| 1. |
- Andersson, Daniel P., et al.
(author)
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Omentectomy in addition to gastric bypass surgery and influence on insulin sensitivity : A randomized double blind controlled trial
- 2014
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In: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 33:6, s. 991-996
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Journal article (peer-reviewed)abstract
- Background & aims: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. Methods: Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. Results: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 +/- 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 +/- 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. Conclusion: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.
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| 2. |
- Bringman, Sven, et al.
(author)
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Feasibility of a combined percutaneous laparoscopic three-millimeter device
- 2014
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In: Journal of the Society of Laparoendoscopic Surgeons. - 1086-8089 .- 1938-3797. ; 18:1, s. 41-45
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Journal article (peer-reviewed)abstract
- Background and Objectives: NeedlescoJ instruments induce minimal trauma and produce excellent cosmetic results. A combination of a 3-mm abdominal wall incision and a 5-mm instrument in the abdominal cavity would combine the beneficial features of these two different sizes.Methods: The Percutaneous Surgical System (PSS) (Ethicon EndoSurgety, Galway, Ireland) is a new instrument consisting of a 3-mm shaft that is introduced percutaneously into the abdominal cavity. Through a 5-mm trocar, a. loader with a 5-mm attachment such as a Maryland dissector is introduced. The attachment is connected to the shaft, and the loader is removed from the abdomen. The feasibility of this device was evaluated retrospectively in 3 Swedish hospitals between January and September 2012.Results: Twenty-eight patients were laparoscopically operated on (cholecystectomy, gastric bypass, fundoplication, incisional hernias, and totally extraperitoneal repair for inguinal hernia) by use of 1 or 2 PSSs in each operation (47 in total). It was feasible to use the PSS in all procedures except during the totally extraperitoneal repair procedure because of the limited available preperitoneal space. Especially in laparoscopic cholecystectomies, the two lateral 5-mm trocars were easily replaced by two 3-mm PSS instruments.Conclusions: The use of the PSS is feasible in a number of laparoscopic procedures, where it can replace 5-mm trocars. Randomized controlled trials are needed to determine the future role of the PSS versus, for example, needlescopic laparoscopy.
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| 3. |
- Bringman, Sven
(author)
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Minimally invasive hernia surgery
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Minimally invasive laparoscopic and open tension-free techniques have been evolved during the 1990's. Different laparoscopic techniques have been used, where the totally extraperitoneal hernioplasty (TEP) is a technically demanding but probably a better approach to minimally invasive hernia surgery than the transabdominal preperitoneal technique (TAPP), which may increase the risk of adhesions and postoperative intestinal obstruction. TEP has been criticized because of expensive disposable equipment. The standard polypropylene mesh used in tension-free operations induces a strong foreign tissue reaction with potentially harmful effects. A mesh with less polypropylene could possibly be beneficial. The aim of this thesis was to evaluate and compare different minimally invasive techniques and meshes for inguinal hernia. In three randomized controlled multi-center studies 1212 patients were randomized and included in follow-up: TEP with or without the use of a dissection balloon (322 patients); TEP using only reusable instruments, mesh-plug or Lichtenstein (299 patients); Lichtenstein with Prolene or Vyproll (which contains less polypropylene) mesh (591 patients). In the last study all randomization and entering of data was performed online in a database through the Internet, which facilitated the completion of the trial. More than 80% of all patients in the studies were operated on in day- surgery. There were more conversions to TAPP or an open technique if a balloon not was used. However the majority of the conversions occurred early in the learning curve, which indicates that the use of a dissection balloon can be helpful during the learning curve, but in experienced hands it just adds costs to the operation, without offering additional benefits. The operation time was shorter in the mesh-plug group compared to Lichtenstein and TER Postoperative pain was diminished after TEP compared to open repair. The time to return to work was shorter after TEP than Lichtenstein (5 vs. 7 days). The time of rehabilitation was shorter after TEP than mesh-plug or Lichtenstein (14 vs. 24.5 vs. 28.5 days). There was a tendency of more pain after Lichtenstein than after TEP or mesh-plug at follow-up. Laparoscopic hernioplasty (TEP) is superior to tension-free open herniorrhaphy with Mesh-plug and patch or Lichtenstein's operation in terms of postoperative pain and rehabilitation. There was no significant difference between Lichtenstein with Prolene or Vyproll concerning postoperative pain, complications, rehabilitation or quality of life. All patients (n=33 275) with a unilateral primary inguinal or femoral hernia with only one operation recorded in the Swedish Hernia Register 1992-2000 were linked to the Swedish Inpatient Register and the Swedish Death Register for the period 1987-2000. The highest adjusted relative risk (RR) of postoperative intestinal obstruction was found in patients with previous multiple admissions for abdominal operations/inflammations, including intestinal obstruction, 58.99. The RR was 2.79 with TAPP and 0.57 with TEP compared to Lichtenstein operated patients.
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| 5. |
- Carlstedt, Anders, et al.
(author)
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Management of Diastasis of the Rectus Abdominis Muscles : Recommendations for Swedish National Guidelines
- 2021
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In: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 10:3, s. 452-459
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Journal article (peer-reviewed)abstract
- Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
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| 6. |
- Rogmark, Peder, et al.
(author)
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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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In: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 258:1, s. 37-45
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Journal article (peer-reviewed)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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