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Enochsson, Lars
Publications (10 of 35) Show all publications
Palsson, S. H., Engstrom, C., Enochsson, L., Osterlund, E. & Sandblom, G. (2020). Risk factors for postoperative myocardial infarct following cholecystectomy: a population-based study. HPB, 22(1), 34-40
Open this publication in new window or tab >>Risk factors for postoperative myocardial infarct following cholecystectomy: a population-based study
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2020 (English)In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 22, no 1, p. 34-40Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to analyse the risk for myocardial infarction (MI) after cholecystectomy.

Methods: The study is based on data from the Swedish Register for Gallstone Surgery (GallRiks) 2006–2014. The cohort was cross-linked with the Swedish Patient Register. Standardised incidence ratio (SIR) was calculated by dividing the observed incidence of MI within 30 days after surgery with the expected incidence of the background population.

Results: Altogether 94,577 procedures were included. MI within 30 days postoperatively (30d-po) were registered in 87 cases (0.09%, SIR for MI 3.03; 95% CI 2.43–3.74). MI occurred more often in men (0.15% vs 0.06%), after open surgery (0.34% vs 0.04%), was age related (age >50 years OR 4.05 > 75 years OR 15.70) and occurred more frequently amongst those with gallstone complications and high ASA score (ASA 1; 0.02%, 2; 0.08%, ≥3; 0,64%). The risk for MI within 30d-po was 52.8% if the patient had suffered an infarct within 8 weeks preoperatively. Laparoscopy converted to open and primarily open surgery were independent risk factors (OR 3.05 vs 2.19). The mortality in the group with 30d-po MI was 11.5% vs 0.02%.

Conclusion: Delaying elective cholecystectomy for at least 8 weeks after a recent MI reduces the risk for postoperative MI.

Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:umu:diva-168900 (URN)10.1016/j.hpb.2019.06.018 (DOI)000516722700005 ()31327561 (PubMedID)
Available from: 2020-03-17 Created: 2020-03-17 Last updated: 2020-03-17Bibliographically approved
Oussi, N., Georgiou, K., Larentzakis, A., Thanasas, D., Castegren, M., Georgiou, E. & Enochsson, L. (2020). Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment. Surgical Innovation, Article ID 1553350619901222.
Open this publication in new window or tab >>Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment
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2020 (English)In: Surgical Innovation, ISSN 1553-3506, E-ISSN 1553-3514, article id 1553350619901222Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background. Our aim was to determine if a newly designed Najar needle holder (NNH) shortens the time for novices to improve advanced laparoscopy (AL) techniques (suturing/knot tying), compared with a conventional macro needle holder (MNH) in a simulator. Furthermore, we aimed to validate a new video scoring system determining AL skills. Methods. Forty-six medical students performed identical surgical tasks in a prospective, crossover study evaluating AL skills (NNH vs MNH). All subjects performed a double-throw knot, 2 single-throw knots following 3 running sutures in the Simball Box (SB) simulator. After resting, subjects switched needle holders. All tasks were videotaped and analyzed using SB software and by 2 independent reviewers using the Objective Video Evaluation Scoring Table (OVEST). Trial performance expressed as SB Overall Score (SBOS) and OVEST. Results. In the group starting with NNH (followed by MNH) OVEST was consistently high during both trials (median = 12.5, range = 6.5-18.0, and median = 13.5, range = 6.5-21.0; P = .2360). However, in the group starting with MNH, OVEST improved significantly when the participants changed to NNH (median = 10.0, range = 2.5-19.5, vs median = 14.5, range = 4.5-18.0; P = .0003); an improvement was also found with SBOS (median = 37%, range = 27% to 92%, vs median = 48%, range = 34% to 70%; P = .0289). In both trials, both independent reviewers' OVEST measures correlated well: Trial 1: beta = 0.97, P < .0001; and Trial 2: beta = 0.95, P < .0001. A correlation also existed between SBOS and OVEST in both trials (beta = 2.1, P < .0001; and beta = 1.9, P = .0002). Conclusions. This study indicates a significantly higher improvement in laparoscopic suturing skills in novices training AL skills using NNH compared with MNH. Starting early, AL training in novices using NNH is a feasible option. Furthermore, OVEST used in experimental settings as an evaluation tool is comparable with the validated SBOS.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2020
Keywords
crossover, laparoscopic needle holder, laparoscopic suturing, learning curve, validation
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-168135 (URN)10.1177/1553350619901222 (DOI)000510624200001 ()32008414 (PubMedID)
Available from: 2020-02-21 Created: 2020-02-21 Last updated: 2020-02-21
Georgiou, K., Oussi, N., Thanasas, D., Enochsson, L., Larentzakis, A. & Papavassiliou, A. G. (2019). Assessing Various Non-Invasive Stress Indices to Predict Novice Surgeons' Performance During Basic Skills Training in a High-End Simulator. Paper presented at Annual Clinical Congress of the American-College-of-Surgeons / 5th Annual Sessions of the Owen-H-Wangensteen-Scientific-Forum, OCT 27-31, 2019, San Francisco, CA. Journal of the American College of Surgeons, 229(4), S236-S236
Open this publication in new window or tab >>Assessing Various Non-Invasive Stress Indices to Predict Novice Surgeons' Performance During Basic Skills Training in a High-End Simulator
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2019 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 229, no 4, p. S236-S236Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-165449 (URN)10.1016/j.jamcollsurg.2019.08.516 (DOI)000492740900452 ()
Conference
Annual Clinical Congress of the American-College-of-Surgeons / 5th Annual Sessions of the Owen-H-Wangensteen-Scientific-Forum, OCT 27-31, 2019, San Francisco, CA
Note

