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Purpose: Faecal incontinence is common in persons with severe obesity. Little is known about how the thicknesses of the internal anal sphincter (IAS) and the external anal sphincter (EAS) change in relation to weight loss following metabolic bariatric surgery (MBS). This study aims to investigate any change in IAS and EAS thickness 6 months after Roux-en-Y gastric bypass surgery (RYGB) and to determine whether any such change correlates with a change in faecal incontinence pattern. Methods: Thirty-one patients underwent three-dimensional endoanal ultrasound to measure anal sphincter thickness before and 6 months after RYGB. Patients completed the validated Wexner and LARS (low anterior resection syndrome) questionnaires at the same time to evaluate any change in faecal incontinence and urgency symptoms following surgery. Results: No significant change in the thicknesses of the IAS and EAS was seen. The Wexner score decreased from 18 to 13 (less incontinence). Conversely, the number of patients with LARS increased from 10 to 15 six months after surgery (more urgency). Conclusion: RYGB had no effect on the thickness of the anal sphincter 6 months after surgery. However, the pattern of faecal incontinence changed, with a decrease in leakage and whole faecal incontinence and an increase in urgency.

Background: Preoperative fasting reduce the risk of pulmonary aspiration during induction of anaesthesia. However, scientific documentation on the correlation between prolonged preoperative fasting and patient discomfort is limited. The aim of the present study was to investigate whether the duration of preoperative fasting correlates with pre- and postoperative patient discomfort, the duration of stay at postoperative care unit and the occurrence of surgical complications within 30 days.

Methods: This prospective observational study included 50 women undergoing elective breast cancer surgery. The Numerical Rating Scale (NRS) was used to assess hunger, thirst, nausea, pain, and anxiety. Patient characteristics, surgical data and occurrence of surgical complications were collected from medical records. Statistical analyses included Sperman’s rank correlation, Pearson’s correlation, Wilcoxon signed rank test, and logistic regression analysis.

Results: The mean fasting duration was 15.1 h for solid food and 12.1 h for fluids. A positive association was observed between fasting duration for solid food and nausea prior to surgery (p = 0.067), although not reaching statistical significance. There was no significant correlation between duration of fasting for both solids and fluids and patient discomfort before and after surgery, nor with the duration of stay on the postoperative care unit, nor with the surgical complication rate within 30 days.

Conclusions: No correlation was observed between the duration of preoperative fasting and patient discomfort, the length of stay in the postoperative care unit, or the incidence of surgical complications. Notably, fasting durations highly exceeded the recommended six hours for solids and two hours for clear fluids.

Colorectal cancer is the third most common cancer worldwide, and the proportion of individuals diagnosed under the age of 50 years, referred to as early-onset colorectal cancer (EOCRC), is increasing. The aim of this study was to evaluate how the demographic and clinical features of EOCR in northern Sweden and Finland have changed over time. All patient data were extracted from local hospital surgical department databases between 1995 and 2022. Two CRC cohorts, Study Cohort I (1995-2005) 1237 patients and Study Cohort II (2006-2022) 4526 patients, were compared for age, sex, disease stage, tumour grade, tumour location, and mismatch repair status. EOCRC patients comprised 7% of all CRCs in Study Cohort I and 4% in Study Cohort II. The mean ages were 42 and 43 years respectively, and 55% of patients were female. The vast part of EOCRC tumours were left-sided stage III-IV cancers. Most tumours (n = 204, 73%) were low grade, and 10% showed mismatch repair deficiency. No significant differences in demographic or tumour characteristics were seen over time. EOCRC in northern Sweden and Finland is characterised by advanced-stage, low tumour grade, a slight female predominance, and stable clinical and pathological features. These findings partly contrast with reports on EOCRC from other high-income countries, highlighting the need for further research on advanced molecular characteristics and potential gender differences in incidence and survival of this population.

Background: Conventional muscle biopsy techniques, such as the Bergström method, require large tissue samples and skin incisions. Fine-needle muscle microbiopsy offers a minimally invasive alternative, but data on tolerability are lacking. We aimed to present a refined minimally-invasive muscle microbiopsy protocol using a 20-gauge needle with topical anaesthesia and compare perceived pain with routine venipuncture.

Methods: Twenty-six healthy adults (50% female) underwent vastus lateralis microbiopsy using a 20-gauge needle (0.9 mm). Pain was assessed immediately after the microbiopsy and a venous blood draw using a 21-gauge needle, with the visual analogue scale (VAS). Procedures were randomized.

