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  • 1.
    Håkanson, B S
    et al.
    Center for Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Department for Clinical Science Intervention and Technology, Division of Surgery, Karolinska University Hospital, Stockholm.
    Thor, K B A
    Queen Sophia Hospital, Stockholm.
    Thorell, A
    Center for Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Department for Clinical Science Intervention and Technology, Division of Surgery, Karolinska University Hospital, Stockholm.
    Ljungqvist, Olle
    Center for Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Department for Clinical Science Intervention and Technology, Division of Surgery, Karolinska University Hospital, Stockholm.
    Open vs laparoscopic partial posterior fundoplication: A prospective randomized trial2007In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 21, no 2, p. 289-98Article in journal (Refereed)
    Abstract [en]

    Objective: This study compares outcomes following open and laparoscopic partial posterior fundoplication for gastroesophageal reflux disease concerning perioperative course, postoperative complications, symptomatic relief, recurrent disease, and the need for reinterventional surgery.

    Methods: A prospective randomized trial was performed. Pre- and postoperative testing included endoscopy, esophageal function testing, patient questionnaire, and clinical assessment. Patients were followed for three years.

    Materials: Ninety-three patients were randomized to open and 99 to laparoscopic surgery.

    Results: Complication rates were higher, and length of stay (LOS) [5 (3-36) vs 3 (1-12) days] and time off work [42 (12-76) vs 28 (0-108) days] was longer in the open group (p < 0.01). Early side effects and recurrences were more common (p < 0.05) in the laparoscopic group. One patient in the open group and 8 patients in the laparoscopic group required surgery for recurrent disease and 7 patients required surgery for incisional hernias after open surgery. Overall, at one and three years, there were no differences in patient-assessed satisfactory outcome (93.5/93.5 vs 88.8/90.8%) or reflux control (p = 0.53) between the open and laparoscopic groups.

    Conclusions: The finding of fewer general complications, shorter length of stay and recovery, similar need for reoperations, and comparable 3-year outcomes, makes the laparoscopic approach the primary choice when considering surgical options for the treatment of gastroesophageal reflux disease (GERD).

  • 2.
    Odeberg, S.
    et al.
    Dept. Anesthesia and Intensive Care, Huddinge University Hospital, Huddinge, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Huddinge University Hospital, Huddinge, Sweden.
    Svenberg, Torgny E.
    Department of Surgery, Karolinska Hospital,6 Stockholm, Sweden.
    Sollevi, Alf
    Dept. Anesthesia and Intensive Care, Huddinge University Hospital, Huddinge, Sweden.
    Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy1998In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 12, no 10, p. 1217-1223Article in journal (Refereed)
    Abstract [en]

    Background: Pneumoperitoneum (PP) for laparoscopic surgery induces prompt changes in circulatory parameters. The rapid onset of these changes suggests a reflex origin, and the present study was undertaken to evaluate whether release of vasopressor substances could be responsible for these alterations. The influence of two different anesthesia techniques was also evaluated. Methods: American Society of Anesthesiologists (ASA) class I patients, scheduled for laparoscopic cholecystectomy, were investigated. The first group (n = 10) was anesthetized intravenously. The second group (n = 6) had inhalation anesthesia. Plasma vasopressin, catecholamines, and plasma renin activity were investigated as neurohumoral vasopressor markers of circulatory stress. The general stress response to surgery was assessed by analysis of plasma cortisol. Results: Induction of pneumoperitoneum caused no apparent activation of vasopressor substances, although several hemodynamic parameters responded promptly. Conclusion: The hemodynamic alterations, seen at the establishment of PP during stable anesthesia, cannot be explained by elevation of vasopressor substances in circulating blood.

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