| 1. |
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| 2. |
- Carlstedt, Anders, et al.
(författare)
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Management of Diastasis of the Rectus Abdominis Muscles : Recommendations for Swedish National Guidelines
- 2021
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Ingår i: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 10:3, s. 452-459
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Tidskriftsartikel (refereegranskat)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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| 3. |
- Clay, Leonard, et al.
(författare)
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Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia : a randomized controlled multicenter study
- 2018
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; :2, s. 325-332
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.
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| 4. |
- Emanuelsson, Peter, et al.
(författare)
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Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis : comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively
- 2014
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Ingår i: Hernia. - Paris : Springer. - 1265-4906 .- 1248-9204. ; 18:4, s. 465-471
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC).RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.
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| 5. |
- Emanuelsson, Peter, et al.
(författare)
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Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis : a 3-month follow-up
- 2014
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Ingår i: Journal of Plastic, Reconstructive & Aesthetic Surgery. - : Elsevier. - 1748-6815 .- 1878-0539. ; 67:8, s. 1082-1088
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to evaluate early complications following retromuscular mesh repair with those after dual layer suture of the anterior rectus sheath in a randomised controlled clinical trial for abdominal rectus muscle diastasis (ARD).METHODS: Patients with an ARD wider than 3 cm and clinical symptoms related to the ARD were included in a prospective randomised study. They were assigned to either retromuscular inset of a lightweight polypropylene mesh or to dual closure of the anterior rectus fascia using Quill self-locking technology. All patients completed a validated questionnaire for pain assessment (Ventral Hernia Pain Questionnaire, VHPQ) and for quality of life (SF36) prior to and 3 months after surgery.RESULTS: The most frequently seen adverse event was minor wound infection. Of the patients, 14/57 had a superficial wound infection; five related to Quill and nine to mesh repair. No deep wound infections were reported. Patient rating for subjective muscular improvement postoperatively was better in the mesh technique group with a mean of 6.9 (range 0-10) compared to a mean of 4.8 (range 0-10) in the Quill group (p=0.01). The pre- and post-operative SF36 scores improved in both groups.CONCLUSIONS: There was no significant difference between the two surgical techniques in terms of early complications and perceived pain at the 3-month follow-up. Both techniques may be considered equally reliable for ARD repair in terms of adverse outcomes during the early postoperative phase, even though patients operated with a mesh experienced better improvement in muscular strength.
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| 6. |
- Emanuelsson, Peter, et al.
(författare)
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Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength : a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures
- 2016
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Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 160:5, s. 1367-1375
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only.METHODS: Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4.RESULTS: One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up.CONCLUSION: There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.
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| 7. |
- Giunta, Riccardo E., et al.
(författare)
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ESPRAS Survey: National and European Societies for Plastic Surgeons
- 2024
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Ingår i: HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE. - 0722-1819 .- 1439-3980.
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Tidskriftsartikel (refereegranskat)abstract
- Background The European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) comprises 40 national societies across Europe. In addition to ESPRAS, there are 8 different European Plastic Surgery societies representing Plastic Surgeons in Europe. The 4 th European Leadership Forum (ELF) of ESPRAS, held under the motto "Stronger together in Europe" in Munich in 2023, aimed to collect and disseminate information regarding the national member societies of ESPRAS and European societies for Plastic Surgeons. The purpose was to identify synergies and redundancies and promote improved cooperation and exchange to enhance coordinated decision-making at the European level. Material and methods An online survey was conducted regarding the organisational structures, objectives and challenges of national and European societies for Plastic Surgeons in Europe. This survey was distributed to official representatives (Presidents, Vice Presidents and General Secretaries) and delegates of national and European societies at the ELF meeting. Missing information was completed using data obtained from the official websites of the respective European societies. Preliminary results were discussed during the 4 th ELF meeting in Munich in March 2023. Results The ESPRAS survey included 22 national and 9 European Plastic Surgery societies representing more than 7000 Plastic Surgeons in Europe. Most national societies consist of less than 500 full members (median 182 members (interquartile range (IQR) 54-400); n=22). European societies, which covered the full spectrum or subspecialities, differed in membership types and congress cycles, with some requiring applications by individuals and others including national societies. The main purposes of the societies include research, representation against other disciplines, specialisation and education as well as more individual goals like patient care and policy regulation. Conclusion This ESPRAS survey offers key insights into the structures, requirements and challenges of national and European societies for Plastic Surgeons, highlighting the relevance of ongoing close exchange between the societies to foster professional advancement and reduce redundancies. Future efforts of the ELF will continue to further explore strategies for enhancing collaboration and harmonisation within the European Plastic Surgery landscape.
