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1.	Ademuyiwa, Adesoji O., et al. (author) Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries 2016 In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4 Journal article (peer-reviewed)abstract Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
2.	Ahlqvist, Sandra, et al. (author) Trocar Site Hernia After Gastric Bypass 2017 In: Surgical technology international. - 1090-3941. ; 30, s. 170-174 Journal article (peer-reviewed)abstract BACKGROUND: The 5.2% rate of trocar site incisional hernia (TSIH) reported appears low in view of the proportion of TSIH repairs being performed. Detecting TSIH by clinical examination may be difficult in the obese. The correlation between clinical examination and a novel radiological examination for the detection of TSIH in obese patients was studied.MATERIALS AND METHODS: Twenty-six patients subjected to laparoscopic gastric bypass in 2010 underwent clinical and radiological examination by three independent assessors for each method, after a mean follow-up time of 33 months. The computed tomography was in the prone position upon a ring.RESULTS: At clinical examination, a TSIH was regarded to be present in six out of 26 patients and at CT scan in four. The Fleiss' Kappa for multiple raters was 0.40 (p = 0.184) with clinical examination and 1 (p <0.05) with CT scan. With CT scan, herniation was diagnosed in three of 26 umbilical trocar sites that had been closed at the index operation, and in one of the 130 other trocar sites that had not been closed.CONCLUSIONS: Clinical examination is not reliable when detecting TSIH in the obese. A CT scan in the prone position was extremely reliable and seems to have the potential of becoming the standard method for detecting TSIH in obese patients.
3.	Ahlqvist, Sandra, et al. (author) Trocar site hernia after gastric sleeve 2022 In: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 36:6, s. 4386-4391 Journal article (peer-reviewed)abstract Background: Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.Methods: Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011–2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.Results: The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.Conclusions: The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.
4.	Björk, Dennis, et al. (author) Detecting incisional hernia at clinical and radiological examination 2015 In: Surgical technology international. - : Surgical Technology Online. - 1090-3941. ; 26, s. 128-131 Journal article (peer-reviewed)abstract PURPOSE: In clinical studies, incisional hernia is usually diagnosed by clinical examination. No other modality has been proven an aid in the diagnosis. The aim was to investigate the correlation between findings at clinical examination and at computed tomography when detecting incisional hernia after midline incisions.METHODS: Patients underwent clinical examination by three surgeons. Computed tomography was performed in both the supine position and in the prone position and was examined by three radiologists. The correlation between investigators and methods were estimated by calculating the Fleiss Kappa values.RESULTS: Twenty-four patients were assessed. For the clinical examination, the Kappa was 0.81. For computed tomography with the patient in the supine position, the Kappa was 0.94 and in the prone position it was 0.89. The Kappa for clinical examination and computed tomography combined was 0.80.CONCLUSIONS: At clinical examination, incisional hernia can be defined as any detectable defect in the abdominal wall with intra-abdominal contents protruding beyond the aponeurosis. The same definition can be used at computed tomography with the addition that any visible hernia sac is also regarded an incisional hernia. With this definition, there is very good agreement between investigators at clinical investigation and at computed tomography in the prone or in the supine position. The highest agreement among investigators is achieved with computed tomography in the supine position. In clinical studies, clinical examination seems adequate for diagnosing herniation but in overweight patients a CT-scan may be a further aid.
5.	Blohm, My, et al. (author) Learning by doing : an observational study of the learning curve for ultrasonic fundus-first dissection in elective cholecystectomy 2022 In: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 36, s. 4602-4613 Journal article (peer-reviewed)abstract BACKGROUND: Surgical safety and patient-related outcomes are important considerations when introducing new surgical techniques. Studies about the learning curves for different surgical procedures are sparse. The aim of this observational study was to evaluate the learning curve for ultrasonic fundus-first (FF) dissection in elective laparoscopic cholecystectomy (LC).METHODS: The study was conducted at eight hospitals in Sweden between 2017 and 2019. The primary endpoint was dissection time, with secondary endpoints being intra- and postoperative complication rates and the surgeon's self-assessed performance level. Participating surgeons (n = 16) were residents or specialists who performed LC individually but who had no previous experience in ultrasonic FF dissection. Each surgeon performed fifteen procedures. Video recordings from five of the procedures were analysed by two external surgeons. Patient characteristics and data on complications were retrieved from the Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks).RESULTS: Dissection time decreased as experience increased (p = 0.001). Surgeons with limited experience showed more rapid progress. The overall complication rate was 14 (5.8%), including 3 (1.3%) potentially technique-related complications. Video assessment scores showed no correlation with the number of procedures performed. The self-assessed performance level was rated lower when the operation was more complicated (p < 0.001).CONCLUSIONS: Our results show that dissection time decreased with increasing experience. Most surgeons identified both favourable and unfavourable aspects of the ultrasonic FF technique. The ultrasonic device is considered well suited for gallbladder surgery, but most participating surgeons preferred to dissect the gallbladder the traditional way, beginning in the triangle of Calot. Nevertheless, LC with ultrasonic FF dissection can be considered easy to learn with a low complication rate during the initial learning curve, for both residents and specialists.
