant disorders, and for those aged over or under 70 years. Between 71% and 77% of the patients experienced no dysphagia at the three evaluations during the first postoperative year. The distribution of the different grades of dysphagia was equal in the two age groups at 3-month (P = 0.339) and 12-month (P = 0.669) follow-up. The 12-year survival rate was 28% and the 5-year rate was 31%, and this was correlated to tumor stage (P = 0.002) but not to age over or under 70 years (P = 0.299). The clinical outcome was the same regardless of whether patients were over or under 70 years of age. Tumor stage but not age over 70 years was the major predictive factor for long-term survival.
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| 2. |
- Naslund, E, et al.
(författare)
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The gut and food intake: an update for surgeons
- 2001
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Ingår i: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. - 1091-255X. ; 5:5, s. 556-567
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Sundbom, M., et al.
(författare)
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Reduction in serum pepsinogen I after Roux-en-Y gastric bypass
- 2003
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Ingår i: Journal of Gastrointestinal Surgery. - 1091-255X .- 1873-4626. ; 7:4, s. 529-535
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Tidskriftsartikel (refereegranskat)abstract
- The excluded stomach after Roux-en-Y gastric bypass (RYGBP) cannot be readily examined by endoscopy for obvious anatomic reasons. Thus it is difficult to monitor possible changes in the gastric mucosa. However, the type and severity of gastritis can now be assessed by a combination of serologic tests: pepsinogen I and antibodies to Helicobacter pylori and H,K-ATPase. Morbidly obese patients were examined before and 1 to 4 years after surgery. A group of 34 patients (mean age 39 years, BMI 44 kg/m2) underwent RYGBP, another group of 30 patients (mean age 42 years, BMI 44 kg/m2) had simple gastric restriction and served as control subjects. All patients, except one in the control group, had normal titers of pepsinogen I before surgery. One year after RYGBP, pepsinogen I levels were significantly reduced, as compared to the control group (P<0.0001), and remained low throughout the study. The control group had stable pepsinogen I levels. In both groups, few patients had increased titers of H. pylori or H,K-ATPase antibodies, but these abnormalities remained unchanged. Low pepsinogen I levels, similar to those we observed in our RYGBP patients, have been linked to chronic atrophic gastritis. However, the absence of food stimulation in the excluded stomach could also be a reason for the low pepsinogen I levels. © 2003 The Society for Surgery of the Alimentary Tract, Inc.
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| 4. |
- Westling, Agneta, et al.
(författare)
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Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery
- 2002
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Ingår i: Journal of Gastrointestinal Surgery. - 1091-255X .- 1873-4626. ; 6:2, s. 206-211
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Tidskriftsartikel (refereegranskat)abstract
- In the treatment of morbid obesity, simple gastric restrictive methods such as silicone adjustable gastric banding, vertical banded gastroplasty, and nonadjustable gastric banding often fail to control weight in the long run or give rise to intolerable side effects. Here we review our results from conversion of such failures to Roux-en-Y gastric bypass. The study comprised 44 patients (median age 42 years, range 24 to 60 years) who underwent revision surgery in 1996 and 1997. Body mass index at revision was 35 kg/m2 (range 21 to 49 kg/m2). Previous bariatric procedures included silicone adjustable gastric banding (n = 26), vertical banded gastroplasty (n = 13), and gastric banding (n = 5). The most common reasons for conversion after silicone adjustable gastric banding and nonadjustable gastric banding were band erosion (n = 12) and esophagitis (n = 11). Staple line disruption (n = 12) with subsequent weight loss failure was the primary cause after vertical banded gastroplasty. There were no postoperative deaths or anastomotic leaks. One patient underwent reexploration because of an infected hematoma. Reflux symptoms and vomiting resolved promptly. At global assessment 2 years later, 70% of the patients were very satisfied. Median body mass index had decreased to 28 kg/m2 (range 18 to 42 kg/m2). No patient was lost to follow-up. As reported previously, failure after vertical gastric banding can be treated by conversion to Roux-en-Y gastric bypass with good results. In this study we found that failure after silicone adjustable gastric banding can be treated successfully with Roux-en-Y gastric bypass as well.
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| 5. |
- Acosta, Stefan, et al.
(författare)
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Epidemiology and Prognostic Factors in Acute Superior Mesenteric Artery Occlusion.