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| 8. |
- Gunnarsson, Ulf, 1967-, et al.
(författare)
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Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength
- 2015
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Ingår i: Digestive Surgery. - : Karger. - 0253-4886 .- 1421-9883. ; 32:2, s. 112-116
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgery for Abdominal Rectus Diastasis (ARD) is a controversial topic and some argue that it is solely an aesthetic problem. Many symptoms in these patients are indefinite, and no objective criteria have been established, indicating which patients are likely to benefit from surgery. This study investigated the correlation between preoperative assessment and intraoperative measurement of ARD width, and objective measurements of muscle strength. Methods: 57 patients undergoing surgery for ARD underwent preoperative assessment of ARD width by clinical measurement and CT scan, and thereafter intraoperative measurement. Abdominal muscle strength was investigated using the Biodex System 4 including flexion, extension and isometric measurements. Correlations were calculated by the Spearman test. Results: Intraoperative ARD width between the umbilicus and the symphysis correlated strongly with Biodex measurements during flexion (p = 0.007, R = -0.35) and isometric work load (p = 0.01, R = -0.34). The following measurements showed no correlation: between muscle strength and BMI; muscle strength and waistline; or between muscle strength and ARD width above the umbilicus, assessed preoperatively at the outpatient clinic, by CT scan, or measured intraoperatively. Conclusion: There is a strong correlation between intraoperatively measured ARD width below the umbilicus and flexion and isometric abdominal muscle strength measured with the Biodex System 4.
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| 9. |
- Holmdahl, Viktor, et al.
(författare)
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Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair : a randomised controlled trial
- 2022
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 26, s. 473-479
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia.Methods: Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL).Results: Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups.Conclusion: The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM.
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| 10. |
- Holmdahl, Viktor, et al.
(författare)
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One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft : a randomised controlled trial
- 2019
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 23:2, s. 355-361
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.
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| 11. |
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| 12. |
- Ohm, Rebecka, et al.
(författare)
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Sequelae treatment needs following peripheral facial palsy : retrospective analysis of 525 patients
- 2024
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 45:5, s. E450-E456
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention.Study Design: Retrospective case review.Setting: Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions.Patients: All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022.Interventions: Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae.Main Outcome: Measures Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading.Results: Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients (p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6.Conclusions: Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.
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| 13. |
- Stark, Birgit, et al.
(författare)
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Definitive reconstruction of full-thickness abdominal wall defects initially treated with skin grafting of exposed intestines
- 2007
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 11:6, s. 533-536
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reconstruction of wide, full-thickness abdominal wall defects of the midline presents a continuing challenge, and consensus concerning the appropriate surgical treatment is lacking.METHOD: In this retrospective review, we describe a simple method of reconstruction in full-thickness defects initially treated with skin grafting directly on to the surface of the intestines. Instead of removing the split-thickness grafts from the surface of the intestines, the abdominal wall was reconstructed by inverting the grafted area and advancing the rectus muscles towards the midline.RESULTS: Four patients with full-thickness transverse defects larger than 10 cm at the level of the waist and extending from the xiphoid to the suprapubic region were operated with this method. All healed uneventfully. In one case, microscopic examination of the inverted skin showed transformation to normal connective tissue.CONCLUSION: Reconstruction of abdominal wall defects previously treated with skin grafting directly on to the intestines can be safely done by reposition of the skin-grafted intestines into the abdominal cavity and realignment of the rectus muscles in the midline.
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| 14. |
- Stark, Birgit
(författare)
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Observations on morphology and function of cutaneous and subcutaneous sensory mechanoreceptors : an experimental study in mammals
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Tactile sensory discrimination is dependent upon an intact system of peripheral mechanoreceptors, their nerve fibre afferents with cell bodies in the dorsal root ganglion and the dorsal column-medial lemniscal system which relays tactile information from the skin to the cortex. Injury to any part of the afferent pathways leads to compromised mechanoreceptive perception. The present study was initiated to extend our knowledge on the morphology and function of peripheral receptors subserving mechanoreception in mammals during normal conditions and after nerve injury. Human Pacinian corpuscles (PC) were clustered close to digital nerves and vessels. Differences in corpuscular size did not reflect morphological variations. PCs in distal phalanges were smaller than in proximal parts of the hand. Nerve afferents of PCs, recognised in close neighbourhood to SA 11 units, were segregated in an orderly fashion in the median nerve at elbow level. PCs but non Meissner corpuscles (MC) and Merkel cells were immuno-reactive to the glucose transporter 1 (Glut-1). Immature and denervated PCs had a strong Glut-1 immuno-reaction. Perineurial cells of peripheral nerves down-regulated Glut-1 during Wallerian degeneration. TGF-ß isoforms appeared in normal and denervated mechanoreceptors. TGF-ß was maintained in sensory neurons, satellite cells of dorsal root ganglia and in peripheral nerves following injury. TGF-ß signalling seems to involve autocrine and paracrine mechanisms. Lamellar cells of the PC expressed the low affinity p75 receptor for neurotrophins and the high affinity trk B receptor in young and adult animals. The increased expression of P75 and trk B in denervated immature and adult PCs supports the notion that anterogradely transported BDNF might promote development and regeneration in PCs. Kitten PCs exhibited a growth inhibition following nerve injury. Conclusion: The data agree with the idea of a general orderly organisation of the somatosensory system in the periphery. Mechanoreceptors differ from each other in terms of their expression of growth factors, cytokines, neurotrophins and their respective receptors. The Pacinian corpuscle can be considered to have the most resemblance to peripheral nerves.