6.	Cengiz, Sezgin, 1984, et al. (author) Effects of Nb on borosiliciding of CoCrFeNiNb x high-entropy alloy 2023 In: Vacuum. - : Elsevier BV. - 0042-207X. ; 207 Journal article (peer-reviewed)abstract The effect of Nb addition (2, 5, 10 at. %) on the borosiliciding behavior of CoCrFeNiNbx high-entropy alloy was studied. Vacuum arc melted CoCrFeNiNbx alloys consisted of FCC and Laves-C14 phases. The increase of Nb in the alloys resulted in a decrease of the amount of FCC phase and an increase of the amount of Laves phase. A multiphase boride layer (BL) and a silicon-rich layer (SL) were evident with the formation of Ni2Si, FeB, Fe2B, Co2B, Cr5B3, Nb5Si3 and NbB2 phases after the thermochemical treatment. The Nb5Si3 and NbB2 phase formation was caused by the Nb addition into the CoCrFeNi alloy. The thickness of the SL + BL dramatically decreased, and the thickness of the transition zone/diffusion zone (DZ) decreased with increasing Nb content. The Nb content in the alloys hinders the inward diffusion of Si/B atoms and decreases the Si/B penetration depth. The total layer thicknesses were 45 μm, 27 μm and 12 μm for the alloys containing 2, 5 and 10 at. % Nb, respectively. The surface hardness values of alloys increased after surface treatment.
7.	Cengiz, Yucel, et al. (author) Fundus first as the standard technique for laparoscopic cholecystectomy 2019 In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 9 Journal article (peer-reviewed)abstract In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004-2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95%CI 1.6-259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
8.	Cengiz, Yucel, et al. (author) Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection : a randomized multicenter trial 2010 In: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 24:3, s. 624-630 Journal article (peer-reviewed)abstract In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection. In a multicenter trial, 243 elective patients were randomized to conventional laparoscopic cholecystectomy using electrocautery (n = 85) or the fundus-first method using either electrocautery (n = 81) or ultrasonic dissection (n = 77). The fundus-first method had a shorter operating time with ultrasonic dissection (58 min) than with electrocautery (74 min; p = 0.002). The fundus-first method using ultrasonic dissection compared with electrocautery or the conventional method produced less blood loss (12 vs. 53 or 36 ml; p < 0.001) and fewer gallbladder perforations (26% vs. 46% or 49%; p = 0.005). Also, the pain and nausea scores at 4 and 6 h were lower, and the sick leave was shorter (6.1 vs. 9.4 and 9 days, respectively; p < 0.001). The fundus-first method using ultrasonic dissection is associated with less blood loss, fewer gallbladder perforations, less pain and nausea, and shorter sick leave than the conventional and fundus-first method using electrocautery. The difference seems related to the use of ultrasonic dissection.
9.	Drake, TM, et al. (author) Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study 2020 In: BMJ global health. - : BMJ. - 2059-7908. ; 5:12 Journal article (peer-reviewed)abstract Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.MethodsA multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).ResultsOf 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.ConclusionThe odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
10.	Edergren, Åsa, et al. (author) Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach 2024 In: Surgery Open Science. - : Elsevier. - 2589-8450. ; 19, s. 141-145 Journal article (peer-reviewed)abstract Background: An alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level.Method: In GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in <20 % of the cases (N = 150,119), in 20–79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time.Results: No difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14–0.86]) and gallbladder perforation (OR 0.61 [0.45–0.82]) were significantly lower in the “fundus first > 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]).Conclusion: In this study including >160,000 cholecystectomies, both methods was found to be equally safe.Key message: During laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.
