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| 2. |
- Hallén, Magnus, et al.
(författare)
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Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial.
- 2008
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Ingår i: Surgery. - : Elsevier BV. - 1532-7361 .- 0039-6060. ; 143:3, s. 313-317
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We have conducted a randomized controlled trial of totally extraperitoneal hernia repair (TEP) versus tension-free open repair (Lichtenstein repair); we have presented the results previously up to 1 year after the operation. The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation. METHODS: Of 168 patients included in a prospective, randomized controlled trial designed to compare TEP with an open tension-free technique, 154 patients (92%) answered a questionnaire and 147 patients (88%) were followed up at an outpatient clinic after a minimum of 6 years after operation. RESULTS: Overall, 89% of patients in the TEP group and 95% of patients in the open group reported complete long-term recovery (P = .23). Permanent impaired inguinal sensibility was more common in the open group (P = .004), whereas the proportion of patients with reported testicular pain was higher in the TEP group (P = .003). Three recurrences were found in the TEP group, and 4 recurrences were found in the open group (P = .99). Four patients in the TEP group underwent operations for complications related to the hernia repair (small bowel obstruction, umbilical hernia, testicular pain, and neuralgia). CONCLUSION: Overall, both groups showed good long-term results with low rates of recurrences. However, the TEP group was associated with a higher proportion of patients with long-term testicular pain, whereas impaired inguinal sensibility was more common in the open group.
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| 3. |
- Lindblom, Pia, et al.
(författare)
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Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia.
- 2002
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Ingår i: Surgery. - : Elsevier BV. - 1532-7361 .- 0039-6060. ; 131:5, s. 515-520
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Selecting patients with a low risk of hypocalcemia is mandatory if patients are to be discharged on the first day after bilateral thyroidectomy. This study investigated the predictive value of intraoperative parathyroid hormone (PTH). METHODS: Thirty-eight patients underwent total or near-total thyroidectomy. Patients with or without biochemical and symptomatic hypocalcemia were compared regarding intraoperative PTH levels and previously suggested risk factors. The accuracy of intraoperative PTH to predict patients at risk for postoperative hypocalcemia was compared with a calcium concentration of less than 2.00 mmol/L (8.0 mg/dL) on the first postoperative day. RESULTS: PTH levels after resection of the second lobe, age, and number of parathyroid glands identified intraoperatively were independently associated with the reduction in serum calcium concentration measured at nadir on the first or second postoperative day. PTH levels after resection of the second lobe were lower among patients who developed biochemical (P <.001) and symptomatic hypocalcemia (P <.01) compared with those who did not. Low levels of intraoperative PTH identified the 3 patients who required intravenous calcium during the first 24 postoperative hours. An intraoperative PTH level below reference range and a calcium concentration of less than 2.00 mmol/L measured 1 day postoperatively both predicted biochemical hypocalcemia with a similar sensitivity (90% vs 90%) and specificity (75% vs 82%). Intraoperative PTH was slightly better than a serum calcium concentration of less than 2.00 mmol/L on postoperative day 1 to predict symptomatic hypocalcemia, with a sensitivity of 71% vs 52% and a specificity of 81% vs 76%, respectively. CONCLUSIONS: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia.
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| 4. |
- Bergenfelz, Anders, et al.
(författare)
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Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy
- 2020
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 167:1, s. 124-128
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Tidskriftsartikel (refereegranskat)abstract
- Background: Permanent hypoparathyroidism is common after thyroidectomy. The present study evaluated the risk for morbidity in patients operated with total thyroidectomy with and without permanent hypoparathyroidism. Methods: Data was retrieved from the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery and cross-linked with the Swedish National Prescription Registry for Pharmaceuticals, the National Data Inpatient Registry, and Causes of Death Registry. Patients with benign thyroid disease were included. Permanent hypoparathyroidism was defined as treatment with active vitamin D for more than 6 months after thyroidectomy. Analyzed morbidity was evaluated by multivariable Cox's regression analysis and presented as hazard ratio and 95% confidence interval. Results: There were 4,828 patients. The mean (standard deviation) follow-up was 4.5 (2.4) years. Some 239 (5.0 %) patients were medicated for permanent hypoparathyroidism. Patients with permanent hypoparathyroidism had an increased risk for renal insufficiency, hazard ratio 4.88 (2.00–11.95), and an increased risk for any malignancy, hazard ratio 2.15 (1.08–4.27). Patients with permanent hypoparathyroidism and known cardiovascular disease at the time of thyroidectomy had an increased risk for cardiovascular events during follow-up, hazard ratio 1.88 (1.02–3.47). Conclusion: Patients with permanent hypoparathyroidism after total thyroidectomy have an increased risk of long-term morbidity. These results are a cause of great concern.
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| 5. |
- Vatansever, Safa, et al.
(författare)
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Robot-assisted versus conventional laparoscopic adrenalectomy : Results from the EUROCRINE Surgical Registry
- 2022
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 171:5, s. 1224-1230
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy. Methods: This is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay. Results: A total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45−65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P <.001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P =.147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P <.001). Conclusion: Analysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted.
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