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- Syrén, Eva-Lena, et al.
(författare)
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Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography
- 2019
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Ingår i: BJS Open. - : JOHN WILEY & SONS LTD. - 2474-9842. ; 3:4, s. 485-489
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) could be related to technical or patient-related factors. The aim of this study was to assess whether clinical variables and co-morbidities influence the risk of developing PEP.Methods: Data were retrieved from the Swedish GallRiks registry, including all ERCP procedures performed in 2006-2014 for common bile duct stones. A total of 15 800 procedures were identified and cross-checked. Univariable and multivariable logistic regression analyses were conducted with the endpoint of PEP using the following co-variables: age, sex, ASA grade, previous history of acute pancreatitis, diabetes, hyperlipidaemia, hypercalcaemia, kidney disease and liver cirrhosis.Results: Women (odds ratio (OR) 1.33, 95 per cent c. i. 1.14 to 1. 55), patients aged less than 65 years (OR 1. 68, 1. 45 to 1. 94), patients with hyperlipidaemia (OR 1. 32, 1. 02 to 1. 70) and those with a previous history of acute pancreatitis (OR 5. 44, 4. 68 to 6. 31) had a significantly increased risk of PEP. In a subgroup analysis of patients with a previous history of acute pancreatitis, the mean time from previous pancreatitis to ERCP 4423 days in patients who developed PEP vs 6990 days in patients who did not (P = 0. 037). However, when the previous episode of pancreatitis had occurred more than 30 days before ERCP, this association was no longer significant (P = 0. 858). Patients with diabetes had a decreased risk of PEP (OR 0. 64, 0. 48 to 0. 85).Conclusion: Age, sex, hyperlipidaemia and previous history of recent acute pancreatitis increase the risk of PEP. The reduced risk of PEP in patients with diabetes should be explored in future studies.
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| 2. |
- Magnusson, Niklas, 1975-, et al.
(författare)
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Reoperation for persistent pain after groin hernia surgery : a population-based study
- 2015
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 19:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to assess the outcome results after reoperation for persistent pain after hernia surgery in a population-based setting.Methods: All patients who had undergone surgery for persistent pain after previous groin hernia surgery 1999-2006 were identified in the Swedish Hernia Register (n = 237). Data on the surgical technique used were abstracted from the medical records. The patients were asked to answer a set of questions including SF-36 to evaluate the prevalence of pain after reoperation.Results: The study group consisted of 95 males and 16 females, mean age 53 years. In 27 % of cases an intervention aimed at suspected ilioinguinal neuralgia was performed. The mesh was removed completely in 28 % and partially in 13 %. A suture at the pubic tubercle was removed in 13 % of cases. Decrease in pain after the most recent reoperation was reported by 69 patients (62 %), no change in pain by 21 patients (19 %) and increase in pain in 21 patients (19 %). There was no significant difference in outcome between mesh removal, removal of sutures at the tubercle or interventions aimed at the ilioinguinal nerve. All subscales of SF-36 were significantly reduced when compared to the age-and gender-matched general population (p < 0.05).Conclusions: Patients reoperated for persistent pain after hernia surgery often report a reduction in pain, but the natural course of persistent pain, the relatively low response rate and selection of patients make it difficult to draw definite conclusions.
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| 3. |
- Nilsson, Hanna, et al.
(författare)
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Serious adverse events within 30 days of groin hernia surgery
- 2016
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Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 20:3, s. 377-385
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Tidskriftsartikel (refereegranskat)abstract
- To analyze severe complications after groin hernia repair with respect to age, ASA score, hernia anatomy, method of repair and method of anesthesia, using nationwide registers. The annual rate of 20 million groin hernia operations throughout the world renders severe complications, although rare, important both for the patient, the clinician, and the health economist. Two nationwide registers, the Swedish Hernia Register and the National Swedish Patient Register were linked to find intraoperative complications, severe cardiovascular events and severe surgical adverse events within 30 days of groin hernia surgery. 143,042 patients, 8 % women and 92 % men, were registered between 2002 and 2011. Intraoperative complications occurred in 801 repair, 592 patients suffered from cardiovascular events and 284 patients from a severe surgical event within 30 days of groin hernia surgery. Emergency operation was a risk factor for both cardiovascular and severe surgical adverse events with odds ratios for cardiovascular events of 3.1 (2.5-4.0) for men and 2.8 (1.4-5.5) for women. Regional anesthesia was associated with an increase in cardiovascular morbidity compared with local anesthesia, odds ratio 1.4 (1.1-1.9). In men, bilateral hernia and sliding hernia approximately doubled the risk for severe surgical events; odds ratio 1.9 (1.1-3.5) and 2.2 (1.6-3.0), respectively. Methods other than open anterior mesh repair increased the risk for surgical complications. Awareness of the increased risk for cardiovascular or surgical complications associated with emergency surgery, bilateral hernia, sliding hernia, and regional anesthesia may enable the surgeon to further reduce their incidence.
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| 6. |
- Sevonius, Dan, et al.
(författare)
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The Impact of Type of Mesh Repair on 2nd Recurrence After Recurrent Groin Hernia Surgery
- 2015
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 39:2, s. 315-322
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Tidskriftsartikel (refereegranskat)abstract
- According to the Swedish Hernia Register (SHR), the reoperation rate is more than doubled after recurrent groin hernia repair compared with primary repair. The aim was to study the impact of type of mesh repair used in recurrent groin hernia surgery on a 2nd recurrence in a population-based cohort derived from the SHR. All 1st recurrent hernia repairs in the south-west region of Sweden, registered in SHR between 1998 up to 2007 were included. A questionnaire was sent in 2009. Patients stating a new lump or persisting problems were examined. A 2nd recurrence was identified as a 2nd reoperation or at physical examination. The incidence was analysed comparing anterior mesh repair (AMR) and posterior mesh repairs (PMR) (endoscopic and open). Eight hundred and fifteen recurrent operations in 767 patents were analysed, 401 AMRs and 414 PMRs. PMR had a lower 2nd recurrence rate compared with AMR (5.6 vs. 11.0 %) (p = 0.025). An increased risk [3.21 (CI 1.33-7.44) (p = 0.009)] of a subsequent 2nd recurrence was seen after anterior index repair followed by AMR and a decreased risk [0.08 (CI 0.01-0.94) (p = 0.045)] after posterior index repair followed by AMR. PMR in recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior. A posterior approach for 1st recurrent operation is recommended after an anterior index repair and an anterior approach after a posterior index operation.
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