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Strigård, Karin
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Publications (10 of 60) Show all publications
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2018). Response to ANNSURG-D-17-02433.. Annals of Surgery
Open this publication in new window or tab >>Response to ANNSURG-D-17-02433.
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2018 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed) Epub ahead of print
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148347 (URN)10.1097/SLA.0000000000002787 (DOI)29672408 (PubMedID)
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-06-09
Lindmark, M., Strigård, K., Löwenmark, T., Dahlstrand, U. & Gunnarsson, U. (2018). Risk Factors for Surgical Complications in Ventral Hernia Repair.. World Journal of Surgery
Open this publication in new window or tab >>Risk Factors for Surgical Complications in Ventral Hernia Repair.
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2018 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The aim of this study was to identify risk factors for an adverse event, i.e. early surgical complication, need for ICU care and readmission, following ventral hernia repair. Our hypothesis was that there is an association between an increased complication rate following ventral hernia repair and specific factors, including hernia size, BMI > 35, concomitant bowel surgery, ASA-class, age, gender and method of hernia repair.

METHODS: Data from a hernia database with prospectively entered data on 408 patients operated for ventral hernia between 2007 and 2014 at two Swedish university hospitals were analysed. A 3-month follow-up of complications, need for intensive care and readmission, was performed by reviewing the medical records.

RESULTS: Eighty-one of 408 patients (20%) had a registered complication. Fifty-eight (14%) of these were classed as Clavien I-IIIa, and in 19 cases a Clavien IIIb-IV complication was reported. Large hernia size was associated with increased risk for early complication. A Kendall Tau test analysis revealed a proportional relationship between hernia size and modified Clavien outcome class (p < 0.001). Morbid obesity, ASA-class, method, hernia recurrence, age and concomitant bowel surgery were not statistically significant predictors of adverse events.

CONCLUSIONS: Assessment of hernia aperture size is of great importance in the preoperative evaluation of ventral hernia patients to consider risk for post-operative complications. These results suggest a careful attitude when applying watchful waiting concepts and when postponing hernia surgery to achieve weight loss. A delaying attitude may result in increased risk of complications caused by increasing hernia size.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148354 (URN)10.1007/s00268-018-4642-6 (DOI)29700567 (PubMedID)
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-06-09
Falk, P., Ruiz-Jasbon, F., Strigård, K., Gunnarsson, U. & Ivarsson, M.-L. (2017). An ex vivo model using human peritoneum to explore mesh-tissue integration. Biology open, 6(9), 1391-1395
Open this publication in new window or tab >>An ex vivo model using human peritoneum to explore mesh-tissue integration
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2017 (English)In: Biology open, ISSN 2046-6390, Vol. 6, no 9, p. 1391-1395Article in journal (Refereed) Published
Abstract [en]

Biological compatibility, in terms of implantation of foreign mesh material in hernia surgery, still needs experimental investigation. Present study develops an experimental model using human peritoneum to study the integration between tissue and different mesh material. The ex vivo model using peritoneal tissue was studied with different mesh material, and integration was monitored over time using microscopy.It could be demonstrated that the peritoneal model may be kept viable in culture for several weeks. Cell migration was seen after 7-10 days in culture and could be further monitored over several weeks. The use of a human artificial model environment enabling the investigation of tissue/mesh integration has, to our knowledge, not been described previously.This proof-of-concept model was developed, for the investigation of peritoneal biology and the integration between tissue and different mesh material. It has the potential to be useful in studies on other important biological mechanisms involving the peritoneum.

Keywords
Experimental model, Peritoneum, Peritoneal tissue, Mesh, Synthetic mesh, Biocompatibility
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-138063 (URN)10.1242/bio.024992 (DOI)000410919200017 ()28760734 (PubMedID)
Available from: 2017-08-04 Created: 2017-08-04 Last updated: 2018-06-09Bibliographically approved
Clay, L., Stark, B., Gunnarsson, U. & Strigård, K. (2017). Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study.. Hernia
Open this publication in new window or tab >>Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study.
2017 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.

METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.

RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.

CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.

Keywords
Abdominal wall reconstruction, Full-thickness skin, Hernia complication, Incisional hernia, Infection, Ventral hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-143226 (URN)10.1007/s10029-017-1712-x (DOI)29247365 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-06-09
Gkekas, I., Novotny, J., Pecen, L., Strigård, K., Palmqvist, R. & Gunnarsson, U. (2017). Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature. Anticancer Research, 37(12), 6563-6574
Open this publication in new window or tab >>Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature
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2017 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 12, p. 6563-6574Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND/AIM: The prognostic role of microsatellite instability (MSI) in stage II colon cancer patients remains controversial despite the fact that it has been investigated in a number of studies. Hazard ratios differ considerably among these studies. We performed a meta-analysis to define the significance of MSI in this group of patients.