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| 15. |
- Stark, Birgit, et al.
(författare)
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Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis
- 2012
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Informa Healthcare. - 2000-656X .- 2000-6764. ; 46:2, s. 102-105
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the validity and reliability of the Biodex system 4 in the assessment of abdominal strength in patients with rectus diastasis, we studied 10 healthy volunteers and 10 patients with rectus diastasis of more than 3 cm. We assessed test-retest reliability at 30(o) and 60(o) of extension/flexion spinal angles, respectively, and isometric muscle strength with and without the abdominal girdle. Reliability was calculated using the interclass correlation coefficient (ICC). Validity was evaluated by correlation with the International Physical Activity Questionnaire (IPAQ) and a visual analogue scale (VAS) for self-assessment of abdominal muscular strength. The Kendall-Tau and Spearman tests were used. Reliability was excellent with ICC values ranging between 0.77 and 0.97. There was no significant difference in muscular strength for tests with or without a girdle except with 60(o) extension. The internal validity assessed as the correlation between VAS and isometric strength (p = 0.008) was excellent, whereas there was no correlation with IPAQ. The Biodex system 4 is a valuable and reliable instrument to measure abdominal wall strength in patients with rectus diastasis. The internal validity is excellent. The incongruence between abdominal muscle strength, as measured using the Biodex system 4, and IPAQ indicates that there is no relation between general physical activity (IPAQ) and muscular strength in patients with rectus diastasis.
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| 16. |
- Strigård, Karin, et al.
(författare)
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Predictive Factors in the Outcome of Surgical Repair of Abdominal Rectus Diastasis
- 2016
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Ingår i: Plastic and Reconstructive Surgery - Global Open. - 2169-7574. ; 4:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to define the indicators predicting improved abdominal wall function after surgical repair of abdominal rectus diastasis (ARD). Preoperative subjective assessment quantified by the validated Ventral Hernia Pain Questionnaire (VHPQ) was related to relative postoperative functional improvement in abdominal muscle strength.METHODS: Fifty-seven patients undergoing surgery for ARD completed the VHPQ before surgery. Preoperative pain assessment results were compared with the relative improvement in muscle strength measured with the BioDex system 4.RESULTS: There was a correlation between the relative improvement in muscle strength measured by the BioDex System 4 for flexion at 30 degrees (P = 0.046) and 60 degrees per second (P = 0.004) and the preoperative question, "Do you find it painful to sit for more than 30 minutes?" There was also a correlation between BioDex improvement for flexion at 30 degrees (P = 0.022) and for isometric work load (P = 0.038) and the preoperative question, "Has abdominal pain limited your ability to perform sports activities?" The VHPQ responses also formed a pattern with a fairly good correlation between other BioDex modalities (with the exception of extension at 60 degrees per second) and the response to the question regarding complaints when performing sports. Postoperative visual analog scale ratings of abdominal wall stability correlated to the questions regarding complaints when sitting (P = 0.040) and standing (P = 0.047). No other correlation was seen.CONCLUSION: VHPQ ratings concerning pain while being seated for more than 30 minutes and pain limiting the ability to perform sports are promising indicators in the identification of patients likely to benefit from surgical correction of their ARD.
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| 17. |
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| 18. |
- Strigård, Karin, 1958-, et al.