11.	Global variation in anastomosis and end colostomy formation following left-sided colorectal resection 2019 In: BJS Open. - : Oxford University Press. - 2474-9842. ; 3:3, s. 403-414 Journal article (peer-reviewed)abstract Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
12.	Jänes, Arthur, 1970-, et al. (author) Experiences with a prophylactic mesh in 93 consecutive ostomies 2010 In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 34:7, s. 1637-1640 Journal article (peer-reviewed)abstract BACKGROUND: Parastomal hernia may be present in half of patients after one year. A prophylactic low-weight prosthetic mesh in a sublay position at the index operation reduces the risk of parastomal hernia, without increasing the rate of complications. MATERIAL: Between April 2003 and November 2006 all patients with an ostomy created at an open laparotomy were followed for at least one year. RESULTS: A prophylactic mesh was used in 75 of 93 patients. In 9 a prophylactic mesh could not be placed due to scarring after previous surgery. In 9 a mesh was omitted after surgeon's decision. In 19 patients a mesh was used in severely contaminated wounds. With a mesh 6 of 73 (8%) patients developed a surgical site infection and without a mesh 4 of 15 (27%). With a mesh parastomal hernia was present in 8 of 61 (13%) patients and without a mesh in 8 of 12 (67%). CONCLUSIONS: Creating a stoma in routine open surgery a prophylactic mesh can be placed in most patients. A mesh does not increase the rate of complications and can be used in severely contaminated wounds.
13.	Jänes, Arthur, et al. (author) Preventing parastomal hernia with a prosthetic mesh : a 5-year follow-up of a randomized study: reply to letter 2009 In: World Journal of Surgery. - : Springer-Verlag New York. - 0364-2313 .- 1432-2323. ; 33:7, s. 1541-1541 Journal article (peer-reviewed)
14.	Jänes, Arthur, 1970-, et al. (author) Preventing parastomal hernia with a prosthetic mesh 2004 In: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 139:12, s. 1356-1358 Journal article (peer-reviewed)abstract HYPOTHESIS: Parastomal hernia is a common complication following colostomy. The lowest recurrence rate has been produced when repair is with a prosthetic mesh. This study evaluated the effect on stoma complications of using a mesh during the primary operation. DESIGN: Randomized clinical study. METHODS: Patients undergoing permanent colostomy were randomized to have either a conventional stoma or the addition of a mesh placed in a sublay position. The mesh used was a large-pore lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material. RESULTS: Twenty-seven patients had a conventional stoma, and in 27 patients the mesh was used. No infection, fistula formation, or pain occurred (observation time, 12-38 months). At the 12-month follow-up, parastomal hernia was present in 13 of 26 patients without a mesh and in 1 of 21 patients in whom the mesh was used. CONCLUSIONS: A lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the stoma site is not associated with complications and significantly reduces the rate of parastomal hernia.
15.	Jänes, Arthur, 1970-, et al. (author) Preventing parastomal hernia with a prosthetic mesh : a 5-year follow-up of a randomized study 2009 In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 33:1, s. 118-121 Journal article (peer-reviewed)abstract BACKGROUND: Parastomal hernia is a major clinical problem. In a randomized, clinical trial, a prosthetic mesh in a sublay position at the index operation reduced the rate of parastomal hernia at 12-month follow-up, without any increase in the rate of complications. This study was designed to evaluate the rate of complications after 5 years. METHODS: Between January 2001 and April 2003, 54 patients who had a permanent ostomy were randomized to a conventional stoma or to a stoma with the addition of a mesh in a sublay position. A large-pore, lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material was used. RESULTS: After 5 years, 21 patients with a conventional stoma were alive and parastomal herniation was recorded in 17 patients, of whom repair had been demanded in 5. In 15 patients operated on with the addition of a mesh herniation, that did not require repair, was present in 2 (P<0.001). No fistulas or strictures developed. No mesh infection was noted and no mesh was removed during the study period. CONCLUSIONS: At stoma formation, a prophylactic low-weight mesh in a sublay position is a safe procedure that reduces the rate of parastomal hernia.
