oru.sePublications
Change search
Refine search result
1 - 14 of 14
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Fang, Xin
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lindgren, Rickard
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1, p. 140-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

    BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

    METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

    RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

    CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

  • 2.
    Angenete, Eva
    et al.
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Thornell, Anders
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp östra, Univ Gothenburg, Gothenburg, Sweden.
    Burcharth, Jakob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Pommergaard, Hans-Christian
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Skullman, Stefan
    Dept Surg, Skaraborgs Hosp, Skövde, Sweden.
    Bisgaard, Thue
    Div Surg, GastroUnit, Hvidovre Hosp, Univ Copenhagen, Hvidovre, Denmark.
    Jess, Per
    Dept Surg, Roskilde Hosp, Roskilde, Denmark.
    Lackberg, Zoltan
    NAL Hosp Grp, Trollhättan, Sweden.
    Matthiessen, Peter
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Heath, Jane
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Rosenberg, Jacob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Haglind, Eva
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis The First Results From the Randomized Controlled Trial DILALA2016In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, no 1, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

    Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.

    Methods:Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.

    Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.

    Conclusions:In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.

  • 3.
    Backman, Olof
    et al.
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Umeå University, Umeå, Sweden.
    Bruze, Gustaf
    Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ottosson, Johan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Marsk, Richard
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Neovius, Martin
    Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Näslund, Erik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels: A Nationwide Cohort Study From Sweden2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 5, p. 895-902Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.

    SUMMARY OF BACKGROUND DATA: Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.

    METHODS: The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.

    RESULTS: Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67-0.89; P < 0.001).

    CONCLUSIONS: Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetes but also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.

  • 4. Bergkvist, Leif
    et al.
    de Boniface, Jana
    Jönsson, Per-Ebbe
    Ingvar, Christian
    Liljegren, Göran
    Örebro University, School of Health and Medical Sciences.
    Frisell, Jan
    Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 1, p. 150-156Article in journal (Refereed)
    Abstract [en]

    Background: Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study.

    Methods: From 3534 patients with primary breast cancer ≤3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual.

    Results: After a median follow-up time of 37 months (0-75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%.

    Conclusions: This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%-3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.

  • 5.
    Currie, Andrew
    et al.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Burch, Jennifer
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Jenkins, John T.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Faiz, Omar
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Kennedy, Robin H.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Demartines, Nicolas
    CHUV Lausanne Surg, Lausanne, Switzerland.
    Hjern, Fredrik
    Danderyds Sjukhus, Danderyd, Sweden.
    Norderval, Stig
    University Hospital of North Norway, Tromsö, Norway.
    Lassen, Kristoffer
    University Hospital of North Norway, Tromsö, Norway.
    Revhaug, Andarthur
    University Hospital of North Norway, Tromsö, Norway.
    Koczkas, Tomas
    Östersunds Sjukhus, Östersund, Sweden.
    Nygren, Jonas
    Ersta Sjukhus, Stockholm, Sweden.
    Gustafsson, Ulf
    Ersta Sjukhus, Stockholm, Sweden.
    Kornfeld, Dan
    Kirurgkliniken St Göran, Stockholm, Sweden.
    Slim, Karem
    University Hospital, Clermont Ferrand, France.
    Hill, Andrew
    Middlemore Hospital, Auckland, New Zealand.
    Soop, Mattias
    North Shore Hospital, Auckland, New Zealand.
    Carlander, Johan
    Västerås Centrallasarett, Västerås, Sweden.
    Lundberg, Owe
    Kirurgkliniken Umeå, Umeå, Sweden.
    Fearon, Ken
    Western General Hospital, Edinburgh, United Kingdom.
    Kennedy, Robin
    St Marks Hospital, London, England..
    The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry2015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 6, p. 1153-1159Article in journal (Refereed)
    Abstract [en]

    Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.

    Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.

    Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.

    Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).

    Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.