Supplement 1

Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2019-11-27Bibliographically approved
Soreide, J. A., Karlsen, L. N., Sandblom, G. & Enochsson, L. (2019). Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review. Surgical Endoscopy, 33(6), 1731-1748
Open this publication in new window or tab >>Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review
2019 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 33, no 6, p. 1731-1748Article, review/survey (Refereed) Published
Abstract [en]

Background: Endoscopic retrograde cholangiopancreatography (ERCP) was introduced more than four decades ago as a diagnostic tool for biliary and pancreatic diseases. Currently, ERCP is mainly used as a therapeutic approach to relieve biliary or pancreatic duct obstruction. Clinical practice has been based on a few large reports and some randomized controlled trials. These data are valuable and important, but the external validity of these reports is limited. Implementation into routine practice should be balanced with the knowledge that these studies were conducted under very specific circumstances. This review was undertaken to describe ERCP results from population-based national registries recorded during routine clinical practice.

Methods: A systematic literature search of the electronic databases Medline Ovid and Embase was conducted. Eligible papers were selected and data were recorded according to the PRISMA criteria.

Results: Thirty-one studies were included: 15 true national population-based and 16 population-level studies. Most studies originated from countries with a governmental public health care system. At least three-quarters of the ERCP procedures are currently therapeutic, and the technical success rate is high (>90%). The postprocedure 30-day mortality rate ranged between 1 and 5% and was strongly correlated with older age, male sex, emergency admission, and noncancer comorbidities, but exhibited a lower correlation with the annual ERCP volume. Patients with primary sclerosing cholangitis or liver cirrhosis should receive particular attention. The risk of developing a bile duct, liver, or pancreas malignancy after ERCP tended to increase, but endoscopic sphincterotomy did not affect this risk.

Conclusion: ERCP is currently mainly used as a therapeutic approach, and the results are generally likely to improve patients' conditions. A nationwide registry enables better monitoring of routine clinical practice. The collection of valuable information from routine clinical practice in population-based databases may help to improve patient care from best evidence to best practice.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
ERCP, National, Registry, Population-based, Outcomes
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-159587 (URN)10.1007/s00464-019-06734-w (DOI)000467688800004 ()30863927 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Enochsson, L. (2019). Impact of Sedation in ERCP on Cannulation Success and Complications: A Prospective Nationwide Study of 31,001 ERCP Procedures. Paper presented at Annual Clinical Congress of the American-College-of-Surgeons / 5th Annual Sessions of the Owen-H-Wangensteen-Scientific-Forum, OCT 27-31, 2019, San Francisco, CA. Journal of the American College of Surgeons, 229(4), E33-E33
Open this publication in new window or tab >>Impact of Sedation in ERCP on Cannulation Success and Complications: A Prospective Nationwide Study of 31,001 ERCP Procedures
2019 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 229, no 4, p. E33-E33Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-165439 (URN)10.1016/j.jamcollsurg.2019.08.815 (DOI)000492749600072 ()
Conference
Annual Clinical Congress of the American-College-of-Surgeons / 5th Annual Sessions of the Owen-H-Wangensteen-Scientific-Forum, OCT 27-31, 2019, San Francisco, CA
Note

Supplement 2

Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2019-11-27Bibliographically approved
Noel, R., Arnelo, U., Lundell, L., Hammarqvist, F., Jumaa, H., Enochsson, L. & Sandblom, G. (2018). Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial. HPB, 20(10), 932-938
Open this publication in new window or tab >>Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial
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2018 (English)In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 20, no 10, p. 932-938Article in journal (Refereed) Published
Abstract [en]

Background: Delayed cholecystectomy is associated with increased risk of biliary events. The objectives of the study were to confirm the superiority of index cholecystectomy over delayed operation in mild gallstone pancreatitis.