16.	Karlsson, Samuel, et al. (author) Long-term follow-up after incisional hernia repair : dynamics of recurrence and patient-reported outcome 2024 In: World Journal of Surgery. - : John Wiley & Sons. - 0364-2313 .- 1432-2323. Journal article (peer-reviewed)abstract Background: Incisional hernia (IH) is common and recurrence rates remain high. Although the goal of treatment should be to improve quality of life, studies addressing this aspect are notably absent. We aimed to evaluate the long-term recurrence rate of open mesh repair of IH, investigate the burden of persisting discomfort, explore patient satisfaction, and identify risk factors for negative outcomes.Methods: A single-center, retrospective study was conducted on all open mesh repairs of IH performed between January 2002 and October 2013. Clinical data were gathered from medical records and operative reports, while patient-reported outcome measures (PROMs) were obtained through telephone interviews. Risk factors for recurrence were assessed by survival analysis. PROMs were analyzed across patient subgroups by clinical and demographic variables.Results: This study included 271 patients undergoing medical record review, with 136 patients completing the telephone interview. Recurrence rates at 2, 5, 10, and 15 years were 6%, 8%, 11%, and 12%, respectively. Risk factors for recurrence were obesity and an estimated mesh-defect overlap <7 cm. Bridged repair posed no increased risk. For PROMs, the median follow-up time was 13.6 years after which 78.7% of the patients reported no discomfort, and 89.0% were satisfied with their surgery. Patients <65 years and females experienced more long-term discomfort.Conclusions: Recurrence rates were higher in obese patients and when the estimated mesh-defect overlap was <7 cm, but not in bridged repairs. Young patients and females are at increased risk for long-term discomfort. High satisfaction levels were reported.
17.	Millbourn, Daniel, et al. (author) Effect of Stitch Length on Complications Reply 2010 In: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 145:6, s. 600-601 Journal article (peer-reviewed)
18.	Millbourn, Daniel, et al. (author) Effect of stitch length on wound complications after closure of midline incisions : a randomized controlled trial 2009 In: Archives of surgery (Chicago. 1960). - : American Medical Association. - 0004-0010 .- 1538-3644. ; 144:11, s. 1056-1059 Journal article (peer-reviewed)abstract HYPOTHESIS: In midline incisions closed with a single-layer running suture, the rate of wound complications is lower when a suture length to wound length ratio of at least 4 is accomplished with a short stitch length rather than with a long one. DESIGN: Prospective randomized controlled trial. SETTING: Surgical department. PATIENTS: Patients operated on through a midline incision. INTERVENTION: Wound closure with a short stitch length (ie, placing stitches <10 mm from the wound edge) or a long stitch length. MAIN OUTCOME MEASURES: Wound dehiscence, surgical site infection, and incisional hernia. RESULTS: In all, 737 patients were randomized: 381 were allocated to a long stitch length and 356, to a short stitch length. Wound dehiscence occurred in 1 patient whose wound was closed with a long stitch length. Surgical site infection occurred in 35 of 343 patients (10.2%) in the long stitch group and in 17 of 326 (5.2%) in the short stitch group (P = .02). Incisional hernia was present in 49 of 272 patients (18.0%) in the long stitch group and in 14 of 250 (5.6%) in the short stitch group (P < .001). In multivariate analysis, a long stitch length was an independent risk factor for both surgical site infection and incisional hernia. CONCLUSION: In midline incisions closed with a running suture and having a suture length to wound length ratio of at least 4, current recommendations of placing stitches at least 10 mm from the wound edge should be changed to avoid patient suffering and costly wound complications.
19.	Millbourn, Daniel, et al. (author) Effect of Stitch Length on Wound Complications Reply 2010 In: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 145:6, s. 599-600 Journal article (peer-reviewed)
20.	Millbourn, Daniel, et al. (author) Risk factors for wound complications in midline abdominal incisions related to the size of stitches 2011 In: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 15:3, s. 261-266 Journal article (peer-reviewed)abstract BACKGROUND: Midline abdominal incisions should be closed continuously with a suture length (SL) to wound length (WL) ratio above 4 using small stitches. The effect on the rate of wound complications of a very high ratio and other potential risk factors when closure is performed with small stitches is unknown. METHODS: Patients operated on through a midline incision were randomised to closure with small stitches, placed 5-8 mm from the wound edge and less than 5 mm apart, or with large stitches, placed more than 1 cm from the wound edge. Patient and operative variables were registered. Surgical site infection and incisional hernia were recorded. RESULTS: Three hundred and twenty-one patients were randomised to closure with small stitches and 370 with large stitches. Infection and herniation were less common with small stitches. With small stitches, no risk factors for infection or herniation were identified. With large stitches, wound contamination and the patient being diabetic were independent risk factors for infection, and long operation time and surgical site infection were risk factors for herniation. A very high SL to WL ratio did not affect the complication rates. CONCLUSIONS: In midline abdominal incisions closed with small stitches, no risk factors for surgical site infection or incisional hernia were identified. Increasing the ratio very much above 4 had no adverse effects on the rate of wound complications. The higher rates of infection and herniation with an SL to WL ratio over 5 and in overweight patients in previous reports were probably related to wounds being closed with large stitches.
