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Haapamäki, Markku M
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Publications (10 of 28) Show all publications
Rutegård, M., Rutegård, J. & Haapamäki, M. M. (2019). Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study. BMJ Open, 9(5), Article ID e027255.
Open this publication in new window or tab >>Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027255Article in journal (Refereed) Published
Abstract [en]

Introduction: Different surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations are potentially mutilating, and the reconstruction method of the pelvic floor has been studied only sparsely. We aim to study whether a porcine-collagen implant is superior or equally beneficial to a gluteus maximus myocutaneous flap as a reconstruction method.

Methods and analysis: This is a multicentre non-blinded randomised controlled trial with the experimental arm using a porcine-collagen implant and the control arm using a gluteus maximus muscle and skin rotation flap. Considered for inclusion are patients with rectal cancer, who are operated on with a wide abdominoperineal rectal excision including most of the levator muscles and where the muscle remnants cannot be closed in the midline with sutures. Patients with a primary or recurrent rectal cancer with an estimated survival of more than a year are eligible. The randomisation is computer generated with a concealed sequence and stratified by participating hospital and preoperative radiotherapy regimen. The main outcome is physical performance 6 months after surgery measured with the timed-stands test. Secondary outcomes are perineal wound healing, surgical complications, quality of life, ability to sit and other outcomes measured at 3, 6 and 12 months after surgery. To be able to state experimental arm non-inferiority with a 10% margin of the primary outcome with 90% statistical power and assuming 10% attrition, we aim to enrol 85 patients from May 2011 onwards.

Ethics and dissemination: The study has been approved by the Regional Ethical Review board at Umeå University (protocol no: NEAPE-2010-335-31M). The results will be disseminated through patient associations and conventional scientific channels.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-161540 (URN)10.1136/bmjopen-2018-027255 (DOI)000471192800261 ()31147361 (PubMedID)
Funder
Västerbotten County Council, VLL-187711Västerbotten County Council, VLL-226241
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2019-07-11Bibliographically approved
Boström, P., Haapamäki, M. M., Rutegård, J., Matthiessen, P. & Rutegård, M. (2019). Population‐based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open, 3(1), 106-111
Open this publication in new window or tab >>Population‐based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer
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2019 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 3, no 1, p. 106-111Article in journal (Refereed) Published
Abstract [en]

Background: Anastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors.

Methods: This was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses.

Results: Of 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage.

Conclusion: Anastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154649 (URN)10.1002/bjs5.50106 (DOI)000457222900012 ()30734021 (PubMedID)
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-02-22Bibliographically approved
Holmgren, K., Haapamäki, M. M., Matthiessen, P., Rutegård, J. & Rutegård, M. (2018). Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome. Acta Oncologica, 57(12), 1631-1638
Open this publication in new window or tab >>Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome
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2018 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 12, p. 1631-1638Article in journal (Refereed) Published
Abstract [en]

Background: A permanent stoma after anterior resection for rectal cancer is common. Nationwide registries provide sufficient power to evaluate factors influencing this phenomenon, but validation is required to ensure the quality of registry-based stoma outcomes.

Methods: Patients who underwent anterior resection for rectal cancer in the Northern healthcare region of Sweden between 1 January 2007 and 31 December 2013 were reviewed by medical records and followed until 31 December 2014 with regard to stoma outcome. A registry-based method to determine nationwide long-term stoma outcomes, using data from the National Patient Registry and the Swedish Colorectal Cancer Registry, was developed and internally validated using the chart reviewed reference cohort. Accuracy was evaluated with positive and negative predictive values and Kappa values. Following validation, the stoma outcome in all patients treated with an anterior resection for rectal cancer in Sweden during the study period was estimated. Possible regional differences in determined stoma outcomes between the six Swedish healthcare regions were subsequently evaluated with the χ2 test.

