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Strigård, Karin
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Publications (10 of 63) Show all publications
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
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.

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)
Available from: 2018-07-20 Created: 2018-07-20 Last updated: 2018-07-20
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, 42(11), 3528-3536
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 1432-2323, Vol. 42, no 11, p. 3528-3536Article 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.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148354 (URN)10.1007/s00268-018-4642-6 (DOI)29700567 (PubMedID)
Funder
Västerbotten County Council, VLL-567051
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-11-01Bibliographically approved
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
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
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
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