| 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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| 11. |
- Keita, Åsa V, et al.
(författare)
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Characterization of antigen and bacterial transport in the follicle-associated epithelium of human ileum
- 2006
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Ingår i: Laboratory investigation. - : Elsevier BV. - 0023-6837 .- 1530-0307. ; 86:5, s. 504-516
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Tidskriftsartikel (refereegranskat)abstract
- The follicle-associated epithelium (FAE), covering Peyer's patches, provides a route of entry for antigens and microorganisms. Animal studies showed enhanced antigen and bacterial uptake in FAE, but no study on barrier function of human FAE has been reported. Our aim was to characterize the normal barrier properties of human FAE. Specimens of normal ileum were taken from 30 patients with noninflammatory colonic disease. Villus epithelium (VE) and FAE were identified and mounted in Ussing chambers. Permeability to 51Cr-EDTA, transmucosal flux of the protein antigen, horseradish peroxidase (HRP), and transport of fluorescent Escherichia coli (chemically killed K-12 and live HB101) were measured. Uptake mechanisms were studied by confocal- and transmission electron microscopy, and by using pharmacological inhibitors in an in vitro coculture model of FAE and in human ileal FAE. HRP flux was substantially higher in FAE than in VE, and was reduced by an amiloride analog. Electron microscopy showed HRP-containing endosomes. Transport of E. coli K-12 and HB101 was also augmented in FAE and was confirmed by confocal microscopy. In vitro coculture experiments and electron microscopy revealed actin-dependent, mainly transcellular, uptake of E. coli K-12 into FAE. 51Cr-EDTA permeability was equal in FAE and VE. Augmented HRP flux and bacterial uptake but similar paracellular permeability, suggest functional variations of transcellular transport in the FAE. We show for the first time that FAE of human ileum is functionally distinct from regular VE, rendering the FAE more prone to bacterial–epithelial cell interactions and delivery of antigens to the mucosal immune system.
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| 12. |
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| 13. |
- Koch Frisén, Angelica, 1970-, et al.
(författare)
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Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon
- 2011
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 15:3, s. 281-288
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Groin hernia repair is a common procedure in general surgery, and is taught to and performed by surgeons early in their training. The aim of this observational study was to compare hernia repair performance and results of surgical trainees with those of a specialized surgeon. The further aim sought to identify what factors may influence short and long-term outcome, and areas for improvement in surgical training. Methods: A non-randomized parallel cohort study was designed to compare a specialized surgeon with surgical trainees, performing the Lichtenstein repair in adult males. Two hundred repairs were included, of which 96 were performed by surgical trainees. Patient characteristics, surgical experience, and operative data including duration of procedural parts and surgical complexity were noted at surgery. Postoperative complications, recurrence, chronic pain and residual symptoms were assessed at longterm follow-up after a median of 34.5 months. Results: Surgical trainees had longer overall operative time consume, with an unproportionally longer time for mobilising the sac and cord. They perceived exposure and mobilisation as more difficult than the specialist, and also a greater demand on own experience during surgery. The trainee repairs had a higher rate of postoperative complications (14.7% versus 5.0%) but recurrence rate was the same as for specialist repairs. At long-term follow-up, specialist repairs had a higher symptom burden and more chronic pain. Conclusions: Comparison of a specialized surgeon to surgical trainees in performance and outcome for inguinal hernia surgery shows it was more efficient, but not necessarily better to let a specialized surgeon perform the repairs. The better long-term outcome for surgical trainees stands in contrast to the prejudice that it is better to have an experienced surgeon to perform standard procedures. It seems likely that targeted training in dissection and mobilisation could decrease level of perceived complexity and shorten operative time consume for surgical trainees. We believe that adequately supervised hernia surgery should remain as a part of the surgical training.
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| 14. |
- Koch Frisén, Angelica, 1970-
(författare)
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Audit of Groin Hernia Repair II
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Groin hernia repair is one of the most common operations performed in general surgery, and every fourth man is expected to have a hernia operation during his lifetime. Although 8% of all repairs are performed in women, there is little published literature relating specifically to female anatomy, risk factors and techniques. There is a continuing development of new mesh materials and health care reorganization with specialized surgical clinics changing the availability of basic surgery for surgeons under training.In 1997 a thesis was published by Anders Kald, Audit of Groin Hernia Repair, which aimed to establish an audit of hernia surgery, evaluating management, risk factors, outcome and economy. The aim of this thesis was to continue the audit of hernia surgery in Sweden, allowing evaluation of gender issues, a new mesh material, and performance of surgeons under training.Our data showed that women have a higher incidence of emergency groin hernia repair than men, and an increased rate of femoral recurrence after an inguinal hernia repair. Time to reoperation suggests that a primary misdiagnosis is common. Detection of femoral hernias could be increased by using preperitoneal techniques, visualizing all three groin hernia locations.Patients who received a lightweight mesh at their hernia operation had a shorter convalescence, with faster return to work and normal activity.It might be more efficient, but not necessarily better to let a specialized hernia surgeon perform the repair. Surgical trainees had more postoperative complications, but fewer patients had chronic pain at the long-term follow-up.