- 2010
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1873-4626 .- 1091-255X. ; 14, s. 628-635
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reports on trends in incidence and mortality of acute superior mesenteric artery (SMA) occlusion and evaluation of prognostic factors in recent years are lacking. METHODS: Patients with acute SMA occlusion were identified through the in-patient and autopsy registry between 1970 and 1982 (n = 270), 1987 to 1996 (n = 135), and 2000 and 2006 (n = 100) in Malmö, Sweden. RESULTS: The overall incidence rate decreased from 8.6 to 5.4/100,000 person years and the autopsy rate from 87% to 25% over time. A higher serum creatinine level was associated with a lower probability of undergoing multi-detector row computed tomography with intravenous contrast (MDCTiv) (p = 0.006). Not performing a MDCTiv (odds ratio 4.0; 95% confidence interval [1.0-16.0]) remained as independent prognostic factor for in-hospital mortality. General and vascular surgeons collaborated in 25 out of 61 patients that underwent an intervention, of which 21 (84%) (p < 0.001) survived. CONCLUSIONS: A close collaboration between radiologists and general and vascular surgeons seems to be most important to lower the mortality in patients with acute SMA occlusion.
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| 7. |
- Björnsson, Steinarr, et al.
(författare)
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Symptomatic Mesenteric Atherosclerotic Disease-Lessons Learned from the Diagnostic Workup.
- 2013
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1873-4626 .- 1091-255X. ; 17:5, s. 973-980
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aims to analyze the diagnostic workup in patients referred for endovascular mesenteric revascularization for symptomatic mesenteric atherosclerotic disease. MATERIAL AND METHODS: Fifty-five patients were identified between 2006 and 2011. Median follow-up time was 24 months. RESULTS: Median age was 71 years, 67 % were women. Forty patients had acute on chronic mesenteric ischemia, eight had acute mesenteric ischemia, and seven had chronic mesenteric ischemia. Other manifestations of atherosclerotic disease were present in 71 %. Body mass index (BMI) <20 kg/m(2) was found in 37 %. Endoscopy diagnosed duodenitis (38 %; 13/34) and colitis in the right colon (57 %;12/21). All ulcers tested for Helicobacter pylori were negative (n = 17). Patients received proton pump inhibitor, antibiotic, and cortisone therapy during diagnostic workup in 73, 42, and 29 % of the cases, respectively. Previous hospitalization for the same complaints had occurred in 78 %. CT angiography showed occlusion (n = 30) and high-grade stenosis (n = 25) of the superior mesenteric artery (SMA). Forty-eight patients were treated with stenting of the SMA. The BMI increased in both women (p = 0.001) and men (p = 0.03) after endovascular therapy. The in-hospital mortality rate was 18 %. CONCLUSION: Patients with abdominal pain, known atherosclerotic disease, right-sided colitis or H. pylori-negative duodenitis should undergo CT angiography immediately to be able to identify symptomatic mesenteric atherosclerotic disease.
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| 8. |
- Blohm, My, et al.
(författare)
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The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis : Data from the National Swedish Registry for Gallstone Surgery, GallRiks
- 2017
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 21:1, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- Up-front cholecystectomy is the recommended therapy for acute cholecystitis (AC). However, the scientific basis for the definition of the optimal timing for surgery is scarce. The aim of this study was to analyze how the timing of surgery, after the admission to hospital for AC, affects the intra- and postoperative outcomes. Within the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014 were identified. Data regarding patient characteristics, intra- and postoperative adverse events (AEs), bile duct injuries, and 30- and 90-day mortality risk were captured, and the correlation between the surgical timing and these parameters was analyzed. In total, data on 87,108 cholecystectomies were analyzed of which 15,760 (18.1 %) were performed due to AC. Bile duct injury, 30- and 90-day mortality risk, and intra- and postoperative AEs were significantly higher if the time from admission to surgery exceeded 4 days. The time course between surgery and complication risks seemed to be optimal if surgery was done within 2 days after hospital admission. Although AC patients operated on the day of hospital admission had a slightly increased AE rate as well as 30- and 90-day mortality rates than those operated during the interval of 1-2 days after admission, the bile duct injury and conversion rates were, in fact, significantly lower. The optimal timing of cholecystectomy for patients with AC seems to be within 2 days after admission. However, the somewhat higher frequency of AE on admission day may emphasize the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available.
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| 17. |
- Haglund, Ulf H., et al.
(författare)
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Right hemihepatectomy
- 2008
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 12:7, s. 1283-1287
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Tidskriftsartikel (refereegranskat)abstract
- A right hemihepatectomy is frequently required for surgical removal of colorectal liver metastases. Today, this procedure can be performed quite safely provided the remaining liver is free from significant disease including steatohepatitis due to prolonged cytostatic treatment. Standard surgical techniques for liver resection are described in surgical textbooks. However, each center has developed its own modifications of important details. In this paper, we describe our technique to resect the right liver lobe using conventional surgical techniques as well as a vascular stapler and an ultrasonic dissector. This technique has proven to be quite safe, and blood loss is most often not significant despite we do not routinely apply the Pringle's manoeuvre during the division of the liver parenchyma.
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| 18. |
- Hansson, Jeanette, 1972, et al.
