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Israelsson, Leif A
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Publications (10 of 26) Show all publications
Israelsson, L. A. (2015). Abdominal incision closure: small but important bites. The Lancet, 386(10000), 1216-1218.
Open this publication in new window or tab >>Abdominal incision closure: small but important bites
2015 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10000, 1216-1218 p.Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2015
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-109907 (URN)10.1016/S0140-6736(15)60687-0 (DOI)000361700100006 ()
Available from: 2015-10-15 Created: 2015-10-09 Last updated: 2017-05-29Bibliographically approved
Muysoms, F. E., Antoniou, S. A., Bury, K., Campanelli, G., Conze, J., Cuccurullo, D., . . . Berrevoet, F. (2015). European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia, 19(1), 1-24.
Open this publication in new window or tab >>European Hernia Society guidelines on the closure of abdominal wall incisions
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2015 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, no 1, 1-24 p.Article, review/survey (Refereed) Published
Abstract [en]

Background The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. Methods The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II instrument. An update of these guidelines is planned for 2017. Results For many of the Key Questions that were studied no high quality data was detected. Therefore, some strong recommendations could be made but, for many Key Questions only weak recommendations or no recommendation could be made due to lack of sufficient evidence. Recommendations To decrease the incidence of incisional hernias it is strongly recommended to utilise a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears effective and safe and can be suggested in high-risk patients, like aortic aneurysm surgery and obese patients. For laparoscopic surgery, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias.

Keyword
Guidelines, Abdominal wall closure, Laparotomy, Laparoscopy, Prophylactic mesh, Prevention, cisional hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-102384 (URN)10.1007/s10029-014-1342-5 (DOI)000351701000001 ()25618025 (PubMedID)
Available from: 2015-05-22 Created: 2015-04-23 Last updated: 2017-05-29Bibliographically approved
Styrke, J., Johansson, M., Granåsen, G. & Israelsson, L. (2015). Parastomal hernia after Heal conduit with a prophylactic mesh: a 10 year consecutive case series. Scandinavian journal of urology, 49(4), 308-312.
Open this publication in new window or tab >>Parastomal hernia after Heal conduit with a prophylactic mesh: a 10 year consecutive case series
2015 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, no 4, 308-312 p.Article in journal (Refereed) Published
Abstract [en]

Objective. There are no data on the frequency of parastomal hernia (PSH) after heal conduit with a prophylactic mesh. The primary objective of this study was to determine the prevalence of PSH. Secondary objectives were to elaborate whether age, gender, body mass index (BMI), previous laparotomy or diabetes influenced the outcome; and to find any mesh-related complications. Materials and methods. In a single centre during 2003-2012, a large-pore, lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits. Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted. During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position. Results. Fifty-eight patients (24 women and 34 men, mean age 69 years) had follow-up examinations after a mean of 35 months (median 32 months). Bladder cancer was the most common cause for surgery. Eight patients (14%) had a PSH. Age, gender, BMI, previous laparotomy and diabetes did not affect the outcome. No mesh-related complications occurred among the 114 patients with a prophylactic mesh. Conclusions. The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh. A prophylactic mesh did not seem to be associated with complications. The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in randomized trials.

Keyword
bladder cancer, ostomy, parastomal hernia, surgical mesh, urinary diversion
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-107861 (URN)10.3109/21681805.2015.1005664 (DOI)000359170200007 ()25656978 (PubMedID)
Available from: 2015-09-16 Created: 2015-08-28 Last updated: 2017-12-04Bibliographically approved
Millbourn, D., Wimo, A. & Israelsson, L. A. (2014). Cost analysis of the use of small stitches when closing midline abdominal incisions. Hernia, 18(6), 775-780.
Open this publication in new window or tab >>Cost analysis of the use of small stitches when closing midline abdominal incisions
2014 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, no 6, 775-780 p.Article in journal (Refereed) Published
Keyword
Cost analysis, Costs, Hernia, Postoperative complications, Surgical wound infection, Wound closure techniques
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-55174 (URN)10.1007/s10029-013-1135-2 (DOI)000345702100001 ()
Note

Originally included in thesis in manuscript form.