Methods: Patients with mild gallstone pancreatitis were randomized into index-or delayed cholecystectomy (IC vs. DC). IC was performed within 48 h from randomization provided a stable or improved clinical condition. The primary outcome was gallstone-related events. Secondary outcomes were rates of cholecystectomy complications, common bile duct stones (CBDS) detected at cholecystectomy and patient reported quality-of-life and pain.

Results: Sixty-six patients were randomized into IC (n = 32) or DC (n = 34) between May 2009 and July 2017. There were significantly higher rates of gallstone-related events in the DC compared with the IC group (nine patients vs. one patient, p = 0.013). No statistically significant differences could be demonstrated in cholecystectomy complications (p = 0.605) and CBDS discovered during cholecystectomy (p = 0.302) between the groups. Pain and emotional well-being measured by SF-36 were improved significantly in the IC group at follow-up.

Conclusions: Delayed cholecystectomy in mild gallstone pancreatitis can no longer be recommended since it is associated with an increased risk for recurrent gallstone-related events and impaired patient's reported outcomes. Trial registration number: clinicaltrials.gov (ID: NCT02630433).

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-153716 (URN)10.1016/j.hpb.2018.03.016 (DOI)000445924800007 ()29703649 (PubMedID)
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Enochsson, L., Blohm, M., Sandblom, G., Jonas, E., Hallerbäck, B., Lundell, L. & Österberg, J. (2018). Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers. BMJ Open, 8(1), Article ID e019551.
Open this publication in new window or tab >>Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019551Article in journal (Refereed) Published
Abstract [en]

Objective: To analyse the completeness in GallRiks of the follow-up frequency in relation to the intraoperative and postoperative outcome.

Design: Population-based register study.

Setting: Data from the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (ERCP), GallRiks.

Population: All cholecystectomies and ERCPs recorded in GallRiks between 1 January 2006 and 31 December 2014.

Main outcome measures: Outcomes for intraprocedural as well as postprocedural adverse events between units with either a 30-day follow-up of AO% compared with those with a less frequent follow-up (<90%).

Results: Between 2006 and 2014, 162 212 cholecystectomies and ERCP procedures were registered in GallRiks. After the exclusion of non-index procedures and those with incomplete data 152 827 procedures remained for final analyses. In patients having a cholecystectomy, there were no differences regarding the adverse event rates, irrespective of the follow-up frequency. However, in the more complicated endoscopic ERCP procedures, the postoperative adverse event rates were significantly higher in those with a more frequent and complete 30-day follow-up (OR 1.92; 95% Cl 1.76 to 2.11).

Conclusions: Differences in the follow-up frequency in registries affect the reported outcomes as exemplified by the complicated endoscopic ERCP procedures. A high and complete follow-up rate shall serve as an additional quality indicator for surgical registries.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148039 (URN)10.1136/bmjopen-2017-019551 (DOI)000431743500090 ()29362270 (PubMedID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-06-09Bibliographically approved
Wanjura, V., Szabo, E., Österberg, J., Ottosson, J., Enochsson, L. & Sandblom, G. (2018). Morbidity of cholecystectomy and gastric bypass in a national database. British Journal of Surgery, 105(1), 121-127
Open this publication in new window or tab >>Morbidity of cholecystectomy and gastric bypass in a national database
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 1, p. 121-127Article in journal (Refereed) Published
Abstract [en]

Background: There is a strong association between obesity and gallstones. However, there is no clear evidence regarding the optimal order of Roux-en-Y gastric bypass (RYGB) and cholecystectomy when both procedures are clinically indicated.

Methods: Based on cross-matched data from the Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks; 79 386 patients) and the Scandinavian Obesity Surgery Registry (SOReg; 36 098 patients) from 2007 to 2013, complication rates, reoperation rates and operation times related to the timing of RYGB and cholecystectomy were explored.