21.	Odelberg, Nina, et al. (author) The Impact of a Surgical Unit's Structure and Operative Technique on Quality in Two Swedish Rural Hospitals 2020 In: Journal of investigative surgery. - : Taylor & Francis Group. - 0894-1939 .- 1521-0553. ; 33, s. 924-929 Journal article (peer-reviewed)abstract Introduction: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure with a low complication rate. It is performed either as an acute or as an elective procedure. Most elective LCs are performed on nonlethal diseases and this is why good quality is important. Our study compared the quality of LC in two surgical units in northern Sweden (Sundsvall and ostersund) which use different clinical structures (subspecialised vs. general surgery) and surgical techniques (ultrasound fundus first vs. conventional diathermy). The study aimed to investigate whether these differences affected the quality of outcomes after LC.Materials and methods: This is a registry-based study which included 607 elective LCs from January 2014 to May 2016. There were 286 from Sundsvall and 321 from ostersund. Primary outcomes were operative time and the percentage of day surgeries. The secondary outcome was the presence of postoperative complications within the first 30 days in terms of bile duct injury, bleeding that necessitated reoperation, bile leakage and abscesses treated with drainage and mortality.Results: The time length of surgery was shorter in Sundsvall (mean 48.3 min) compared to ostersund (mean 108.6 min, p < 0.001. The percentage of day care surgeries was 94% in Sundsvall and 23% in ostersund, p < 0.001. Six patients (2.1%) had a complication in Sundsvall compared to seven patients (2.2%) in ostersund, p = 1.00.Conclusion: There is a significant difference between the two hospitals regarding operative time and the percentage of day surgeries. Complication rates in both units were equal and low.
22.	Tempe, Fredrik, et al. (author) Cost analysis comparing ultrasonic fundus-first and conventional laparoscopic cholecystectomy using electrocautery 2013 In: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 27:8, s. 2856-2859 Journal article (peer-reviewed)abstract Costs associated with laparoscopic fundus-first cholecystectomy using ultrasonic dissection versus a conventional laparoscopic cholecystectomy has not been compared. Adult patients subjected to elective laparoscopic cholecystectomy between June 2002 and March 2004 were randomized to either an ultrasonic fundus-first dissection or dissection from the triangle of Calot with electrocautery. Differences in direct and indirect costs related to either technique were studied. The duration of the operation and hospitalization was longer when dissection was with the conventional technique. With the ultrasonic fundus-first technique, the direct cost was 1,190 SEK lower, and the total cost, taking also the cost for sick leave into account, was 5,370 SEK lower. Both direct and indirect costs are lower with a laparoscopic fundus-first cholecystectomy using ultrasonic dissection than conventional laparoscopic cholecystectomy using electrocautery.
23.	Turkmen, Sahruh, et al. (author) Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome 2015 In: Gynecological Endocrinology. - : Informa Healthcare. - 0951-3590 .- 1473-0766. ; 31:4, s. 301-305 Journal article (peer-reviewed)abstract Polycystic ovary syndrome (PCOS) is associated with abnormal eating habits. We examined whether surgical treatment affected allopregnanolone levels and eating behaviour in nine women with PCOS who qualified for Rou-en-Y gastric bypass surgery. Blood samples were obtained to measure sex-hormone-binding globulin, total testosterone, progesterone, and allopregnanolone, and eating behaviour was evaluated using the Three-Factor Eating Questionnaire before surgery and at 6 and 12 months after surgery. Body mass index and total testosterone levels decreased, and progesterone and sex-hormone-binding globulin levels increased after bariatric surgery compared with pre-surgical values. In patients with anovulatory menstrual cycles, both the serum allopregnanolone level and the allopregnanolone/progesterone ratio were unchanged after surgery. The patients had high uncontrolled and emotional eating scores, and low cognitive restraint scores before surgery, and these scores had improved significantly at 6 and 12 months after surgery. The presurgical allopregnanolone levels were significantly correlated with uncontrolled eating. In conclusion, these results suggest that allopregnanolone appear to be part of the mechanism underlying the abnormal eating behaviour of obese PCOS patients by causing the loss of control over food intake. Roux-en-Y gastric bypass surgery can improve eating behaviour and clinical symptoms, and may facilitate weight loss in obese women with PCOS.

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