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| 15. |
- Koch Frisén, Angelica, et al.
(författare)
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Prospective evaluation of 6895 groin hernia repairs in women
- 2005
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 92:12, s. 1553-1558
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair.Methods: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men.Results: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women.Conclusion: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
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| 16. |
- Koch Frisén, Angelica, et al.
(författare)
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Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh
- 2008
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 95:10, s. 1226-1231
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Tidskriftsartikel (refereegranskat)abstract
- Background: Groin hernia repair is one of the commonest operations in general surgery. Existing techniques have very low and acceptable recurrence rates, but chronic pain and discomfort remain a problem for many patients. New mesh materials are being developed to increase biocompatibility, and the aim of this study was to compare a new titanium-coated lightweight mesh with a standard polypropylene mesh. Methods: A randomized controlled single-centre clinical trial was designed, with the basic principle of one unit, one surgeon, one technique (Lichtenstein under general anaesthesia) and two meshes. Pain before and after surgery, and during convalescence (primary outcomes) was estimated in 317 patients. At 1-year clinical follow-up, recurrence, pain, discomfort and quality of life (secondary outcomes) were evaluated. Results: Patients with the lightweight mesh returned to work after 4 days, compared with 6.5 days for the standard mesh (P = 0.040). The lightweight group returned to normal activity after 7 days, versus 10 days for the standard group (P = 0.005). There was no difference in postoperative pain or recurrence at the 1-year follow-up. Conclusion: Patients with the lightweight mesh had a shorter convalescence than those with the standard heavyweight mesh. Registration number: ISRCTN36979348 (http://www.controlled-trials.com). Copyright © 2008 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd.
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| 17. |
- Nordin, P, et al.
(författare)
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Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair
- 2003
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 90:8, s. 1004-1008
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although mesh techniques are used with increasing frequency, sutured repair still has a place in groin hernia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh technique on the risk of reoperation in open groin hernia repair using data from the Swedish Hernia Register. Methods: The relative risk of reoperation after sutured repair using non-absorbable, late absorbable and early absorbable sutures was compared in multivariate analyses, taking into account known confounding factors. Results: Between 1992 and 2000, 46 745 hernia repairs were recorded in the Swedish Hernia Register. Of these, 18 057 repairs were performed with open non-mesh methods and were included in the analysis. Using non-absorbable suture as reference, the relative risk of reoperation after repair with early absorbable suture and late absorbable suture was 1.50 (95 per cent confidence interval (c.i.) 1.22 to 1.83) and 1.03 (95 per cent c.i. 0.83 to 1.28) respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk of reoperation (1.22, 95 per cent c.i. 1.03 to 1.44). Conclusion: A non-absorbable or a late absorbable suture is recommended for open non-mesh groin hernia repair. The Shouldice technique was found to be superior to other open methods.
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| 18. |
- Nordin, Pär, et al.
(författare)
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Sutures and surgical techniques in herniorrhaphy : an analysis of 18 057 sutured non-mesh repairs
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although mesh techniques are used with increasing frequency sutured repairs will continue to have a place in groin hemia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh techniques on risk for reoperation in open groin hernia repair using data from the Swedish Hernia Register (SHR).Methods: The relative risk for reoperation after sutured repairs using nonabsorbable, late absorbable and early absorbable sutures were compared in multivariate analyses taking into account known confounding factors.Results: During 1992 -2000, 46,745 hernia repairs were recorded in the SHR. Of these 18,057 repairs were performed with open non-mesh methods and included in the analysis. With nonabsorbable suture as reference the relative risk for reoperation of early absorbable suture and of late absorbable suture was 1.50 (95% CI 1.22-1.83) and 1.03 (95% CI 0.83-1.28), respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk for reoperation 1.22 (95% CI 1.03-1.44).Conclusion: For open non-mesh groin hernia repairs a nonabsorbable or a late absorbable suture is recommended. The Shouldice technique was found superior to other open methods.
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| 19. |
- Nyström, Per-Olof, et al.
(författare)
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Laparoscopic sigmoid resection for diverticular disease
- 1999
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Ingår i: Zentralblatt für Chirurgie. - 0044-409X .- 1438-9592. ; 124:12, s. 1147-1151
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Tidskriftsartikel (refereegranskat)abstract
- It is still difficult to determine the exact indication for a laparoscopic sigmoid resection for diverticular disease. Frequently, the severity of diverticulitis is not sufficiently defined. For this reason a modification of the Hinchey classification is proposed to which a stage II b for fistula formation and a differentiation between acute and chronic disease have been added. Another problem is the lack of criteria which define a "laparoscopic" resection. A sigmoid resection should be called "laparoscopic" if the mobilization of the sigmoid colon, the transsection of the mesenteric vein and artery and the mesentery itself and the distal transsection of the bowel are done laparoscopically. The resection of the bowel and the introduction of the anvil of the stapler device can be done extraabdominally, however, the anastomosis again should be performed laparoscopi- cally. A so defined sigmoid rejection can be done in the chronic stage I. In the chronic stage II a there will be significant problems due to adhesion formation, and in the acute stages II a and II b as well as in the chronic stage II b a laparoscopic resection should not be attempted.