MATERIALS AND METHODS: Studies indexed in PubMed presenting separate data on MSI status and survival outcomes for stage II colon cancer patients have been analyzed using fixed-effect meta-analysis of hazard ratio (HR) according to the method of Peto.

RESULTS: Analysis was performed on 19 studies including 5,998 patients. A 47.3% of patients received postoperative chemotherapy and included 52.8% males and 47.2% females. Eight studies included some rectal cancer patients although this cohort was not clearly defined in 3 of these. MSI observed in 20.8% (mean) of patients (median 19.9%). HR for overall survival (OS) of MSI vs. microsatellite stable (MSS) tumors for the entire population: 0.73 (95% confidence interval (CI)=0.33-1.65); HR for disease-free survival (DFS):0.60 (95%CI=0.27-1.32). No statistical significant difference was found when studies analyzing MSI with genotyping (MG) and immunohistochemistry (IHC) were compared separately (MG vs. IHC: HR OS 0.45, 95%CI=0.10-2.05 vs. 0.95, 95%CI=0.57-1.58; HR DFS 0.51, 95%CI=0.14-1.85 vs. 0.67, 95%CI=0.26-1.70). However, numerically MSI determination with genotyping shows significantly lower hazard ratios for both DFS and OS. Separate analysis of studies describing colon cancer patients only showed HR OS 0.72 (95%CI=0.31-1.71); HR DFS 0.60 (95%CI=0.27-1.31).

CONCLUSION: No significant relation was found between MSI status and OS or DFS. Routine determination of MSI status to guide postoperative management of stage II colon cancer patients cannot be recommended. New large scale high quality studies are needed to answer this question definitively, since currently analyzed studies vary considerably.

Keywords
Colon cancer, meta-analysis, microsatellite instability, predictive factor, prognostic factor, systematic review
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-142558 (URN)10.21873/anticanres.12113 (DOI)000417022100008 ()29187431 (PubMedID)
Available from: 2017-12-05 Created: 2017-12-05 Last updated: 2018-06-09Bibliographically approved
Inkiläinen, A., Styrke, J., Ljungberg, B. & Strigård, K. (2017). Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study. Scandinavian journal of urology, 52(1), 54-58
Open this publication in new window or tab >>Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study
2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 1, p. 54-58Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Abdominal bulging and incisional hernia are known sequelae after open partial nephrectomy (OPN) via a flank incision. Precise rates are not known. The aims of this study were to determine the rates of bulging and hernia after OPN, and to examine potential risk factors.

MATERIALS AND METHODS: A retrospective review was undertaken of 197 consecutive patients operated on with OPN via a flank incision between 2004 and 2014. After exclusion, 184 patients remained. Medical records and radiological images from the preoperative work-up, and follow-up after surgery at 3, 12 and 24 months, were reviewed.

RESULTS: A visible bulge was noted in 36 of the 184 patients at clinical examination. Only 20 cases (12%) remained at the last follow-up. Radiological changes interpreted as a bulge were initially seen in 50 patients, while only 35 (19%) remained at the last radiological examination. Clinical incisional hernia was reported in five patients (3%), and radiological hernia was seen in 10 patients (5%). Patients who developed a hernia had a higher body mass index (30 vs 26 kg/m(2), p = 0.02). Other demographic variables showed no significant correlation.

CONCLUSIONS: Bulging is a common sequela after flank incision. The rate of incisional hernia after flank incision is comparable to rates after other forms of abdominal surgery. Further studies are required to evaluate the psychological and physiological effects of bulging, the pain and weakness caused, and the cosmetic embarrassment suffered by the patient.

Keywords
Bulge, flank incision, incisional hernia, open partial nephrectomy, renal cell carcinoma
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-140297 (URN)10.1080/21681805.2017.1376352 (DOI)000425799400010 ()28934886 (PubMedID)
Available from: 2017-10-04 Created: 2017-10-04 Last updated: 2018-06-09Bibliographically approved
Näsvall, P., Rutegård, J., Dahlberg, M., Gunnarsson, U. & Strigård, K. (2017). Parastomal hernia repair with intraperitoneal mesh. Surgery Research and Practice, 2017, Article ID 8597463.
Open this publication in new window or tab >>Parastomal hernia repair with intraperitoneal mesh
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2017 (English)In: Surgery Research and Practice, ISSN 2356-7759, Vol. 2017, p. 51+4article id 8597463Article in journal (Refereed) Published
Abstract [en]

Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2017. p. 51+4
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-103309 (URN)10.1155/2017/8597463 (DOI)29204515 (PubMedID)978-91-7601-241-3 (ISBN)
Note

Originally included in thesis in manuscript form.