  • 6.
    Essén, Pia
    et al.
    Depts. of Anesth. and Intensive Care, Huddinge University Hospital, Stockholm, Sweden; Depts. of Anesth. and Intensive Care, Karolinska Institute, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    McNurlan, Margaret A.
    Rowett Research Institute, Aberdeen, United Kingdom.
    Anderson, Susan
    Rowett Research Institute, Aberdeen, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    Wernerman, Jan
    Depts. of Anesth. and Intensive Care, Huddinge University Hospital, Stockholm, Sweden; Depts. of Anesth. and Intensive Care, Karolinska Institute, Stockholm, Sweden.
    Garlick, Peter J.
    Department of Surgery, State University of New York, Stony Brook NY, United States.
    Laparoscopic cholecystectomy does not prevent the postoperative protein catabolic response in muscle1995In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 222, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The authors determined the effect of laparoscopic cholecystectomy on protein synthesis in skeletal muscle. In addition to a decrease in muscle protein synthesis, after open cholecystectomy, the authors previously demonstrated a decrease in insulin sensitivity. This study on patients undergoing laparoscopic and open surgery, therefore, included simultaneous measurements of protein synthesis and insulin sensitivity.

    SUMMARY BACKGROUND DATA:

    Laparoscopy has become a routine technique for several operations because of postoperative benefits that allow rapid recovery. However, its effect on postoperative protein catabolism has not been characterized. Conventional laparotomy induces a drop in muscle protein synthesis, whereas degradation is unaffected.

    METHODS:

    Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(2H5)phenylalanine, during a hyperinsulinemic normoglycemic clamp to assess insulin sensitivity.

    RESULTS:

    The protein synthesis rate decreased by 28% (1.77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01) in the open cholecystectomy group. In contrast, the fall in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) compared with open surgery (49 +/- 5%).

    CONCLUSIONS:

    Laparoscopic cholecystectomy did not avoid a substantial decline in muscle protein synthesis, despite improved insulin sensitivity. The change in the two parameters occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis.

  • 7.
    Machado, Mikael
    et al.
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Nygren, Jonas
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Goldman, Sven
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Ljungqvist, Olle
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial.2003In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 238, no 2, p. 214-20Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare a colonic J-pouch or a side-to-end anastomosis after low-anterior resection for rectal cancer with regard to functional and surgical outcome.

    Summary beckground data: A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function. The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms. An alternative method is to use a simple side-to-end anastomosis.

    Methods: One-hundred patients with rectal cancer undergoing total mesorectal excision and colo-anal anastomosis were randomized to receive either a colonic pouch or a side-to-end anastomosis using the descending colon. Surgical results and complications were recorded. Patients were followed with a functional evaluation at 6 and 12 months postoperatively.

    Results: Fifty patients were randomized to each group. Patient characteristics in both groups were very similar regarding age, gender, tumor level, and Dukes' stages. A large proportion of the patients received short-term preoperative radiotherapy (78%). There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height (4 cm), perioperative blood loss (500 ml), hospital stay (11 days), postoperative complications, reoperations or pelvic sepsis rates. Comparing functional results in the 2 study groups, only the ability to evacuate the bowel in <15 minutes at 6 months reached a significant difference in favor of the pouch procedure.

    Conclusions: The data from this study show that either a colonic J-pouch or a side-to-end anastomosis performed on the descending colon in low-anterior resection with total mesorectal excision are methods that can be used with similar expected functional and surgical results.

  • 8. Marimuthu, Kanagaraj
    et al.
    Varadhan, Krishna K.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Lobo, Dileep N.
    A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 255, no 6, p. 1060-1068Article in journal (Refereed)
    Abstract [en]

    Background: Immune modulating nutrition (IMN) has been shown to reduce complications after major surgery, but strong evidence to recommend its routine use is still lacking. Objective: The aim of this meta-analysis was to evaluate the impact of IMN combinations on postoperative infectious and noninfectious complications, length of hospital stay, and mortality in patients undergoing major open gastrointestinal surgery. Methods: Randomized controlled trials published between January 1980 and February 2011 comparing isocaloric and isonitrogenous enteral IMN combinations with standard diet in patients undergoing major open gastrointestinal surgery were included. The quality of evidence and strength of recommendation for each postoperative outcome were assessed using the GRADE approach and the outcome measures were analyzed with RevMan 5.1 software (Cochrane Collaboration, Copenhagen, Denmark). Results: Twenty-six randomized controlled trials enrolling 2496 patients (1252 IMN and 1244 control) were included. The meta-analysis suggests strong evidence in support of decrease in the incidence of postoperative infectious [risk ratio (RR) (95% confidence interval [CI]): 0.64 (0.55, 0.74)] and length of hospital stay [mean difference (95% CI): -1.88 (-2.91, -0.84 days)] in those receiving IMN. Even though significant benefit was observed for noninfectious complications [RR (95% CI): 0.82 (0.71, 0.95)], the quality of evidence was low. There was no statistically significant benefit on mortality [RR (95% CI): 0.83 (0.49, 1.41)]. Conclusions: IMN is beneficial in reducing postoperative infectious and noninfectious complications and shortening hospital stay in patients undergoing major open gastrointestinal surgery.

