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Strigård, Karin
Alternative names
Publications (10 of 69) Show all publications
Näverlo, S., Strigård, K. & Gunnarsson, U. (2019). Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma.. International Journal of Colorectal Disease
Open this publication in new window or tab >>Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma.
2019 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma.

METHODS: Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden.

RESULTS: In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery.

CONCLUSIONS: Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.

Keywords
Defunctioning stoma, Distance, Permanent stoma, Rectal cancer, Rural, Stoma reversal
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-156475 (URN)10.1007/s00384-019-03258-6 (DOI)30747282 (PubMedID)
Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-02-18
Holmdahl, V., Stark, B., Clay, L., Gunnarsson, U. & Strigård, K. (2019). One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial.. Hernia
Open this publication in new window or tab >>One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial.
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2019 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.

METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.

RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.

CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

Keywords
Abdominal muscle strength, Full-thickness skin, Incisional hernia, Recurrence rate, Ventral hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-156474 (URN)10.1007/s10029-019-01900-4 (DOI)30737622 (PubMedID)
Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-02-18
Carlstedt, A., Petersson, U., Stark, B., Strigård, K., Bringman, S., Egberth, M., . . . Theodorsson, E. (2018). Abdominell rektusdiastas kan ge funktionella besvär: Indikation för behandling måste förtydligas. Läkartidningen, 115, Article ID FCL4.
Open this publication in new window or tab >>Abdominell rektusdiastas kan ge funktionella besvär: Indikation för behandling måste förtydligas
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id FCL4Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154180 (URN)30457664 (PubMedID)2-s2.0-85056718354 (Scopus ID)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-17Bibliographically approved
Blind, N., Strigård, K., Gunnarsson, U. & Brännström, F. (2018). Distance to hospital is not a risk factor for emergency colon cancer surgery.. International Journal of Colorectal Disease, 33(9), 1195-1200
Open this publication in new window or tab >>Distance to hospital is not a risk factor for emergency colon cancer surgery.
2018 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, no 9, p. 1195-1200Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.

METHODS: Data on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.

RESULTS: Distance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).

CONCLUSION: Distance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.

Keywords
Colon cancer, Distance, Emergency surgery, Rural
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148535 (URN)10.1007/s00384-018-3074-y (DOI)000441102200006 ()29797050 (PubMedID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-09-11Bibliographically approved
Winsnes, A., Gunnarsson, U., Falk, P., Stark, B., Moskaug, J. Ø. & Strigård, K. (2018). Evaluating full-thickness skin grafts in intraperitoneal onlay mesh position versus onlay position in mice. Journal of Surgical Research, 230, 155-163
Open this publication in new window or tab >>Evaluating full-thickness skin grafts in intraperitoneal onlay mesh position versus onlay position in mice
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2018 (English)In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 230, p. 155-163Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Importance: Hernia surgery requires reinforcement material with few side effects when used in the intraperitoneal position. Autologous skin grafting may meet this requirement, but animal experiments are obligatory before being applied in humans.

OBJECTIVE: To compare survival and effects of isogeneic full-thickness skin grafts in the intraperitoneal onlay mesh (IPOM) position in mice, with a control group using the onlay position. Primary end point was graft survival and secondary end point adhesion formation and inflammation through NF-κB activity.

METHODS: Design: Intervention study with 8-week follow-up in accordance with ARRIVE criteria, performed between 2015 and 2016.

SETTING: Animal laboratory.

PARTICIPANTS: Transgenic C57BL/6 mice with isogeneic background were used. Recipients were female wild-type phenotype mice >3 mo (n = 24). Donors were male or female mice >7 mo, with phenotype-positive for the luciferase gene (n = 20) or positive for NF-κB-luciferase gene (n = 4).

INTERVENTION: Full-thickness skin was grafted in the IPOM position and compared with grafts in the onlay position as controls. Survival was evaluated by regular longitudinal postoperative luminescence imaging over 8 wk. Adherence formation was evaluated macroscopically after sacrifice. Inflammation of full-thickness skin grafts in IPOM position of NF-κB mice was evaluated in four additional mice. Main outcome and measure: Survival of grafts, evaluated by luminescence.

RESULTS: Ten animals received grafts in the IPOM position, and 10 in the onlay position as controls. Graft survival after 8 wk was 100% (20/20). Average luminescence at the end of the 8-week period was 999,597 flux (min 162,800, max 2,521,530) in the IPOM group (n = 10) and 769,708 flux (min 76,590, max 2,164,080) in the onlay control group (n = 10). No adhesions requiring sharp dissection (Jenkins' scale >2) were seen. Four animals with grafts in the IPOM position showed peak inflammation (NF-κB activity) 5 d after surgery subsiding toward the end of follow-up.