(författare)
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A Model to Select Patients Who May Benefit from Antibiotic Therapy as the First Line Treatment of Acute Appendicitis at High Probability.
- 2014
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 18:5, s. 961-967
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Tidskriftsartikel (refereegranskat)abstract
- Randomized studies indicated that 88-95% of patients with acute appendicitis recover on antibiotics without surgery, although it is unclear which patient would benefit with high probability on antibiotics. We hypothesized that patients with phlegmonous appendicitis should be a group where antibiotics may be a sufficient treatment. Accordingly, our aim was to propose a model to support treatment application for unselected patients with acute appendicitis.
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| 19. |
- Hasselgren, Kristina, 1976-, et al.
(författare)
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Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion: FLR Increase in Patients with CRLM Is Highest the First Week After PVO
- 2019
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 23:3, s. 556-562
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPortal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks.MethodsPatients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) <30% treated with PVO were prospectively included. All patients had at least one CT evaluation before radical hepatectomy.ResultsForty-eight patients were included. During the first week after PVO, the kinetic growth rate (KGR) was 5.4 (4), compared to 1.5 (+/- 2) between the first and second CT (p<0.05). For patients reaching adequate FLR and therefore treated with radical hepatectomy, the KGR was 7 (+/- 4) the first week, compared to 4.3 (+/- 2) for patients who failed to reach a sufficient volume (p=0.4). During the interval between the first and second CT, the KGR was 2.2 (+/- 2), respectively (+/- 0.1) (p=0.017).Discussion p id=Par4 The increase in liver volume after PVO is largest during the first week. As KGR decreases over time, it is important to shorten the interval between PVO and the first volume evaluation; this may aid in decision-making and reduce unnecessary waiting time.
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| 24. |
- Lindqvist, Lisa, et al.
(författare)
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The Impact of Hospital Level of Care on the Management of Acute Cholecystitis : a Population-Based Study
- 2022
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer. - 1091-255X .- 1873-4626. ; 26, s. 2551-2558
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital.METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals.RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075).CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.
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| 25. |
- Lundström, Patrik, et al.
(författare)
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Effectiveness of Prophylactic Antibiotics in a Population-Based Cohort of Patients Undergoing Planned Cholecystectomy
- 2010
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 14:2, s. 329-334
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Tidskriftsartikel (refereegranskat)abstract
- In the absence of randomized controlled trials with sufficient power to assess the effectiveness of prophylactic antibiotics (PA), the best evidence is provided by large population-based register studies. The Swedish Register of Gallstone Surgery and ERCP (GallRiks) started in May 2005 and reached 75% national coverage in 2007. During 2006 and 2007, a total of 16,400 operations were registered in GallRiks. In the present study, all elective procedures performed in 2006-2007 in units performing at least 25 operations annually were included in an analysis of the risk for postoperative infectious complications Altogether 10,927 procedures were performed 2006-2007. Univariate logistic regression analysis revealed a paradoxical increase in postoperative infectious complications requiring antibiotic treatment and postoperative abscess if PA were given (p < 0.05). This increase disappeared in multivariate analysis with adjustment for age, gender, presence of cholecystitis, accidental gallbladder perforation, and presence of bile duct stones. No benefit from PA was seen in this study on elective cholecystectomy. Although a randomized controlled trial could possibly show a reduction in the risk for postoperative infectious complications not detected in this study, such a reduction must be weighed against the risk of promoting drug resistance by the widespread use of PA.
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| 27. |
- Nordin, L., et al.
(författare)
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Corticosteroids or Not for Postoperative Nausea : A Double-Blinded Randomized Study
- 2016
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 20:8, s. 1517-1522
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Tidskriftsartikel (refereegranskat)abstract
- Background: Postoperative nausea and vomiting (PONV) is common after general anaesthesia, and corticosteroids are used in many protocols for enhanced recovery after surgery (ERAS). However, surgical techniques are developing, and ERAS protocols need to be reevaluated from time to time. Patients and method: In this study, we compared the effects of oral vs. parenteral corticosteroid administration on postoperative nausea. Elective Roux-y-gastric bypass (RYGB) patients were randomly assigned to either 8 mg betamethasone orally (n = 50) or parentally (n = 25) or as controls (n = 25), in a double-blind design. PONV risk factors were noted. All patients had the same anaesthetic technique. Data were collected at baseline, on arrival to the recovery room (RR) and at five more time points during the first 24 h. Nausea and tiredness were patient assessed using visual analogue scales; rescue drug consumption was recorded. Results: Operation time was 30–40 min. Neither demographics nor risk factors for nausea differed between groups. Neither peak values for nor total amount of nausea differed between groups. The number of supplemental injections was the same for all groups. Comments: In a setting of modern laparoscopic RYGB, the value of betamethasone in preventing PONV seems to be limited. ERAS protocols may need re-evaluation.
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