Results: Seventy-eight microbiopsies were successfully obtained. Mean pain scores were low for both procedures (microbiopsy: 1.0 ± 0.9; venipuncture: 1.4 ± 1.2) with no significant difference (P = 0.311). Most participants reported minimal or low discomfort (VAS ≤3) from the microbiopsy.

Conclusion: Fine-needle muscle microbiopsy using a 20-gauge needle is well tolerated, with pain comparable to routine venipuncture. This approach substantially reduces invasiveness compared to traditional biopsies while providing adequate material for proteomic analysis. These findings support its ethical and practical application in sensitive populations and longitudinal research.

Introduction: Roux-en-Y Gastric Bypass (RYGB) is a common treatment option for obesity. After RYGB, loss of both adipose tissue and lean body mass is seen. In this study, we have investigated the dynamic metabolic changes of hyaluronan (HA) and associated biomarkers reflecting the extracellular matrix after RYGB.

Materials and Methods: In this exploratory cohort study, a total of 306 serum samples were collected at 5 different times from 96 RYGB patients, preoperatively until 6 months after surgery, where 44/96 (46%) contributed samples at 6 months. HA and the cell-surface receptor CD44 were studied by enzyme-linked immunosorbent assay (ELISA), while Luminex Multiplex assays were used for MMP-2, MMP-9, TNF-α, IL-1β, IL-6 and IL-10.

Results: Preoperatively, an elevated HA-concentration (> 120 ng/ml) was seen in 39.6% of the study population. From baseline to day of surgery, we found a statistically significant decrease (p < 0.05) in HA (Δ-21.4ng/mL [-42.6, -0.27]), CD44 (Δ-26.7ng/mL [-46.4, -6.9]), MMP-2 (Δ-32.4 ng/mL [-41.4 -23.4]) and MMP-9 (Δ-138.2 ng/mL [-188.0, -88.4]), TNF-α(Δ-3.1 pg/mL [-5.4, -0.8]), IL-1β (Δ-14.4 pg/mL [-22.2, -6.6]) and IL-6 (Δ-2.0 pg/mL [-3.1, -0.9]). At one month postoperatively, a subsequent increase was seen. Although the mean concentration of HA was unchanged at 6 months, patients with baseline HA ≥ 120 ng/mL demonstrated a decrease, (Δ-37.1 [-55.8 to -14.7] p < 0.01; exploratory analysis)

Conclusion: Although mean HA levels returned to baseline at 6 months, a significant transient decrease was observed immediately postoperatively, and patients with elevated preoperative HA (> 120ng/ml) showed a sustained reduction. The postoperative increase of MMP-2 suggests a continuous remodeling of the extracellular matrix.

Introduction: Physical activity is an important part of accomplishing and maintaining weight loss. As far as the improvement in associated disease is concerned, the effects of Metabolic Bariatric Surgery (MBS) are well known, but the effects on physical activity and ability to perform everyday activities are less obvious. This study explores how weight loss after Roux-en-Y gastric bypass (RYGB) improves physical activity and movement, and how this impacts everyday life.

Method: Semi-structured interviews were held with patients 1–3 years after RYGB. Audio recordings were transcribed verbatim, and the texts were condensed in steps and abstracted with an inductive approach using Qualitative Content Analysis.

Results: 15 individuals, 12 women and 3 men, median age 36 years (26−73), and median body mass index (BMI) 28 (range 22–45), were interviewed until information power was reached.

The overall theme “New Life and Freedom” was the result of the analysis process. This was derived from two sub-themes: 1. Discovery of Having Higher Physical Capacity, including the categories Higher Capacity for Physical Activity, No More Limitations, Daily Tasks Are Less Strenuous, and Bodily Change is an Achievement; and 2. Physical Activity is More Rewarding, including the categories Increased Motivation and Initiative, Increased Social Participation, Better Wellbeing, and More Energy.

Conclusion: After MBS, patients describe they have gained a new life and freedom thanks to greater ease of participating in physical activities. Patients should be encouraged to continue increased physical activity during follow-up.

Aim: The aim of this study was to explore patients’ experiences of participation in a preoptimisation programme prior to ventral hernia repair, focusing on the programme’s feasibility and patient-perceived potential.

Introduction: Preoptimisation of modifiable risk factors has received growing attention, but little is known about ventral hernia patients’ perspectives on such programmes. Understanding patient motivation and perceived barriers is critical for designing effective interventions.

Method: Eight ventral hernia patients participated in a home-based preoptimisation programme lasting at least three weeks. Focus group interviews were conducted and analysed using reflexive thematic analysis.