Available from: 2012-05-10 Created: 2012-05-10 Last updated: 2017-05-29Bibliographically approved
van Ramshorst, G. H., Klop, B., Hop, W. C., Israelsson, L. A. & Lange, J. F. (2013). Closure of midline laparotomies by means of small stitches: practical aspects of a new technique. Surgical technology international, 23(1), 34-38.
Open this publication in new window or tab >>Closure of midline laparotomies by means of small stitches: practical aspects of a new technique
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2013 (English)In: Surgical technology international, ISSN 1090-3941, Vol. 23, no 1, 34-38 p.Article in journal (Refereed) Published
Abstract [en]

Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). A structured implementation of the technique had been performed at SH but not at EMC. Personnel were interviewed by questionnaire. At each hospital, 18 closures were analyzed. Closure time was significantly longer (p = 0.023) at SH (median 18 minutes, range: 9-59) than at EMC (median 13 minutes, range: 5-23). An SL:WL ratio of more than 4 was achieved in 8 of 18 cases at EMC and in all 18 cases at SH. We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.

Place, publisher, year, edition, pages
Universal Medical Press, Incorporated, 2013
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-88085 (URN)24081841 (PubMedID)
Available from: 2014-04-23 Created: 2014-04-23 Last updated: 2015-06-26Bibliographically approved
Israelsson, L. A. & Millbourn, D. (2013). Prevention of Incisional Hernias How to Close a Midline Incision. Surgical Clinics of North America, 93(5), 1027-+.
Open this publication in new window or tab >>Prevention of Incisional Hernias How to Close a Midline Incision
2013 (English)In: Surgical Clinics of North America, ISSN 0039-6109, E-ISSN 1558-3171, Vol. 93, no 5, 1027-+ p.Article in journal (Refereed) Published
Abstract [en]

The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Mid line incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Wound closure techniques, Postoperative complications, Surgical wound infection, Surgical wound dehiscence, Hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-83101 (URN)10.1016/j.suc.2013.06.009 (DOI)000325841200003 ()
Available from: 2013-11-18 Created: 2013-11-18 Last updated: 2017-12-06Bibliographically approved
Palm, A., Israelsson, L., Bolin, M. & Danielsson, I. (2013). Symptoms after obstetric sphincter injuries have little effect on quality of life. Acta Obstetricia et Gynecologica Scandinavica, 92(1), 109-115.
Open this publication in new window or tab >>Symptoms after obstetric sphincter injuries have little effect on quality of life
2013 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 1, 109-115 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique. Design. Retrospective casecontrol study. Setting. Regional hospital, Sweden. Population. 305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery. Methods. In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow-up time was 15 months to 8 years. Main outcome measures. Anal incontinence, dyspareunia and quality of life. Results. Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p < 0.05). There was no significant difference of incontinence of solid stool, soiling, or fecal urgency between the groups. The quality of life questions showed no significant difference between the groups. In the sphincter group, there was significantly more superficial coital pain compared to controls (p= 0.02). Significantly more women with complete sphincter injury reported anal incontinence than women with a partial sphincter injury. Conclusion. In spite of increased rate of anal incontinence and dyspareunia after anal sphincter rupture, there was no statistically significant reduction in the women's quality of life.

Keyword
surgical techniques, obstetric sphincter injury, anal incontinence, dyspareunia, quality of life
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-66799 (URN)10.1111/j.1600-0412.2012.01532.x (DOI)000313714500015 ()
Available from: 2013-03-08 Created: 2013-03-05 Last updated: 2017-12-06Bibliographically approved
Israelsson, L. A. & Millbourn, D. (2012). Closing midline abdominal incisions. Langenbeck's archives of surgery (Print), 397(8), 1201-1207.
Open this publication in new window or tab >>Closing midline abdominal incisions
2012 (English)In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 397, no 8, 1201-1207 p.Article, review/survey (Refereed) Published
Abstract [en]

The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8 mm from the wound edge than with larger stitches placed more than 10 mm from the wound edge. Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals.