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| 20. |
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| 21. |
- Sandblom, Gabriel, et al.
(författare)
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Audit and recurrence rates after hernia surgery
- 2000
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Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 166:2, s. 154-158
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the effect of quality assurance on the recurrence rate after hernia repair. Design: A prospective longitudinal cohort study. Setting: District hospital, Sweden. Subjects: All (n = 1232) patients aged 15-80 years operated upon for inguinal or femoral hernia in Motala 1984, 1986-1988, 1990, and 1992-1994. Intervention: A questionnaire enquiring about pain or a lump in the operated area was sent 3-6 years postoperatively to all patients, excluding those who had already been operated on for recurrence and those who had died. Selected cases were examined depending on the answers to the questionnaire. Main outcome measures: Recurrence rate estimated by adding already confirmed recurrences to those found at the clinical examination, reoperation for recurrence, hospital stay, and number of day cases. Cumulative incidence of reoperation was analysed by actuarial analysis of all patients operated on from 1986-1997. Results: The recurrence rate decreased from 18% in 1984 and 1986 to 3% in 1993 and 1994. The reoperation rate for recurrence at three years was 10.8% (95% confidence interval, CI: 9.3 to 12.2%), 3.6% (2.6 to 4.4%) and 2.2% (1.7 to 2.7%) for patients operated on between 1986-1988, 1989-1991 and 1992-1997, respectively. Differences between the first and the second and between the first and the third period were both highly significant (p < 0.001) whereas the difference between the second and third period was not (p = 0.09). Mean hospital stay decreased from 3.5 days in 1984 to 0.9 days in 1994. Conclusion: By recording recurrence rate or its surrogate endpoint, reoperation rate for recurrence, or both, hospital stay, and number of day cases, and presenting these results to participating surgeons, we provided incentives to improve outcome. This has resulted in a rapid decrease in recurrence rate and a shortened hospital stay, thereby improving cost-effectiveness.
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| 22. |
- Smeds, Staffan, et al.
(författare)
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Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study
- 2010
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Ingår i: HERNIA. - : Springer Science Business Media. - 1265-4906 .- 1248-9204. ; 14:3, s. 249-252
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess the variation of self-reported pain over a period of 2 years in three groups of patients with no, moderate and severe pain at 3 months after primary open inguinal hernia repair. In two cohorts of patients from 2004 (n = 272) and 2005 (n = 292) who had given a self-report of postoperative pain at 3 months, 79 randomly selected patients without pain (box visual analogue scale [VAS] level 10) and all patients with moderate (Box VAS level 7-9) and severe pain (Box VAS level 1-6), 91 and 9, respectively, were included in the case series. The self-assessments were repeated for all patients 1-1.5 and 2-2.5 years after surgery (November 2006). It was observed that moderate pain reappeared among the pain-free patients in 28 and 23% after 1-1.5 and 2-2.5 years, respectively. Of those patients with moderate pain at 3 months, 39 and 49% reported no pain at 1-1.5 and 2-2.5 years, respectively, after surgery. A worsening from moderate pain to severe pain was reported by 22% of patients after 1-1.5 years and by 15% of patients after 2-2.5 years. Hernia recurrence (n = 3) was observed only in patients with increased pain. All nine patients with severe pain at 3 months reported less pain, but only one was pain-free at 2-2.5 years after surgery. The study shows that a significant proportion of the patients developed pain later than 3 months after the operation. It further points to a difference in pain evolvement in patients with moderate pain and those with severe postoperative pain at 3 months. Pain can increase in intensity from moderate to severe, both with and without the presence of a clinical recurrence.
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| 23. |
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| 24. |
- Zdolsek, Johann, et al.
(författare)
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A prospective evaluation of the PerFix® Plug technique for groin hernia repair
- 2000
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the study was to prospectively evaluate complication rates, sick-leave, recurrence rate, and chronic post-operative pain after mesh-plug hernia repair. All 385 consecutive inguinal hernias (373 patients) operated at our department with the PerFix® Plug from September 1996 to December 1997 were included in the study. Follow-up included a questionnaire 3 and 12 months after the repair. Replies to the both of these questionnaires were obtained from 363 of 373 patients (98%). All patients who either reported a lump or sensory disturbance in the operated groin were offered a clinical examination. A third questionnaire focusing on chronic post-operative pain was completed by 77 of 90 patients reporting groin pain. The recurrence rate was 2% (9/385). After 25 months (17-36 months) 38 patients (10%) still experienced inguinal pain to some degree. In 7 male patients there was either pain or discomfort during sexual activities. In a patient with poorly controlled ascites the plug was removed. Day-case surgery was performed in 86% of patients with epidural or local anaesthesia, and 64% in general- or spinal anaesthesia. Employed/self-employed patients were off work for a median of 7 days (0-65). The median time to full recovery for all patients was 20 days. Conclusion: Mesh-plug hernia repair has a reasonably low complication rate together with quick recovery in a non-specialised surgical setting. Chronic inguinal pain is, however, still present to some degree in 10% of patients after two years.
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