Results: There was a higher aggregate complication risk when cholecystectomy was performed after RYGB rather than before (odds ratio (OR) 1.35, 95 per cent c.i. 1.09 to 1.68; P=0.006). A complication after the first procedure independently increased the complication risk of the following procedure (OR 2.02, 1.44 to 2.85; P<0.001). Furthermore, there was an increased complication risk when cholecystectomy was performed at the same time as RYGB (OR 1.72, 1.14 to 2.60; P=0.010). Simultaneous cholecystectomy added 61.7 (95 per cent c.i. 56.1 to 67.4) min (P<0.001) to the duration of surgery.

Conclusion: Cholecystectomy should be performed before, not during or after, RYGB.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-143625 (URN)10.1002/bjs.10666 (DOI)000418390500014 ()29044465 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-06-09Bibliographically approved
Oussi, N., Loukas, C., Kjellin, A., Lahanas, V., Georgiou, K., Henningsohn, L., . . . Enochsson, L. (2018). Video analysis in basic skills training: a way to expand the value and use of BlackBox training?. Paper presented at INTEC, Stockholm, Sweden. [Enochsson, Lars] Umea Univ, Dept Surg & Perioperat Sci, Div Surg, S-97180 Umea, Sweden.. Surgical Endoscopy, 32(1), 87-95
Open this publication in new window or tab >>Video analysis in basic skills training: a way to expand the value and use of BlackBox training?
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2018 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 32, no 1, p. 87-95Article in journal (Refereed) Published
Abstract [en]

Background: Basic skills training in laparoscopic high-fidelity simulators (LHFS) improves laparoscopic skills. However, since LHFS are expensive, their availability is limited. The aim of this study was to assess whether automated video analysis of low-cost BlackBox laparoscopic training could provide an alternative to LHFS in basic skills training.

Methods: Medical students volunteered to participate during their surgical semester at the Karolinska University Hospital. After written informed consent, they performed two laparoscopic tasks (PEG-transfer and precision-cutting) on a BlackBox trainer. All tasks were videotaped and sent to MPLSC for automated video analysis, generating two parameters (Pl and Prtcl_tot) that assess the total motion activity. The students then carried out final tests on the MIST-VR simulator. This study was a European collaboration among two simulation centers, located in Sweden and Greece, within the framework of ACS-AEI.

Results: 31 students (19 females and 12 males), mean age of 26.2 +/- 0.8 years, participated in the study. However, since two of the students completed only one of the three MIST-VR tasks, they were excluded. The three MIST-VR scores showed significant positive correlations to both the Pl variable in the automated video analysis of the PEG-transfer (RSquare 0.48, P < 0.0001; 0.34, P = 0.0009; 0.45, P < 0.0001, respectively) as well as to the Prtcl_tot variable in that same exercise (RSquare 0.42, P = 0.0002; 0.29, P = 0.0024; 0.45, P < 0.0001). However, the correlations were exclusively shown in the group with less PC gaming experience as well as in the female group.

Conclusion: Automated video analysis provides accurate results in line with those of the validated MIST-VR. We believe that a more frequent use of automated video analysis could provide an extended value to cost-efficient laparoscopic BlackBox training. However, since there are gender-specific as well as PC gaming experience differences, this should be taken in account regarding the value of automated video analysis.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
BlackBox trainer, MIST-VR simulation, Virtual reality, Video analysis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-144969 (URN)10.1007/s00464-017-5641-7 (DOI)000422854700009 ()28664435 (PubMedID)
Conference
INTEC, Stockholm, Sweden. [Enochsson, Lars] Umea Univ, Dept Surg & Perioperat Sci, Div Surg, S-97180 Umea, Sweden.
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-06-09Bibliographically approved
Wanjura, V., Sandblom, G., Österberg, J., Enochsson, L., Ottosson, J. & Szabo, E. (2017). Cholecystectomy after gastric bypass: incidence and complications. Surgery for Obesity and Related Diseases, 13(6), 979-987
Open this publication in new window or tab >>Cholecystectomy after gastric bypass: incidence and complications
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2017 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 13, no 6, p. 979-987Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.

OBJECTIVES: To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.

SETTING: Nationwide Swedish multiregister study.

METHODS: The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.

RESULTS: The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P<.001); the ratio peaked at 11.4 (10.2-12.6, P<.001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P<.001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P<.001), including reoperation (odds ratio 3.84, 2.76-5.36; P<.001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.

CONCLUSION: Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal.

Keywords
Bariatric surgery, Cholecystectomy, Gallstone, Gastric bypass, Obesity
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-132456 (URN)10.1016/j.soard.2016.12.004 (DOI)000406080500014 ()28185764 (PubMedID)
Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-06-09Bibliographically approved
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