  • 9.
    Mayer, D.
    et al.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Aeschbacher, S.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Pfammatter, T.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Veith, F. J.
    The Cleveland Clinic, Cleveland OH, USA; New York University Medical Center, New York, USA.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Rancic, Z.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Lachat, M.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Larzon, Thomas
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 256, no 5, p. 688-696Article in journal (Refereed)
    Abstract [en]

    Objective: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.

    Background: : Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.

    Methods: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.

    Results: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).

    Conclusions: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.

  • 10.
    Nygren, Jonas
    et al.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Jacobsson, Hans
    Department of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden.
    Larsson, Stig
    Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden.
    Schnell, Per-Olof
    Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden.
    Hylén, Lotta
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Preoperative gastric emptying: the effects of anxiety and carbohydrate administration1995In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 222, no 6, p. 728-734Article in journal (Refereed)
    Abstract [en]

    Background: Overnight fasting is routine before elective surgery. This may not be the optimal way to prepare for surgical stress, however, because intravenous carbohydrate supplementation instead of fasting has recently been shown to reduce postoperative insulin resistance. In the current study, gastric emptying of a carbohydrate-rich drink was investigated before elective surgery and in a control situation. Methods: Twelve patients scheduled for elective surgery were randomly given 400 mL of either a carbohydrate-rich drink (285 mOsm/kg, 12.0% carbohydrates, n = 6) or water 4 hours before being anesthetized. Gastric emptying was measured (gamma camera, 99Tcm). Each patient repeated the protocol postoperatively as a control. All values were presented as the mean ± SEM by means of a nonparametric statistical evaluation. Results: Despite the increased anxiety experienced by patients before surgery (p < 0.005), gastric emptying did not differ between the experimental and control situations. Initially, water emptied more rapidly than carbohydrate. However, after 90 minutes, the stomach was emptied regardless of the solution administered (3.2 ± 1.1% [mean ± SEM] remaining in the stomach in the carbohydrate group versus 2.3 ± 1.2% remaining in the stomach in the water group). Conclusions: Preoperative anxiety does not prolong gastric emptying. The stomach had been emptied 90 minutes after ingestion of both the carbohydrate-rich drink and water, thereby indicating the possibility of allowing an intake of iso-osmolar carbohydrate-rich fluids before surgery.

  • 11.
    Stenberg, Erik
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hildén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pregnancy As a Risk Factor for Small Bowel Obstruction After Laparoscopic Gastric Bypass Surgery2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery.

    BACKGROUND: Small bowel obstruction is a common and feared long-term complication to laparoscopic gastric bypass surgery that may be more common during pregnancy. It is unclear if the risk truly increases during pregnancy.

    METHODS: Women, 18 to 55 years, operated with a primary laparoscopic gastric bypass procedure from 2010 until 2015 were identified through the Scandinavian Obesity Surgery Registry (n = 25,853). Through record-linkage to the Medical Birth Registry, the National Patient Registry, and review of hospital charts, information on pregnancy periods and outcome were obtained. The main outcome was operation due to small bowel obstruction after the laparoscopic gastric bypass procedure.

