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Szabo, Eva, PhD
Publications (10 of 46) Show all publications
Hedberg, J., Sundbom, M., Edholm, D., Aahlin, E. K., Szabo, E., Lindberg, F., . . . Achiam, M. P. (2024). Randomized controlled trial of nasogastric tube use after esophagectomy: study protocol for the kinetic trial. Diseases of the esophagus, Article ID doae010.
Open this publication in new window or tab >>Randomized controlled trial of nasogastric tube use after esophagectomy: study protocol for the kinetic trial
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2024 (English)In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, article id doae010Article in journal (Refereed) Epub ahead of print
Abstract [en]

Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
complications, esophagectomy, surgery, trials
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111663 (URN)10.1093/dote/doae010 (DOI)38366900 (PubMedID)
Funder
Swedish Cancer Society, CAN 2021/1086
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-02-21Bibliographically approved
Al-Tai, S., Axer, S., Szabo, E., Ottosson, J. & Stenberg, E. (2024). The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry. Surgery for Obesity and Related Diseases, 20(2), 139-145
Open this publication in new window or tab >>The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry
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2024 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 20, no 2, p. 139-145Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.

OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.

SETTING: Nationwide registry-based study.

METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.

CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Bougie size, Complications, Distance from the pylorus, Sleeve gastrectomy, Weight loss
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-108826 (URN)10.1016/j.soard.2023.08.014 (DOI)37802662 (PubMedID)2-s2.0-85173186530 (Scopus ID)
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2024-01-30Bibliographically approved
Wallén, S., Szabo, E., Ekbäck, M. P., Näslund, I., Ottosson, J., Näslund, E. & Stenberg, E. (2023). Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery. Surgery for Obesity and Related Diseases, 19(12), 1375-1381
Open this publication in new window or tab >>Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery
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2023 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 19, no 12, p. 1375-1381Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth.

OBJECTIVES: The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery.

SETTING: All hospitals performing bariatric surgery in Sweden.

METHODS: This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use.

RESULTS: Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use.

CONCLUSION: Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Bariatric surgery, Gastric bypass surgery, Obesity, Opioid analgesics, Oral morphine equivalents, Pain, Roux-en-Y gastric bypass, Socioeconomy
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107478 (URN)10.1016/j.soard.2023.06.005 (DOI)37532668 (PubMedID)2-s2.0-85166547596 (Scopus ID)
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2024-01-12Bibliographically approved
Stenberg, E., Ottosson, J., Magnuson, A., Szabo, E., Wallén, S., Näslund, E., . . . Näslund, I. (2023). Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery: A Randomized Clinical Trial. JAMA Surgery, 158(7), 709-717
Open this publication in new window or tab >>Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery: A Randomized Clinical Trial
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2023 (English)In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 158, no 7, p. 709-717Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use.

OBJECTIVE: To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention. INTERVENTIONS: During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure.

MAIN OUTCOME AND MEASURES: The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm.

RESULTS: A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n = 1259) or nonclosure (n = 1248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11).

CONCLUSIONS AND RELEVANCE: This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01137201.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-105910 (URN)10.1001/jamasurg.2023.1042 (DOI)000987290800002 ()37163240 (PubMedID)2-s2.0-85164624395 (Scopus ID)
Funder
Region Örebro CountyRegion Stockholm
Note

Funding agencies:

Bengt Ihre Foundation

Erling-Persson Foundation

Available from: 2023-05-11 Created: 2023-05-11 Last updated: 2023-08-11Bibliographically approved
Axer, S., Szabo, E. & Näslund, I. (2023). Non-response After Gastric Bypass and Sleeve Gastrectomy-the Theoretical Need for Revisional Bariatric Surgery: Results from the Scandinavian Obesity Surgery Registry. Obesity Surgery, 33(10), 2973-2980
Open this publication in new window or tab >>Non-response After Gastric Bypass and Sleeve Gastrectomy-the Theoretical Need for Revisional Bariatric Surgery: Results from the Scandinavian Obesity Surgery Registry
2023 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, no 10, p. 2973-2980Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. The aim was to analyze the theoretical need for revisional surgery after SG and GBP when applying four indication benchmarks. METHOD: Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. excess weight loss (%EWL) < 50%, 2. weight regain of more than 10 kg after nadir, 3. fulfillment of previous IFSO-guidelines, or 4. ADA criteria for bariatric metabolic surgery 2 years after primary surgery.

RESULTS: A total of 60,426 individuals were included in the study (SG: n = 7856 and GBP: n = 52,570). Compared to patients in the GBP group, more SG patients failed to achieve a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), and more often fulfilled the IFSO criteria (8.0% versus 4.5%, p < .001) or the ADA criteria (3.3% versus 1.8%, p < 001) at the 2-year follow-up.

CONCLUSION: SG is associated with a higher risk for weight non-response compared to GBP. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments are necessary.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Gastric bypass, Revisional bariatric surgery, Sleeve gastrectomy
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107660 (URN)10.1007/s11695-023-06783-0 (DOI)001049781200003 ()37587379 (PubMedID)2-s2.0-85168096191 (Scopus ID)
Funder
Örebro University
Available from: 2023-08-17 Created: 2023-08-17 Last updated: 2023-10-16Bibliographically approved
Wallén, S., Bruze, G., Ottosson, J., Marcus, C., Sundström, J., Szabo, E., . . . Neovius, M. (2023). Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention. Annals of Surgery, 277(3), e552-e560
Open this publication in new window or tab >>Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention
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2023 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. e552-e560Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OF

BACKGROUND DATA: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups.

METHODS: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention.

RESULTS: During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98).

CONCLUSIONS: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
Keywords
bariatric surgery, gastric bypass surgery, obesity, opioids, sleeve gastrectomy, weight loss
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-103633 (URN)10.1097/SLA.0000000000005192 (DOI)000928273100011 ()36700782 (PubMedID)2-s2.0-85147444164 (Scopus ID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding agencies:

Funding Grants Office at Region Örebro County 

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA

Available from: 2023-01-27 Created: 2023-01-27 Last updated: 2023-03-16Bibliographically approved
Wallhuss, A., Ottosson, J., Cao, Y., Andersson, E., Bergemalm, D., Eriksson, C., . . . Stenberg, E. (2023). Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: A nationwide registry-based cohort study. Surgery, 174(2), 144-151
Open this publication in new window or tab >>Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: A nationwide registry-based cohort study
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2023 (English)In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 174, no 2, p. 144-151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obesity is becoming more prevalent in patients with inflammatory bowel disease. Although bariatric surgery is an effective treatment for obesity, questions remain regarding its safety and effectiveness for patients with inflammatory bowel disease. The aim of this study was to evaluate the safety and effectiveness of bariatric surgery in patients with inflammatory bowel disease.

METHOD: This registry-based, propensity-matched cohort study included all patients who had primary Roux-en-Y gastric bypass or sleeve gastrectomy in Sweden from January 2007 to June 2020 who had an inflammatory bowel disease diagnosis and matched control patients without an inflammatory bowel disease diagnosis. The study included data from the Scandinavian Obesity Surgery Registry, the National Patient Register, the Swedish Prescribed Drugs Register, the Total Population Register, and the Education Register from Statistics Sweden.

RESULTS: In total, 71,093 patients who underwent bariatric surgery, including 194 with Crohn's disease and 306 with ulcerative colitis, were 1:5 matched to non-inflammatory bowel disease control patients. The patients with Crohn's disease had a higher readmission rate within 30 days (10.7% vs 6.1%, odds ratio = 1.84, 95% confidence interval 1.02-3.31) than the control patients, with no significant difference between the surgical methods. The patients with ulcerative colitis had a higher risk for serious postoperative complications after Roux-en-Y gastric bypass (8.0% vs 3.7%, odds ratio = 2.64, 95% confidence interval 1.15-6.05) but not after sleeve gastrectomy compared to control patients (0.8% vs 2.3%). No difference was observed in postoperative weight loss or postoperative health-related quality of life.

CONCLUSION: Sleeve gastrectomy appears to be a safe and effective treatment for obesity in patients with inflammatory bowel disease, whereas Roux-en-Y gastric bypass was associated with a higher risk for postoperative complications in patients with ulcerative colitis.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-106170 (URN)10.1016/j.surg.2023.04.059 (DOI)001050743000001 ()37263879 (PubMedID)2-s2.0-85160511654 (Scopus ID)
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-09-06Bibliographically approved
Jans, A., Rask, E., Ottosson, J., Magnuson, A., Szabo, E. & Stenberg, E. (2023). Reliability of the DSS-Swe Questionnaire. Obesity Surgery, 33(11), 3487-3493
Open this publication in new window or tab >>Reliability of the DSS-Swe Questionnaire
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2023 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, no 11, p. 3487-3493Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Symptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability.

METHODS: The study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test-retest methods.

RESULTS: A total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach's alpha coefficient of 0.82, and very good agreement in terms of test-retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88-0.93). The items related to hypoglycemia yielded a good Cronbach's alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85-0.91).