Results: With 312 chart reviewed patients as reference, stoma outcome was accurately predicted through the registry-based method in 299 cases (95.8%), with a positive predictive value of 85.1% (95% CI 75.8%-91.8%), and a negative predictive value of 100.0% (95% CI 98.4%-100.0%), while the Kappa value was 0.89 (95% CI 0.82-0.95). In Sweden, 4768 patients underwent anterior resection during the study period, of which 942 (19.8%) were determined to have a permanent stoma. The stoma rate varied regionally between 17.8-29.2%, to a statistically significant degree (p = .001).

Conclusion: Using data from two national registries to determine long-term stoma outcome after anterior resection for rectal cancer proved to be reliable in comparison to chart review. Permanent stoma prevalence after such surgery remains at a significant level, while stoma outcomes vary substantially between different healthcare regions in Sweden.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-152765 (URN)10.1080/0284186X.2018.1521988 (DOI)30306825 (PubMedID)2-s2.0-85054883319 (Scopus ID)
Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2019-01-08Bibliographically approved
Rutegård, M., Gümüsçü, R., Stylianidis, G., Nordin, P., Nilsson, E. & Haapamäki, M. M. (2018). Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh. Hernia, 22(3), 411-418
Open this publication in new window or tab >>Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh
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2018 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 22, no 3, p. 411-418Article in journal (Refereed) Published
Abstract [en]

PURPOSE: There is a paucity of high-quality evidence concerning mesh choice in open inguinal hernia repair. Using an expertise-based randomized clinical trial design, we aimed to evaluate the postoperative impact of two different mesh types on pain and discomfort, quality of life and sex life.

METHODS: , ULTRAPRO™, Ethicon). Follow-up data were collected by questionnaires and outpatient visits in the range of 1-3 years after surgery.

RESULTS: Some 412 patients were randomized and 363 patients were analysed. There was no difference in pain between groups after surgery but a statistically significant difference concerning awareness of a groin lump and groin discomfort, favouring the lightweight group 1 year after surgery. No differences in quality of life between groups could be detected but both groups had a substantially better quality of life postoperatively, as compared to before surgery. In the analysis of impact on sex life, no differences between mesh groups were found.

CONCLUSION: The Lichtenstein operation performed for primary inguinal hernia improves quality of life for most of the male patients, independently of the type of mesh used. The lightweight mesh group experienced less awareness of a groin lump and groin discomfort 1 year postoperatively. ClinicalTrials.gov Identifier: NCT00451893.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Groin hernia repair, Lichtenstein operation, Patient-reported outcome measures
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-146882 (URN)10.1007/s10029-018-1734-z (DOI)000432794700005 ()29353339 (PubMedID)
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-06-27Bibliographically approved
Holmgren, K., Kverneng Hultberg, D., Haapamäki, M. M., Rutegård, J., Matthiessen, P. & Rutegård, M. (2018). Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study' [Letter to the editor]. Colorectal Disease, 20(4), 342-343
Open this publication in new window or tab >>Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study'
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2018 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 20, no 4, p. 342-343Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-146720 (URN)10.1111/codi.14035 (DOI)000428991400015 ()29377501 (PubMedID)
Available from: 2018-04-18 Created: 2018-04-18 Last updated: 2018-06-09Bibliographically approved
Rosenmüller, M. H., Nilsson, E., Lindberg, F., Åberg, S.-O. & Haapamaki, M. M. (2017). Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy: an expertise-based randomised controlled trial. BMC Gastroenterology, 17, Article ID 48.
Open this publication in new window or tab >>Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy: an expertise-based randomised controlled trial
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2017 (English)In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 17, article id 48Article in journal (Refereed) Published
Abstract [en]