    RESULTS: Pregnancy was associated with increased risk for small bowel obstruction following laparoscopic gastric bypass surgery (incidence rates 46.5, 95% CI 38.0-56.9/1000 person-years, vs 20.9 95% CI 19.9-22.0; adjusted-HR 1.72, 95% CI 1.39-2.12, P < 0.001). While no excess risk was observed during the first trimester, the second (adjusted-HR 1.67, 95% CI 1.17-2.39, P = 0.005) and third (adjusted-HR 2.69, 95% CI 2.02-3.59, P < 0.001) conferred increased risk. The incidence rate of small bowel obstruction during pregnancy was 42.9 (95% CI 32.4-57.0/1000 person-years) among women for whom the mesenteric defects had been closed during the primary procedure, and 53.2 (95% CI 38.9-72.8/1000 person-years) for women in whom they had been left open.

    CONCLUSION: Pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery during the second and third trimesters.

  • 12.
    Stenberg, Erik
    et al.
    Örebro University Hospital. Department of Surgery, Lindesberg Hospital, Lindesberg, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Szabo, Eva
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ågren, Göran
    Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Näslund, Erik
    Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden .
    Boman, Lars
    Department of Surgery, Lycksele Hospital, Lycksele, Sweden .
    Bylund, Ami
    Department of Surgery, Ersta Hospital, Stockholm, Sweden .
    Hedenbro, Jan
    Skåne University Hospital, Lund University, Lund, Sweden; Department of Surgery, Aleris Obesity Skåne, Lund, Sweden .
    Laurenius, Anna
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden .
    Lundegårdh, Göran
    Österlenskirurgin, Simrishamn Hospital, Simrishamn, Sweden .
    Lönroth, Hans
    Österlenskirurgin, Simrishamn Hospital, Simrishamn, Sweden .
    Möller, Peter
    Department of Surgery, Kalmar County Hospital, Kalmar, Sweden .
    Sundbom, Magnus
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden .
    Ottosson, Johan
    Örebro University Hospital. Department of Surgery, Lindesberg Hospital, Lindesberg, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Näslund, Ingmar
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry2014In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 260, no 6, p. 1040-1047Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.

    BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.

    METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.

    RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.

    CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.

  • 13.
    Sundbom, Magnus
    et al.
    Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Hedberg, Jakob
    Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Marsk, Richard
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Boman, Lars
    Department of Surgery, Lycksele Hospital, Lycksele, Sweden.
    Bylund, Ami
    Department of Surgery, Ersta Hospital, Stockholm, Sweden.
    Hedenbro, Jan
    Aleris Obesity and Clinical Sciences, Lund University, Lund, Sweden.
    Laurenius, Anna
    Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Lundegårdh, Göran
    Österlenskirurgin, Simrishamn Hospital, Simrishamn, Sweden.
    Möller, Peter
    Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
    Olbers, Torsten
    Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Ottosson, Johan
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Näslund, Ingmar
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Näslund, Erik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry2017In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 265, no 6, p. 1166-1171Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort.

    BACKGROUND: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few.

    METHODS: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases.

    RESULTS: BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%-5.9%), hypertension (29.7%-19.5%), dyslipidemia (14.0%-6.8%), and sleep apnea (9.6%-2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%-27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively.

    CONCLUSIONS: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation.

  • 14. Veith, Frank J.
    et al.
    Lachat, Mario
    Mayer, Dieter
    Malina, Martin
    Holst, Jan
    Mehta, Manish
    Verhoeven, Eric L. G.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Gennai, Stefano
    Coppi, Gioacchino
    Lipsitz, Evan C.
    Gargiulo, Nicholas J.
    van der Vliet, J. Adam
    Blankensteijn, Jan
    Buth, Jacob
    Lee, W. Anthony
    Biasi, Giorgio
    Deleo, Gaetano
    Kasirajan, Karthikeshwar
    Moore, Randy
    Soong, Chee V.
    Cayne, Neal S.
    Farber, Mark A.
    Raithel, Dieter
    Greenberg, Roy K.
    van Sambeek, Marc R. H. M.
    Brunkwall, Jan S.
    Rockman, Caron B.
    Hinchliffe, Robert J.
    Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 5, p. 818-824Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers. METHODS: Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR). RESULTS: Overall 30-day mortality after EVAR in 1037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%-32%) for 680 EVAR patients and 36.3% (range: 8%-53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% +/- 12.0% (+/-SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% +/- 8.3% (+/-SD) of these EVAR patients. CONCLUSION: These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.

1 - 14 of 14
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf