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  • 1. Bringman, S.
    et al.
    Holmberg, Henrik
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Osterberg, J.
    Location of recurrent groin hernias at TEP after Lichtenstein repair: a study based on the Swedish Hernia Register2016In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 20, no 3, p. 387-391Article in journal (Refereed)
    Abstract [en]

    To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair. Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014. Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7 %). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair. Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.

  • 2.
    Clay, Leonard
    et al.
    Department of Clinical Science, Intervention and Technology (CLINTEC), H9, Karolinska Institutet, 171 64, Stockholm, Sweden.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 64, Stockholm, Sweden..
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study2018In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, no 2, p. 325-332Article in journal (Refereed)
    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.

  • 3.
    Emanuelsson, Peter
    et al.
    Department for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, 117 76, Stockholm, Sweden .
    Dahlstrand, Ursula
    Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Strömsten, U.
    Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden .
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden .
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Stark, Birgit
    Department for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden .
    Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively2014In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, no 4, p. 465-471Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.

    METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC).

    RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.

    CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.

  • 4.
    Fränneby, Ulf
    et al.
    Dept of Surgery, Sodersjukhuset, Stockholm, Sweden.
    Gunnarsson, Ulf
    The Department of Surgical Sciences, Akademiska sjukhuset, Colorectal Unit, Uppsala University, SE 751 85, Uppsala, Sweden.
    Wollert, S
    Sandblom, G
    Discordance between the patient's and surgeon's perception of complications following hernia surgery.2005In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 9, no 2, p. 145-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The study was undertaken in order to assess the degree of concordance between the patient's and surgeon's perceptions of adverse events after groin hernia surgery.

    METHODS: 206 patients who underwent elective surgery for groin hernia at Samariterhemmet, Uppsala, Sweden in 2003 were invited to a follow-up visit after 3-6 weeks. At this visit the patient was instructed to answer a questionnaire including 12 questions concerning postoperative complications. A postoperative history was taken and a clinical examination performed by a surgeon who was not present at the operation and did not know the outcome of the questionnaire. All complications noted by the physician were recorded for corresponding questions in the questionnaire.

    RESULTS: 174 (84.5%) patients attended the follow up, 161 men and 13 women. A total of 190 complications were revealed by the questionnaire, 32 of which had caused the patient to seek help from the health-care system. There were 131 complications registered as a result of the follow-up clinical examinations and history. Kappa levels ranged from 0.11 for urinary complications to 0.56 for constipation.

    CONCLUSION: In general, the concordance was poor. These results emphasise the importance of providing detailed information about the usual postoperative course prior to the operation. Whereas the surgeon, from a professional point of view, has a better idea about what should be expected in the postoperative period and how any complications should be categorised, only the patient has a complete picture of the symptoms and adverse events. This makes it impossible to reach complete agreement between the patient's and surgeon's perceptions of complications, even under the most ideal circumstances.

  • 5.
    Gunnarsson, Ulf
    et al.
    Department of Surgery, Mora Hospital, Mora, Sweden .
    Heuman, R
    Patient experience ratings in surgery for recurrent hernia1999In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 3, no 2, p. 69-73Article in journal (Refereed)
  • 6.
    Gunnarsson, Ulf
    et al.
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Gastrocentrum K53, 141 86, Huddinge, Stockholm, Sweden .
    Johansson, M
    Department of Physiotherapy, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden .
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 4, p. 417-421Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The decrease in recurrence rates in ventral hernia surgery have led to a redirection of focus towards other important patient-related endpoints. One such endpoint is abdominal wall function. The aim of the present study was to evaluate the reliability and external validity of abdominal wall strength measurement using the Biodex System-4 with a back abdomen unit.

    MATERIAL AND METHOD: Ten healthy volunteers and ten patients with ventral hernias exceeding 10 cm were recruited. Test-retest reliability, both with and without girdle, was evaluated by comparison of measurements at two test occasions 1 week apart. Reliability was calculated by the interclass correlation coefficients (ICC) method. Validity was evaluated by correlation with the well-established International Physical Activity Questionnaire (IPAQ) and a self-assessment of abdominal wall strength.

    RESULTS: One person in the healthy group was excluded after the first test due to neck problems following minor trauma. The reliability was excellent (>0.75), with ICC values between 0.92 and 0.97 for the different modalities tested. No differences were seen between testing with and without a girdle. Validity was also excellent both when calculated as correlation to self-assessment of abdominal wall strength, and to IPAQ, giving Kendall tau values of 0.51 and 0.47, respectively, and corresponding P values of 0.002 and 0.004.

    CONCLUSION: Measurement of abdominal muscle function using the Biodex System-4 is a reliable and valid method to assess this important patient-related endpoint. Further investigations will be made to explore the potential of this technique in the evaluation of the results of ventral hernia surgery, and to compare muscle function after different abdominal wall reconstruction techniques.

  • 7. Hallén, M
    et al.
    Sevonius, D
    Westerdahl, J
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, G
    Risk factors for reoperation due to chronic groin postherniorrhaphy pain2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, no 6, p. 863-869Article in journal (Refereed)
    Abstract [en]

    Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP. All 195,707 repairs registered in the Swedish Hernia Register between 1999 and 2011 were included in the study. Out of these, 28,947 repairs were excluded since they were registered as procedures on the same patient after a previous repair. Age, gender, hernia anatomy (indirect reference), method of repair (anterior sutured repair reference) and postoperative complications were included in a multivariate Cox analysis with reoperation due to CGPP as endpoint. Of the patients included in the study cohort, 218 (0.13 %) later underwent reoperation due to CGPP, including 31 (14 %) women. Median age at the primary repair was 61.5 years. Risk factors for being reoperated were age < median [hazard ratio (HR) 3.03, 95 % confidence interval (CI) 2.22-4.12], female gender (HR 2.13, CI 1.41-3.21), direct hernia (HR 1.35, CI 1.003-1.81), other hernia (HR 6.03, CI 3.08-11.79), Lichtenstein repair (HR 2.22, CI 1.16-4.25), plug repair (HR 3.93, CI 1.96-7.89), other repair (HR 2.58, CI 1.08-6.19), bilateral repair (HR 2.58, CI 1.43-4.66) and postoperative complication (HR 4.40, CI 3.25-5.96). Risk factors for being reoperated due to CGPP in this cohort included low age, female gender, a direct hernia, a previous Lichtenstein or plug repair, bilateral repair and postoperative complications. Further research on how to avoid CGPP and explore the effectiveness of surgery for CGPP is necessary.

  • 8.
    Hemberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Holmberg, H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Tobacco use is not associated with groin hernia repair, a population-based study2017In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 21, no 4, p. 517-523Article in journal (Refereed)
    Abstract [en]

    Purpose The pathogenesis of groin hernia is not fully understood and some suggested risk factors are debatable. This population-based study evaluates the association between groin hernia repair and tobacco use. Method An observational study based on register linkage between the Swedish Hernia Register and the Vasterbotten Intervention Program (VIP). All primary groin hernia repairs performed from 2001 to 2013 in the county of Vasterbotten, Sweden, were included. Results VIP provided data on the use of tobacco in 102,857 individuals. Neither smoking nor the use of snus, increased the risk for requiring a groin hernia repair. On the contrary, heavy smoking decreased the risk for men, HR 0.75 (95% CI 0.58-0.96), as did having a BMI over 30 kg/m 2 HR (men) 0.33 (95% CI 0.27-0.40). Conclusion Tobacco use is not a risk factor for requiring a groin hernia repair, whereas having a low BMI significantly increases the risk.

  • 9.
    Holmdahl, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden..
    Clay, Leonard
    Department of Clinical Science and Education, Karolinska Institute, Solna, Sweden..
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial2019In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 23, no 2, p. 355-361Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 10.
    Israelsson, Leif A
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Smedberg, Sam
    Montgomery, Agneta
    Nordin, Pär
    Spangen, L
    Incisional hernia repair in Sweden 20022006In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 10, no 3, p. 258-261Article in journal (Refereed)
    Abstract [en]

    Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures. Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair, 19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed may not be optimal. This study has led to the instigation of a national incisional hernia register.

  • 11. Janson, A R
    et al.
    Jänes, Arthur
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Laparoscopic stoma formation with a prophylactic prosthetic mesh.2010In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 14, no 5, p. 495-498Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One year after stoma formation with an open technique, the rate of parastomal hernia is almost 50%. The herniation rate can be reduced to 10% with the use of a prophylactic mesh in a sublay position. For stomas formed with a laparoscopic technique, a surgical method with the use of prophylactic mesh should be sought. METHODS: Patients with a sigmoidostomy created with a laparoscopic technique were provided with a prophylactic large-pore, low-weight mesh in a sublay position. Follow-up examination was carried out after at least 12 months. RESULTS: Between March 2003 and May 2007, a sigmoidostomy was created in 25 patients. The patients' mean age was 65 years (range 31-89), the mean body mass index was 26 (range 21-32) and 15 were female. One stoma necrosis and two minor wound infections occurred. Parastomal hernia was present in 3 of 20 patients (15%) available for follow-up examination after 11-31 months (mean 19). No fistulas or strictures had developed. No mesh infection was noted and no mesh was removed. CONCLUSION: In laparoscopic stoma formation, a prophylactic large-pore, low-weight mesh in a sublay position is an easy and safe procedure associated with a low rate of parastomal hernia.

  • 12. Johansson, M
    et al.
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institute, Karolinska University Hospital, Gastrocentrum K53, 141 86, Huddinge, Stockholm, Sweden .
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Different techniques for mesh application give the same abdominal muscle strength2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 1, p. 65-68Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study investigates abdominal muscle strength after surgery for giant hernia with the onlay, sublay or intraperitoneal (IPOM) method. Theoretically, placement of the mesh may result in different possibilities regarding function and postoperative physical activity related to abdominal muscle function.

    METHOD: Twenty-four patients operated for large ventral hernias using the onlay, sublay or IPOM technique were evaluated 1 year following surgery for abdominal wall strength using Biodex system 4.

    RESULTS: Despite the different surgical techniques used, no differences were observed in abdominal wall strength between the groups.

    CONCLUSION: The postoperative strength of abdominal wall muscles is independent of the method used for reconstruction of large abdominal wall hernia, and the choice of surgical technique should be directed by anatomical circumstances.

  • 13.
    Jänes, Arthur
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Weisby, Lena
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Parastomal hernia: clinical and radiological definitions2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 2, p. 189-192Article in journal (Other academic)
    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.

  • 14.
    Lundström, K
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmberg, H
    Topic: INGUINAL HERNIA - Post op chronic pain: incidence, evaluation, legal consequences, therapy, follow up: Choice of anesthesia and chronic pain after groin hernia repair2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, p. S270-S270, article id PO:152Article in journal (Refereed)
    Abstract [en]

    Chronic pain is common after groin hernia surgery, affecting approximately 10% of patients. The type of anesthesia has been shown to affect short term pain (within 30 days) where Local Anesthesia (LA) has advantages over Regional- and General Anesthesia (RA and GA) The aim of this study was to compare the impact of anesthesia on chronic pain one year after open anterior mesh repair

  • 15. Magnusson, N.
    et al.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Smedberg, S.
    Hedberg, M.
    Sandblom, G.
    Reoperation for persistent pain after groin hernia surgery: a population-based study2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of the present study was to assess the outcome results after reoperation for persistent pain after hernia surgery in a population-based setting. Methods All patients who had undergone surgery for persistent pain after previous groin hernia surgery 1999-2006 were identified in the Swedish Hernia Register (n = 237). Data on the surgical technique used were abstracted from the medical records. The patients were asked to answer a set of questions including SF-36 to evaluate the prevalence of pain after reoperation. Results The study group consisted of 95 males and 16 females, mean age 53 years. In 27 % of cases an intervention aimed at suspected ilioinguinal neuralgia was performed. The mesh was removed completely in 28 % and partially in 13 %. A suture at the pubic tubercle was removed in 13 % of cases. Decrease in pain after the most recent reoperation was reported by 69 patients (62 %), no change in pain by 21 patients (19 %) and increase in pain in 21 patients (19 %). There was no significant difference in outcome between mesh removal, removal of sutures at the tubercle or interventions aimed at the ilioinguinal nerve. All subscales of SF-36 were significantly reduced when compared to the age-and gender-matched general population (p < 0.05). Conclusions Patients reoperated for persistent pain after hernia surgery often report a reduction in pain, but the natural course of persistent pain, the relatively low response rate and selection of patients make it difficult to draw definite conclusions.

  • 16.
    Magnusson, N
    et al.
    Department of Surgery, Mora Hospital, Mora, Sweden and Department of Surgery, Örebro University Hospital, Södra Grevrosengatan, 703 62, Örebro, Sweden .
    Nordin, Pär
    Hedberg, M
    Department of Surgery, Mora Hospital, Mora, Sweden .
    Gunnarsson, Ulf
    CLINTEC, Division of Surgery, Karolinska Institutet, Stockholm, Sweden .
    Sandblom, G
    CLINTEC, Division of Surgery, Karolinska Institutet, Stockholm, Sweden .
    The time profile of groin hernia recurrences2010In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 14, no 4, p. 341-344Article in journal (Refereed)
    Abstract [en]

    PURPOSE: If the pathogeneses of the development of a recurrence varies following the different methods of hernia repair, the time required to develop a recurrence could be expected to vary. The aim of the study was to identify risk factors affecting the time interval between the primary repair and the reoperation.

    METHODS: Data from the Swedish Hernia Register were used. Each year of the 5-year follow-up period was treated as a separate subgroup and merged together into one large group. For each risk factor, we performed a Cox proportional hazard analysis, testing for interactions between the year and the risk factor, with reoperation as the endpoint.

    RESULTS: Altogether, 142,578 repairs were recorded, of which 7.7% were performed on women. The mean age of the cohort was 59 years. The overall recurrence rate in the 5-year period was 4.3%. Multivariate analysis showed that recurrence following surgery for recurrent hernia occurred relatively early (P < 0.05).Recurrence also appeared early if postoperative complications were registered (P < 0.05). Recurrence after suture repair or laparoscopic repair appeared relatively early compared to recurrence following open mesh repair (P < 0.05). In a separate analysis, a relatively higher risk for early recurrence was seen for all sutured repairs compared to all mesh repairs (P < 0.05).

    CONCLUSIONS: The pathogenesis behind the development of recurrence probably differs depending on the technique applied during the hernia repair. The higher proportion of early recurrences following laparoscopic repair, suture repair and recurrent repair may be explained by the high proportion of technical failures.

  • 17.
    Millbourn, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Cengiz, Yucel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Risk factors for wound complications in midline abdominal incisions related to the size of stitches2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, p. 261-266Article in journal (Refereed)
    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.

  • 18.
    Millbourn, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wound complications and stitch length2004In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 8, no 1, p. 39-41Article in journal (Refereed)
    Abstract [en]

    The effect of suturing with a very short stitch on the development of wound complications in midline incisions was investigated. Three hundred sixty-eight patients were analysed. The suture length to wound length ratio and mean stitch length were calculated. Wound infection occurred in 4% (four of 103) of patients sutured with a mean stitch length of less than 4 cm, in 8% (nine of 117) with stitch length 4-4.9 cm, and in 16% (24 of 148) with a longer stitch ( P=0.004). At 12-month follow up, incisional hernia was present in 3% (two of 76) of patients sutured with a mean stitch length of less than 4 cm and in 12% (25 of 215) sutured with a longer stitch ( P=0.043). In midline incisions closed with a suture length to wound length ratio of at least 4, a short stitch is associated with a lower rate of both wound infection and incisional hernia.

  • 19.
    Millbourn, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wimo, Anders
    Karolinska Institutet, Institutionen för Neurobiologi, Vårdvetenskap och Samhälle, Sektionen KI Alzheimer Disease Research Center.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Cost analysis of the use of small stitches when closing midline abdominal incisions2014In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, no 6, p. 775-780Article in journal (Refereed)
  • 20. Miserez, M
    et al.
    Peeters, E
    Aufenacker, T
    Bouillot, JL
    Campanelli, G
    Conze, J
    Fortelny, R
    Heikkinen, T
    Jorgensen, LN
    Kukleta, J
    Morales-Conde, S
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Schumpelick, V
    Smedberg, S
    Smietanski, M
    Weber, G
    Simons, MP
    Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients2014In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, no 2, p. 151-163Article in journal (Refereed)
    Abstract [en]

    PURPOSE: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence.

    METHODS: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members.

    RESULTS: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold).

    CONCLUSIONS: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015.

  • 21. Muysoms, F. E.
    et al.
    Antoniou, S. A.
    Bury, K.
    Campanelli, G.
    Conze, J.
    Cuccurullo, D.
    de Beaux, A. C.
    Deerenberg, E. B.
    East, B.
    Fortelny, R. H.
    Gillion, J. -F
    Henriksen, N. A.
    Israelsson, Leif
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Jairam, A.
    Jaenes, A.
    Jeekel, J.
    Lopez-Cano, M.
    Miserez, M.
    Morales-Conde, S.
    Sanders, D. L.
    Simons, M. P.
    Smietanski, M.
    Venclauskas, L.
    Berrevoet, F.
    European Hernia Society guidelines on the closure of abdominal wall incisions2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19, no 1, p. 1-24Article, review/survey (Refereed)
    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.

  • 22.
    Nilsson, Erik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Invited commentary by E. Nilsson to the use of hernia registers for improving patient outcome (manuscripts by Stechemesser et al. and Muysoms et al.)2012In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 16, no 3, p. 237-238Article in journal (Other academic)
  • 23.
    Nilsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden.
    Angeras, U.
    Sandblom, G.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Serious adverse events within 30 days of groin hernia surgery2016In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 20, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    To analyze severe complications after groin hernia repair with respect to age, ASA score, hernia anatomy, method of repair and method of anesthesia, using nationwide registers. The annual rate of 20 million groin hernia operations throughout the world renders severe complications, although rare, important both for the patient, the clinician, and the health economist. Two nationwide registers, the Swedish Hernia Register and the National Swedish Patient Register were linked to find intraoperative complications, severe cardiovascular events and severe surgical adverse events within 30 days of groin hernia surgery. 143,042 patients, 8 % women and 92 % men, were registered between 2002 and 2011. Intraoperative complications occurred in 801 repair, 592 patients suffered from cardiovascular events and 284 patients from a severe surgical event within 30 days of groin hernia surgery. Emergency operation was a risk factor for both cardiovascular and severe surgical adverse events with odds ratios for cardiovascular events of 3.1 (2.5-4.0) for men and 2.8 (1.4-5.5) for women. Regional anesthesia was associated with an increase in cardiovascular morbidity compared with local anesthesia, odds ratio 1.4 (1.1-1.9). In men, bilateral hernia and sliding hernia approximately doubled the risk for severe surgical events; odds ratio 1.9 (1.1-3.5) and 2.2 (1.6-3.0), respectively. Methods other than open anterior mesh repair increased the risk for surgical complications. Awareness of the increased risk for cardiovascular or surgical complications associated with emergency surgery, bilateral hernia, sliding hernia, and regional anesthesia may enable the surgeon to further reduce their incidence.

  • 24.
    Nilsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sahlgrenska University Hospitalt, Göteborg, Sweden.
    Nilsson, Erik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Angerås, U
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mortality after groin hernia surgery: delay of treatment and cause of death2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, p. 301-307Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency hernia surgery, in contrast to elective hernia surgery, is associated with appreciable mortality. Incarcerated hernia is the second most common cause of small bowel obstruction after adhesions, and the leading cause of bowel strangulation.

    METHODS: Information on patients who died within 30 days of groin hernia surgery was retrieved from the Swedish Hernia Register, from the Cause-of-Death Register, and from hospital notes.

    RESULTS: Of 103,710 groin hernia operations between 1992 and 2004, 292 patients died within 30 days of surgery. Hospital notes and cause of death were retrieved for 242 cases (82%). In 5 of these patients, the hernia operation was done in addition to more urgent surgery and therefore excluded from further analyses; 152 patients were admitted as emergency cases and 55 of these patients underwent bowel resection. A total of 107 patients had signs of bowel obstruction when admitted. For 37% of these patients, physical examination of the groin was not documented. Patients with bowel obstruction without a note on a palpable groin lump were more likely to undergo imaging investigation preoperatively (P < 0.001) and they had an increased time to surgery compared to patients with a palpable lump. Women and patients with femoral hernia were significantly less likely to undergo a groin examination compared to other patients. Local anaesthesia was used in 7% of all patients who died postoperatively, and in 3% of emergency cases. Pulmonary disease, sepsis and malignant disease were more common as causes of death after emergency surgery than after elective surgery.

    CONCLUSIONS: Groin examination of patients presenting with bowel obstruction is of utmost importance in order to minimise delay to hernia surgery.

  • 25.
    Nordin, Pär
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ahlberg, J.
    Johansson, H.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hafstrom, L.
    Risk factors for injuries associated with damage claims following groin hernia repair2017In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 21, no 2, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Surgical repair of groin hernia should be carried out with minimal complication rates, and it is important to have regular quality control and accurate means of assessment. The Swedish healthcare system has a mutual insurance company (LA-F) that receives claims from patients who have suffered healthcare-related damage or malpractice. The Swedish Hernia Register (SHR) currently covers around 98% of all Swedish groin hernia operations. The aim of this study was to analyse damage claims following groin hernia repair surgery and link these with entries in the SHR, in order to identify risk factors and causes of injuries and malpractice associated with hernia repair. Data on all 48,574 groin hernia operations registered in the SHR between 2008 and 2010 were compared and linked with data on claims made to the Swedish National Patient Injury Insurance (LA-F). Of the 130 damage claims received by LA-F, 26 dealt with bleeding, 20 with testicular injury and 7 with intestinal lesions. Eighty (62%) of the complications were considered malpractice according to the Swedish Patient Injury Act. Acute and recurrent surgery, sutured repair and general anaesthesia were associated with a significantly increased risk for a damage claim independently the patients were compensated or not. Females filed claims in greater proportion than males. There was no significant difference in background factors between claims accepted by LA-F and compensated and those who were rejected compensation. Risk factors for filing a damage claim included acute surgery, operation for recurrence, sutured repair and general anaesthesia, whereas local anaesthesia reduced the risk.

  • 26.
    Rutegård, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gümüsçü, Rojda
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stylianidis, G.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nilsson, Erik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haapamäki, Markku M.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    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 mesh2018In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 22, no 3, p. 411-418Article in journal (Refereed)
    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.

  • 27. Simons, M P
    et al.
    Aufenacker, T
    Bay-Nielsen, M
    Bouillot, J L
    Campanelli, G
    Conze, J
    de Lange, D
    Fortelny, R
    Heikkinen, T
    Kingsnorth, A
    Kukleta, J
    Morales-Conde, S
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Schumpelick, V
    Smedberg, S
    Smietanski, M
    Weber, G
    Miserez, M
    European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.2009In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 13, no 4, p. 343-403Article in journal (Refereed)
    Abstract [en]

    The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.

  • 28.
    Stark, Birgit
    et al.
    Department of Reconstructive Plastic Surgery, Institution of Molecular, Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute at the Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Definitive reconstruction of full-thickness abdominal wall defects initially treated with skin grafting of exposed intestines2007In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 11, no 6, p. 533-536Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The reconstruction of wide, full-thickness abdominal wall defects of the midline presents a continuing challenge, and consensus concerning the appropriate surgical treatment is lacking.

    METHOD: In this retrospective review, we describe a simple method of reconstruction in full-thickness defects initially treated with skin grafting directly on to the surface of the intestines. Instead of removing the split-thickness grafts from the surface of the intestines, the abdominal wall was reconstructed by inverting the grafted area and advancing the rectus muscles towards the midline.

    RESULTS: Four patients with full-thickness transverse defects larger than 10 cm at the level of the waist and extending from the xiphoid to the suprapubic region were operated with this method. All healed uneventfully. In one case, microscopic examination of the inverted skin showed transformation to normal connective tissue.

    CONCLUSION: Reconstruction of abdominal wall defects previously treated with skin grafting directly on to the intestines can be safely done by reposition of the skin-grafted intestines into the abdominal cavity and realignment of the rectus muscles in the midline.

  • 29.
    Strigård, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Clay, Leonard
    Stark, Birgit
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Reply to Comment to: Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized-controlled multicenter study. P. Agarwal, D. Sharma2018In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 22, no 6, p. 1001-1001Article in journal (Refereed)
  • 30. Sukegawa, M
    et al.
    Chihara, N
    Suzuki, H
    Watanabe, M
    Nomura, S
    Uchida, E
    Napoliello, D
    Mykytiuk, S
    Vlasov, V
    Pidmurniak, O
    Prystupa, M
    Latynskyi, E
    Pidoprygora, Y U
    Brytanchuk, R
    Demiryas, S
    Kucuk, Y
    Umman, V
    Ulualp, K
    Ertem, M
    Tasci, I
    Ahn, S
    Park, D J
    Kim, H H
    Morgell, A
    Nilsson, H
    Nordin, Pär
    0stersunds Sjukhus, Ostersund, SWEDEN.
    Angerås, U
    Sandblom, G
    Topic: Femoral Hernia - Approach, results.2015In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 19 Suppl 1, p. S220-2Article in journal (Refereed)
  • 31.
    Winsnes, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haapamäki, Markku
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence2016In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 20, no 4, p. 509-516Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare recurrence and surgical complications following two dominating techniques: the use of suture and mesh in umbilical hernia repair.

    METHODS: 379 consecutive umbilical hernia repair procedures performed between 1 January 2005 and 14 March 2014 in a university setting were included. Gathering was made using International Classification of Diseases codes for both procedure and diagnosis. Each patient record was scrutinized with respect to 45 variables, and the results entered in a database.

    RESULTS: Exclusion <18 years-of-age (32), non-primary umbilical hernia (25), wrong diagnosis (7), concomitant major abdominal surgery (5), double registration (3) and pregnancy (1) left 306 patients eligible for analysis. Gender distribution was 97 women and 209 men. There was no difference between mesh and suture with regard to the primary outcome variable, cumulative recurrence rate, 8.4 %. Recurrence was both self-reported and found on clinical revisit and defined as recurrence when verified by a clinician and/or radiologist. Results presented as odds ratio (OR) with 95 % confidence interval (CI) show a significantly higher risk for recurrence in patients with a coexisting hernia OR 2.84, 95 % CI 1.24-6.48. Secondary outcome, postoperative surgical complication (n = 51 occurrences), included an array of postoperative surgical events commencing within 30 days after surgery. Complication rate was significantly higher in patients receiving mesh repair OR 6.63, 95 % CI 2.29-20.38.

    CONCLUSIONS: Suture repair decreases the risk for surgical complications, especially infection without an increase in recurrence rate. The risk for recurrence is increased in patients with a history of another hernia.

1 - 31 of 31
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