CONCLUSION: The DSS-Swe questionnaire shows good reliability regarding both internal consistency and test-retest performance for use in Swedish populations.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Bariatric surgery, Hypoglycemia, Questionnaire, Reliability test, Translation
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-108819 (URN)10.1007/s11695-023-06841-7 (DOI)001081587000001 ()37798509 (PubMedID)2-s2.0-85173778883 (Scopus ID)
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2023-11-24Bibliographically approved
Al-Tai, S., Axer, S., Szabo, E., Ottosson, J. & Stenberg, E. (2023). THE IMPACT OF THE BOUGIE SIZE AND THE EXTENT OF ANTRAL RESECTION ON WEIGHT-LOSS AND POSTOPERATIVE COMPLICATIONS FOLLOWING SLEEVE GASTRECTOMY: RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY. Paper presented at 26th World Congress of the International Federationfor the Surgery of Obesity and Metabolic Disorders (IFSO 2023), Naples, Italy, August 30 - September 1, 2023. Obesity Surgery, 33(Suppl. 2), 332-332, Article ID O-316.
Open this publication in new window or tab >>THE IMPACT OF THE BOUGIE SIZE AND THE EXTENT OF ANTRAL RESECTION ON WEIGHT-LOSS AND POSTOPERATIVE COMPLICATIONS FOLLOWING SLEEVE GASTRECTOMY: RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY
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2023 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, no Suppl. 2, p. 332-332, article id O-316Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained increasing popularity world-wide. However, controversies still exist regarding several operative aspects, such as the optimal diameter of thesleeve and the optimal distance from the pylorus to the edge of the resection line, and whether these aspects haveeffects on weight-loss results and the risk to develop postoperative complications.

Objective: The aim of this study was to compare weight-loss results and the incidence of postoperative complications betweensleeve with different diameters measured in bougie size and with different distances from the pylorus to the edge ofthe resection line measured in centimeter.

Setting: Nationwide registry-based study.

Method: This study is an analysis of sleeve gastrectomy performed in Sweden between 2012 and 2019. Data were collectedfrom Scandinavian Obesity Surgery Registry (SOReg). Patients with bougie size 30-32 and 35-36 and patients withdistance from pylorus 1-4 cm, 5 cm, 6-8 cm were identified and compared regarding weight-loss results and the riskto develop postoperative complications.

Results: 9,360 patients were included. Follow-up rate was 96% at day 30, 78.8% at one year and 50% at two years. Bothbougie size 30-32 compared to 35-36 and distance from the pylorus 1-4 cm compared to 5 cm were associated withsignificant higher weight-loss at one and two years. No difference in the risk for early or late complications was seenbetween bougie size groups 30-32 and 35-36. Resection starting 1-4 cm from the pylorus compared to 5 cm was as-sociated with higher risk for overall early postoperative complications (OR 1.46 (1.17-1.82, P=.001)), but there wasno significant difference in the risk to develop late complication at 1 and 2 years. No difference in the leak rate andin the risk to develop stricture was seen between different Bougie sizes, nor distances from the Pylorus.

Conclusion: Using a smaller Bougie size and starting the resection closer to the pylorus was associated with better maximumweight-loss. Closer resection to the Pylorus, but not Bougie size was associated with increased risk for early postop-erative complications after sleeve gastrectomy.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-109059 (URN)001058718400318 ()
Conference
26th World Congress of the International Federationfor the Surgery of Obesity and Metabolic Disorders (IFSO 2023), Naples, Italy, August 30 - September 1, 2023
Available from: 2023-10-20 Created: 2023-10-20 Last updated: 2023-10-20Bibliographically approved
Kanold, P., Nyhlin, N., Szabo, E. & van Nieuwenhoven, M. A. (2023). The Swedish Standardized Course of Care-Diagnostic Efficacy in Esophageal and Gastric Cancer. Diagnostics, 13(23), Article ID 3577.
Open this publication in new window or tab >>The Swedish Standardized Course of Care-Diagnostic Efficacy in Esophageal and Gastric Cancer
2023 (English)In: Diagnostics, ISSN 2075-4418, Vol. 13, no 23, article id 3577Article in journal (Refereed) Published
Abstract [en]

Fast-track pathways for diagnosing esophageal or gastric cancer (EGC) have been implemented in several European countries. In Sweden, symptoms such as dysphagia, early satiety, and other alarm symptoms call for a referral for gastroscopy, according to the Swedish Standardized Course of Care (SCC). The aim of this study was to evaluate the diagnostic yield of the SCC criteria for EGC, to review all known EGC cases in Region Örebro County between March 2017 and February 2021, and to compare referral indication(s), waiting times, and tumor stage. In our material, EGC was found in 6.2% of the SCC referrals. Esophageal dysphagia had a positive predictive value (PPV) of 5.6%. The criterion with the highest PPV for EGC was suspicious radiological findings, with a PPV of 24.5%. A total of 139 EGCs were diagnosed, 99 (71%) through other pathways than via the SCC. Waiting times were approximately 14 days longer for patients evaluated via non-SCC pathways. There was no statistically significant association between referral pathway and primary tumor characteristics. The results show that a majority of the current SCC criteria are poor predictors of EGC, and some alarm symptoms lack a sufficiently specific definition, e.g., dysphagia. Referral through this fast track does not seem to have a positive impact on disease outcomes.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
Alarm symptoms, esophageal and gastric cancer, fast track, positive predictive value, standardized course of care
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110363 (URN)10.3390/diagnostics13233577 (DOI)001116644700001 ()38066818 (PubMedID)2-s2.0-85179305702 (Scopus ID)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-01-10Bibliographically approved
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