Background: Health care providers need solid evidence based data on cost differences between alternative surgical procedures for common surgical disorders. We aimed to compare small-incision open cholecystectomy (SIOC) and laparoscopic cholecystectomy (LC) concerning costs and health-related quality of life using data from an expertise-based randomised controlled trial. Methods: Patients scheduled for cholecystectomy were assigned to undergo LC or SIOC performed by surgeons in two different expert groups. Total costs were calculated in USD. Reusable instruments were assumed for the cost analysis. Quality of life was measured using the EuroQol 5-D 3-L (EQ 5-D-3L), at five postoperative time points and calculated to Area Under Curve (AUC) for 1 year postoperatively. Two hospitals participated in the trial, which included both emergency and elective surgery. Results: Of 477 patients that underwent a cholecystectomy during the study period, 355 (74.9%) were randomised and 323 analysed, 172 LC and 151 SIOC patients. Both direct and total costs were less for SIOC than for LC patients. The total costs were 5429 (4293-6932) USD for LC and 4636 (3905-5746) USD for SIOC, P = 0.001. The quality of life index did not differ between the LC and SIOC groups at any time. Median values (25th and 75th percentiles (p25-p75)) for AUC at 1 year were as follows: 349 (337-351) for LC and 349 (338-350) for SIOC. Conclusions: In this expertise-based randomised controlled trial LC was a more costly procedure and quality of life did not differ after SIOC and LC. (ClinicalTrials.gov Identifier: NCT00370344, August 30, 2006).

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Minilaparotomy, Health care costs, Surgical procedures
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-134819 (URN)10.1186/s12876-017-0601-1 (DOI)000398709200001 ()28388942 (PubMedID)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-06-09Bibliographically approved
Holmgren, K., Kverneng Hultberg, D., Haapamäki, M. M., Matthiessen, P., Rutegård, J. & Rutegård, M. (2017). High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study. Colorectal Disease, 19(12), 1067-1075
Open this publication in new window or tab >>High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study
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2017 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 12, p. 1067-1075Article in journal (Refereed) Published
Abstract [en]

AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.

METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.

RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.

CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

Keywords
Defunctioning stoma, diverting stoma, faecal diversion, permanent stoma
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-142563 (URN)10.1111/codi.13771 (DOI)000416856200006 ()28612478 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-06-09Bibliographically approved
Kverneng Hultberg, D., Afshar, A. A., Rutegård, J., Lange, M., Haapamäki, M. M., Matthiessen, P. & Rutegård, M. (2017). Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer. Colorectal Disease, 19(11), 987-995
Open this publication in new window or tab >>Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer
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2017 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 11, p. 987-995Article in journal (Refereed) Published
Abstract [en]

Aim Previous research indicates that high tie of the inferior mesenteric artery during anterior resection for rectal cancer might be associated with an increased risk of postoperative functional disturbances. The goal of this population-based retrospective cohort study was to further investigate that association.

Method Patients who underwent anterior resection for rectal cancer from April 2011 to September 2012 were identified through the Swedish Colorectal Cancer Registry. Bowel and urogenital function were assessed by a postal questionnaire 2 years after surgery. Information on the level of mesenteric tie and clinical variables was retrieved from the registry. The outcome was defined as any defaecatory, urinary or sexual dysfunction as reported by the patient. The association between high tie and the outcome was evaluated with multivariable logistic and linear regression with adjustment for confounders, such as sex, body mass index, comorbidity and preoperative radiation.

Results With a response rate of 86%, 805 patients were included in the study. Of these, 46% were operated with high tie. After adjustment for confounders, high tie did not affect the risk of faecal incontinence (OR 0.85; 95% CI 0.59-1.22), urinary incontinence (OR 0.94; 95% CI 0.63-1.41) or various aspects of sexual dysfunction (erectile dysfunction, anejaculation, dyspareunia and coital vaginal dryness). However, an association between high tie and defaecation at night was detected (OR 1.44; 95% CI 1.02-2.03).