Available from: 2015-05-20 Created: 2015-05-20 Last updated: 2018-06-07Bibliographically approved
Näsvall, P., Dahlstrand, U., Löwenmark, T., Rutegård, J., Gunnarsson, U. & Strigård, K. (2017). Quality of life in patients with a permanent stoma after rectal cancer surgery. Quality of Life Research, 26(1), 55-64
Open this publication in new window or tab >>Quality of life in patients with a permanent stoma after rectal cancer surgery
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2017 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 1, p. 55-64Article in journal (Refereed) Published
Abstract [en]

AIM: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

METHODS: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

RESULTS: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

CONCLUSION: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-128565 (URN)10.1007/s11136-016-1367-6 (DOI)000393571300005 ()27444778 (PubMedID)
Available from: 2016-12-07 Created: 2016-12-07 Last updated: 2018-06-09Bibliographically approved
Renman, D., Lundberg, E., Gunnarsson, U. & Strigård, K. (2017). Statin consumption as a risk factor for developing colorectal cancer: a retrospective case study. World Journal of Surgical Oncology, 15, Article ID 222.
Open this publication in new window or tab >>Statin consumption as a risk factor for developing colorectal cancer: a retrospective case study
2017 (English)In: World Journal of Surgical Oncology, ISSN 1477-7819, E-ISSN 1477-7819, Vol. 15, article id 222Article in journal (Refereed) Published
Abstract [en]

Background: Statins are the backbone of lipid-lowering therapy and are among the most commonly prescribed drugs in the elderly population in Sweden today. Colorectal cancer is the second most common cancer in men and women, after prostate and breast cancer, respectively, with a median age of 72 years at diagnosis. Statins induce mitochondrial damage leading to accumulation of reactive oxygen species in the cell. Reactive oxygen species can cause mutations in mitochondrial as well as nuclear DNA leading to the development of cancer. Our hypothesis was that statins increase the risk for colorectal cancer.

Methods: A case study was performed on consecutive cases of colorectal cancer diagnosed at Norrlands University Hospital (NUS) in Umeå between 2012 and 2015 (n = 325). Patients diagnosed with diabetes mellitus type II (DM II n = 65) were excluded in the primary endpoint analysis (occurrence of colorectal cancer). As control, three databases were used to create an age-matched population in order to calculate the proportion of inhabitants using statins in the county of Västerbotten, Sweden. A secondary endpoint was cancer-specific survival among our study group of colorectal cancer patients, including those with DM II, investigating whether there was a difference if the patient was a 'recent' statin user or not at the time of diagnosis.

Results: Statin use at the time of colorectal cancer diagnosis in the study group was 23.8%. The corresponding figure in an age-matched population in Västerbotten was 24.6%. Using a one-proportional one-sided z test, there was no significant difference between these (23.8%, 95% CI 18.6-29.0%, p = 0.601). When comparing groups 20-64 years of age, the difference was greater with recent statin use in 17.8% in the study population and 11.9% in Västerbotten (17.8%, 95% CI 9.0-26.6%, p = 0.059). When considering cancer-specific survival, no significant difference in survival was seen when comparing 'former/never' statin users as reference category with 'recent' users diagnosed with colorectal cancer (HR 1.39, 95% CI 0.89-2.16).

Conclusions: No significant increase in risk for developing colorectal cancer among patients (type II diabetics excluded) medicated with statins was found. We found no correlation between 'recent' statin use at the time of diagnosis and cancer-specific survival.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Colorectal cancer, Diabetes mellitus, Mitochondrial DNA damage, Reactive oxygen species, Risk factor, Statin
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-143223 (URN)10.1186/s12957-017-1287-0 (DOI)000418080400001 ()29246227 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-06-09Bibliographically approved
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2017). Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH. Annals of Surgery
Open this publication in new window or tab >>Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH
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2017 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
Keywords
mesh, parastomal hernia, prophylaxis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-142585 (URN)10.1097/SLA.0000000000002542 (DOI)29064900 (PubMedID)
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-06-09

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