CONCLUSIONS: Full-thickness skin survives as well in the IPOM position as in the onlay control position, and few adherences develop. Further studies are required to fully characterize the tissue remodeling and repair processes associated with IPOM skin grafting. The result is relevant in the search for alternative reinforcement materials to be used in complex hernia surgery in humans.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Abdominal wall reinforcement, Acellular scaffold, Autologous full-thickness skin graft, Hernia repair, IPOM/onlay, Intraperitoneal, Isogeneic
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-151807 (URN)10.1016/j.jss.2018.04.041 (DOI)000441170900023 ()30100033 (PubMedID)2-s2.0-85047625025 (Scopus ID)
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-10-05Bibliographically approved
Clay, L., Stark, B., Gunnarsson, U. & Strigård, K. (2018). Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study. Hernia (2), 325-332
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
2018 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, no 2, p. 325-332Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Springer, 2018
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)000428248700014 ()29247365 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-08-07Bibliographically approved
Inkiläinen, A., Styrke, J., Ljungberg, B. & Strigård, K. (2018). 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
2018 (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.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
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: 2018-09-28Bibliographically approved
Odensten, C., Strigård, K., Dahlberg, M., Gunnarsson, U. & Näsvall, P. (2018). Parastomal Hernia Repair; Seldom Performed and Seldom Reported: Results From a Nationwide Survey. Scandinavian Journal of Surgery, Article ID 1457496918818984.
Open this publication in new window or tab >>Parastomal Hernia Repair; Seldom Performed and Seldom Reported: Results From a Nationwide Survey
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2018 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, article id 1457496918818984Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence.

METHODS: A broad search of the Swedish National Patient Register 1998-2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed.

RESULTS: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant.

CONCLUSION: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.

Keywords
Hernia, abdominal wall, colorectal surgery, ostomy, risk factors, treatment outcome
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154781 (URN)10.1177/1457496918818984 (DOI)30563418 (PubMedID)
Funder
Norrbotten County Council
Available from: 2019-01-03 Created: 2019-01-03 Last updated: 2019-02-14
Lindmark, M., Strigård, K., Nordin, P. & Gunnarsson, U. (2018). Patient Reported Injuries After Ventral Hernia Repair. Scandinavian Journal of Surgery, Article ID 1457496918783727.
Open this publication in new window or tab >>Patient Reported Injuries After Ventral Hernia Repair
2018 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, article id 1457496918783727Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND AIMS: The Swedish National Patient Insurance Company (LÖF) can compensate patients who believe they have been exposed to an avoidable injury or malpractice in healthcare. Its register covers 95% of Swedish healthcare providers.

MATERIAL AND METHODS: Data on patients operated for primary or incisional ventral hernia in Sweden between 2010 and 2015 and who had filed a claim, were retrieved from LÖF. A total of 290 cases were identified and included. Files include a copy of records, relevant imaging, and an expert advisor's opinion.

RESULTS: Inadvertent enterotomy occurred during 25 repairs and in these cases, laparoscopic repair was clearly overrepresented ( p  < 0.001). Complications related to the surgical site (infection and ugly scar) were predominantly related to open repairs ( p  < 0.001). Twenty percentage (57/290) of the claims were directly related to an anesthetic mishap. Univariate ordinal regression showed that the odds of receiving a high reimbursement was significantly increased if laparoscopic repair was performed p  < 0.001 (odds ratio: 0.37; 95% confidence interval: 0.21-0.65). Sixty-three percentage of claims were filed by women.

CONCLUSION: Inadvertent enterotomy is overrepresented, and the probability that a claim filed for an avoidable injury leads to high reimbursement is greater if laparoscopic repair is performed rather than open ventral hernia repair. The high amount of injuries related to general anesthesia during umbilical hernia repair may be reduced with an increased proportion executed in local anesthesia.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Ventral hernia, enterotomy, hernia repair, iatrogenic patient injury, insurance, laparoscopic repair, local anesthesia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-150228 (URN)10.1177/1457496918783727 (DOI)29966500 (PubMedID)
Funder
Västerbotten County Council, VLL-675981
Available from: 2018-07-20 Created: 2018-07-20 Last updated: 2019-02-14
Strigård, K., Clay, L., Stark, B. & Gunnarsson, U. (2018). Reply to Comment to: Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized-controlled multicenter study. P. Agarwal, D. Sharma [Letter to the editor]. Hernia, 22(6), 1001-1001
Open this publication in new window or tab >>Reply to Comment to: Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized-controlled multicenter study. P. Agarwal, D. Sharma
2018 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 22, no 6, p. 1001-1001Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148532 (URN)10.1007/s10029-018-1779-z (DOI)000452070700014 ()29744687 (PubMedID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2019-01-08Bibliographically approved
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