Conclusion This study does not support that the level of vascular tie influences the risk of major defaecatory, urinary or sexual disturbances 2 years after anterior resection for rectal cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Autonomic function, ligation level, faecal incontinence, urinary incontinence, sexual function
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-141980 (URN)10.1111/codi.13745 (DOI)000414180900010 ()28544473 (PubMedID)
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2018-06-09Bibliographically approved
Rutegård, M., Hassmén, N., Hemmingsson, O., Haapamäki, M. M., Matthiessen, P. & Rutegård, J. (2016). Anterior Resection for Rectal Cancer and Visceral Blood Flow: An Explorative Study. Scandinavian Journal of Surgery, 105(2), 78-83
Open this publication in new window or tab >>Anterior Resection for Rectal Cancer and Visceral Blood Flow: An Explorative Study
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2016 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 2, p. 78-83Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Impaired blood perfusion may be implicated in anastomotic leakage after anterior resection for rectal cancer. We investigated whether high ligation of the inferior mesenteric artery or total mesorectal excision compromises visceral blood flow in the colonic limb and the rectal stump, respectively.

MATERIAL AND METHODS: A prospective cohort study was conducted in a university hospital setting. We used Laser Doppler flowmetry to evaluate the impact of level of tie on colonic limb perfusion and the extent of the mesorectal excision on the rectal blood flow. In the rectum, different quadrants were also assessed. The Mann-Whitney U test was used to compare mean blood flow ratios between groups.

RESULTS: Some 23 patients were recruited in a convenience sample during a period in 2012-2013. The mean blood flow ratio was not decreased after high tie compared to low tie surgery (1.71 vs 1.19; p = 0.28). Total mesorectal excision reduced the mean blood flow ratio in the rectum, as compared with partial mesorectal excision (0.76 vs 1.28; p = 0.14). This was especially pronounced in the posterior aspect of the rectum (0.66 vs 1.68; p = 0.02).

CONCLUSION: High tie ligation did not seem to decrease colonic limb perfusion, while total mesorectal excision may decrease rectal blood flow. The posterior quadrant of the rectum might be particularly vulnerable to the dissection involved in total mesorectal excision.

Keywords
Inferior mesenteric artery, left colic artery, mesorectal excision, high tie, Laser Doppler flowmetry
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-120694 (URN)10.1177/1457496915593692 (DOI)000375715400003 ()26250353 (PubMedID)
Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2018-06-07Bibliographically approved
Rutegård, M., Boström, P., Haapamäki, M., Matthiessen, P. & Rutegård, J. (2016). Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision. International Journal of Colorectal Disease, 31(3), 579-585
Open this publication in new window or tab >>Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision
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2016 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 3, p. 579-585Article in journal (Refereed) Published
Abstract [en]

Purpose A diverting stoma is commonly used to reduce the risk of anastomotic leakage when performing total mesorectal excision (TME) in anterior resection for rectal cancer. The purpose of this study was to evaluate the impact of fecal diversion in relation to partial mesorectal excision (PME).

Methods A retrospective analysis was undertaken on a national cohort, originally created to study the impact of central arterial ligation on patients with increased cardiovascular risk. Some 741 patients operated with anterior resection for rectal cancer during the years 2007 through 2010 were followed up for 53 months. Multivariate logistic regression was used to evaluate the impact of diverting stoma on the risk of anastomotic leakage and permanent stoma, expressed as odds ratios (ORs) and 95 % confidence intervals (CIs).

Results The risk of anastomotic leakage was increased in TME surgery when not using a diverting stoma (OR 5.1; 95 % CI 2.2-11.6), while the corresponding risk increase in PME patients was modest (OR 1.8; 95 % CI 0.8-4.0). At study completion or death, 26 and 13 % of TME and PME patients, respectively, had a permanent stoma. A diverting stoma was a statistically significant risk factor for a permanent stoma in PME patients (OR 4.7; 95 % CI 2.5-9.0), while less important in TME patients (OR 1.8; 95 % CI 0.6-5.5).

Conclusion The benefit of a diverting stoma concerning anastomotic leakage in this patient group seems doubtful. Moreover, the diverting stoma itself may contribute to the high rate of permanent stomas.

Keywords
Rectal cancer, Defunctioning stoma, Fecal diversion, Permanent stoma
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-118987 (URN)10.1007/s00384-015-2465-6 (DOI)000371400900012 ()26670673 (PubMedID)
Available from: 2016-05-03 Created: 2016-04-07 Last updated: 2018-06-07Bibliographically approved
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