(författare)
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Ventral hernia and patient experience of an elastic girdle
- 2015
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Ingår i: ANZ journal of surgery. - : Wiley-Blackwell. - 1445-1433 .- 1445-2197. ; 85:7-8, s. 525-528
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Abdominal girdles are used to prevent hernia and to facilitate the in-growth of mesh following ventral hernia surgery or instead of surgery. Scientific evidence supporting the use of girdle, including patient experience, is lacking. The aim was to investigate patient experience of wearing an elastic girdle in terms of support and tolerability. METHODS: A trans-sectional study with quantitative onset was performed. Telephone interviews following a strict protocol were performed 2 years after girdle prescription. Of the 89 eligible patients, 67 completed the interview. The questionnaire constituted 13 questions. RESULTS: Of the 52 women and 15 men, two thirds had ventral hernia surgery. Patients over 70 years more often used girdle as a substitute for surgery. Most patients (64%) were satisfied with the girdle and 94% used it as prescribed. Five out of 53 who used girdles preoperatively stated no improvement in their inconvenience. Almost all patients (97%) had some problem with the girdle. CONCLUSION: In this first study on patient experience, nearly all patients used it as prescribed and subjective benefit was achieved even though side effects were present in most cases. Individual fitting and improved information about when and how to use the girdle is important for patient comfort and optimal function. This study attended patient experience of negative side effects from wearing a girdle. Improvement may be reached concerning comfort from the patients' perspective. The importance of both written and oral information has been revealed.
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| 19. |
- Swedenhammar, Ebba, et al.
(författare)
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Long-term follow-up after surgical repair of abdominal rectus diastasis : a prospective randomized study
- 2021
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Ingår i: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 110:3, s. 283-289
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life.METHODS: A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8-6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire.RESULTS: No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. "Pain this week" had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003).CONCLUSION: No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.
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| 20. |
- Winsnes, Annika
(författare)
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Evaluating an experimental model consecutive to abdominal wall hernia repair outcome
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Abdominal wall hernia is a common surgically treated condition. Patients with primary umbilical hernia are operated with suture or mesh repair, but recurrence and complication rates have been debated.Larger abdominal wall hernias need implantation of reinforcing material for repair. Synthetic implants are dominating. In complex hernia cases neither synthetic nor biologic implants are optimal. A randomized controlled trial has revealed satisfactory results from autologous full thickness skin grafts (FTSGs) in onlay position. Further application intraperitoneally (IPOM) in laparoscopic surgery and for repair of parastomal hernia in humans, must be based on a translational concept including animal and morphologic studies since the IPOM position has not been evaluated systematically. This thesis aims to be a link in a translational chain, focused on establishing an experimental model for FTSG evaluation.Problem formulations: - Does synthetic mesh decrease the probability of recurrence and/or complications in primary umbilical hernia?- Can FTSG be evaluated for IPOM versus onlay position in a transgenic mouse model using luminescence from substrate activated by the enzyme luciferase expressed in donor tissue?- How does the FTSG in IPOM position perform compared to FTSG in onlay position?Results:Recurrence rate at a median of 6.8 years follow-up was 9% for suture- and 8% for mesh repair, odds ratio (OR) 0.9, 95% confidence interval (CI) 0.40-2.02, in 306 patients investigated patients. Surgical complications were in favor of suture repair, OR 6.6, 95% CI 2.29-20.38.In an experimental evaluation of FTSG, 20 mice received intervention with either onlay or IPOM graft. Survival of FTSG was revealed for 8 weeks by luminescence detection. All animals regained weight within 8 days in median. At sacrifice 8 weeks postoperatively, adhesions were evaluated by a modified Jenkins’ scale. No onlay mice displayed adhesions while two IPOM mice had firm and one dense adhesions. Inflammatory response evaluated in four animals expressing nuclear factor ĸB (NF-ĸB) showed a peak at day 2 and returned to stable low levels from day 5 until end of the 33-day follow up. FTSG in IPOM position showed similar morphology and immunohistochemistry stain patterns as controls in onlay position. There was a low expression of the inflammatory markers tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and myeloperoxidase. Vascular structures were visualized by von Willebrand factor-stain. In Picrosirius red stain, collagen bundles in dermis of FTSG in both IPOM and onlay position was thicker, compared to internal controls. FTSG extracellular matrix had metamorphosed mainly into thick collagen bundles, with partially degraded skin appendages. Matrix metalloproteinases (MMP)-stain from MMP-1, MMP-8 and MMP-9 were not co-distributed with their respective collagen substrates.Conclusions:Synthetic mesh does not decrease the probability of recurrence but significantly increase complications in repair of small umbilical hernia. FTSG can be evaluated in IPOM and onlay position in an experimental transgenic mouse model. The two positions were similar in terms of graft survival, few adhesions, micro-vessel formation, low grade inflammation, cyst formation and collagen distribution. FTSG implanted in IPOM position does not exhibit any systematic differences from onlay position, thus from this perspective no difference in biomechanical behavior can be anticipated.
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