Place, publisher, year, edition, pages
Springer, 2012
Keyword
Suture technique, Wound dehiscence, Wound closure, Surgical site infection, Incisional hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-63766 (URN)10.1007/s00423-012-1019-4 (DOI)000312067000002 ()
Available from: 2013-01-14 Created: 2013-01-07 Last updated: 2017-05-29Bibliographically approved
Jänes, A., Weisby, L. & Israelsson, L. A. (2011). Parastomal hernia: clinical and radiological definitions. Hernia, 15(2), 189-192.
Open this publication in new window or tab >>Parastomal hernia: clinical and radiological definitions
2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 2, 189-192 p.Article in journal (Other academic) Published
Abstract [en]

INTRODUCTION: Parastomal hernia is a frequent complication after stoma formation. No consistent definition of parastomal hernia has been used in previous studies using clinical examination or computed tomography (CT) scan. The correlation between herniation rates found with clinical examination and CT scan has been poor. A definition of parastomal hernia with clinical examination that correlates with findings from CT scan should be sought.

METHODS: Parastomal hernia, was with surgeons' clinical examination, defined as any protrusion in the vicinity of the stoma with the patient straining in a supine and an erect position. A new CT scan method was developed with the patient examined in the prone position. Radiologists defined herniation as any intra-abdominal content protruding beyond the peritoneum or the presence of a hernia sac. The correlation between investigators and methods were estimated by calculating Fleiss' Kappa values.

RESULTS: Twenty-seven patients were assessed by three surgeons and three radiologists. For the surgeons, the Kappa value was 0.85. For the radiologists, it was 0.85 with CT scan in the prone position and 0.82 in the supine position. For the surgeons and radiologists collectively, the Kappa value was 0.80 for CT scan in the prone position and 0.63 in the supine position.

CONCLUSION: With the new CT scan method examining patients in the prone position, the clinical and radiological definitions were highly reproducible and correlated strongly between methods and raters. With the strong correlation between clinical and radiological assessments, clinical examination alone is sufficient as follow-up. Conventional CT scan with the patient supine is not a reliable tool for diagnosing parastomal hernia.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-36752 (URN)10.1007/s10029-010-0769-6 (DOI)21188441 (PubMedID)
Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2017-12-12Bibliographically approved
Millbourn, D., Cengiz, Y. & Israelsson, L. A. (2011). Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia, 15(3), 261-266.
Open this publication in new window or tab >>Risk factors for wound complications in midline abdominal incisions related to the size of stitches
2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, 261-266 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Midline abdominal incisions should be closed continuously with a suture length (SL) to wound length (WL) ratio above 4 using small stitches. The effect on the rate of wound complications of a very high ratio and other potential risk factors when closure is performed with small stitches is unknown.

METHODS: Patients operated on through a midline incision were randomised to closure with small stitches, placed 5-8 mm from the wound edge and less than 5 mm apart, or with large stitches, placed more than 1 cm from the wound edge. Patient and operative variables were registered. Surgical site infection and incisional hernia were recorded.

RESULTS: Three hundred and twenty-one patients were randomised to closure with small stitches and 370 with large stitches. Infection and herniation were less common with small stitches. With small stitches, no risk factors for infection or herniation were identified. With large stitches, wound contamination and the patient being diabetic were independent risk factors for infection, and long operation time and surgical site infection were risk factors for herniation. A very high SL to WL ratio did not affect the complication rates.

CONCLUSIONS: In midline abdominal incisions closed with small stitches, no risk factors for surgical site infection or incisional hernia were identified. Increasing the ratio very much above 4 had no adverse effects on the rate of wound complications. The higher rates of infection and herniation with an SL to WL ratio over 5 and in overweight patients in previous reports were probably related to wounds being closed with large stitches.

Keyword
Suture technique, Postoperative complications, Surgical wound infection, Surgical site infection, Incisional hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-55171 (URN)10.1007/s10029-010-0775-8 (DOI)21279664 (PubMedID)
Available from: 2012-05-10 Created: 2012-05-10 Last updated: 2017-12-07Bibliographically approved
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