Results: Participants generally perceived the preoptimisation programme positively. Clear and structured advice was valued, with participants appreciating straightforward instructions on physical activity and lifestyle change. Reported barriers included everyday life circumstances, orthopaedic comorbidities, and in some cases the hernia itself. Patients described perceived positive health effects, including improved fitness, weight loss, and better diabetes control. No adverse effects were raised during the interviews.

Conclusion: This is, to our knowledge, the first qualitative study of pre-optimisation programmes in ventral hernia surgery. As an exploratory, hypothesis-generating study, its findings are shaped by sample size and setting but provide novel insights that complement quantitative research by highlighting patient perspectives. Pre-optimisation programmes appear feasible and meaningful to ventral hernia patients, particularly when supported by clear guidance, structured follow-up, and surgeon involvement. The findings are discussed in the light of Self-Determination Theory, which emphasises internalisation of motivation through autonomy, competence, and relatedness.

Background/Aim: Deficient mismatch repair (dMMR) colorectal cancer (CRC) arises from either sporadic epigenetic changes or hereditary Lynch syndrome. This retrospective multicenter cohort study is the first to evaluate the differences in risk for dMMR non-colorectal malignancy between patients with sporadic CRC and those with Lynch syndrome-associated CRC.

Patients and Methods: A cohort of 1,753 patients treated between 1996 and 2019 in Sweden, Finland, and the Czech Republic was evaluated for MMR status by immunohistochemistry and classified as either proficient (pMMR) or dMMR. The last one underwent BRAF V600E and MLH1 methylation testing to classify sporadic versus Lynch-associated cases. Non-CRC malignancies occurring within ±20 years of CRC diagnosis were identified via national cancer registries and medical records. Incidence rate ratios (IRRs) were estimated using Poisson regression adjusted for age, sex, tumor site, and stage.

Results: Among 277 dMMR cases (186 sporadic, 91 Lynch), 101 patients (36%) developed at least one non-CRC malignancy. Sporadic dMMR was associated with significantly lower risk compared to Lynch-associated dMMR [multivariable IRR=0.82; 95% confidence interval (CI)=0.51-0.91; p=0.014]. The reduced risk was consistent for malignancies occurring both before (IRR=0.48; p=0.047) and after CRC diagnosis (IRR=0.37; p=0.026). Age was an independent predictor of risk.

Conclusion: Sporadic dMMR CRC confers a substantially lower risk of non-colorectal malignancy than Lynch syndrome-associated CRC. These findings underscore the importance of incorporating MMR etiology into personalized surveillance strategies.

Anal fistula is a complex and often prolonged condition that significantly impacts patients’ daily lives and psychological well-being. This qualitative study explored how individuals living with anal fistula experience stigma, disruption, and identity strain in everyday life. Fifteen participants undergoing active treatment were interviewed at two hospitals. Data was analyzed using qualitative content analysis. Findings show that living with anal fistula was marked by shame, uncertainty, and social withdrawal, often contributing to an altered or fractured sense of self. Participants navigated this experience through three identity-shaping mechanisms: Knowledge Uncertainty, Expectations and Experiences, and Quality-of-Life. These mechanisms influenced how participants made sense of their condition, coped with invisibility, and negotiated bodily control in the context of pain and stigma. While many struggled to maintain a coherent identity in the face of chronic symptoms, interactions with empathetic healthcare providers, particularly those offering consistent information and emotional support played a critical role in helping patients feel seen and supported. The study highlights the need for more holistic, person-centered approaches to care that address not only the physical but also the psychosocial dimensions of life with an anal fistula.

Background: Abdominal bulging affects up to one-fourth of patients after flank incision, with half experiencing impaired quality of life. Identifying patients at risk for morbid bulge could improve preventive and supportive care.

Purpose: To characterise muscular changes related to postoperative abdominal bulging and design a visual scoring system to grade bulge on postoperative CT scans

Material and Methods: Patients treated with open partial nephrectomy via a flank incision between 2005 and 2016 at the University Hospital of Ume & aring; were included. Pre- and postoperative CT scans of the first 50 consecutive patients were used to characterise imaging features of the postoperative abdominal wall. From these features, a four-tiered scoring system for abdominal bulge was designed. Two independent observers tested the system on CT scans from the 50 next patients. Inter-rater reliability was assessed using Fleiss' Kappa.

Results: Common features of abdominal bulging were extracted and a four-tier visual score ranging from normal abdominal wall to severe bulge was developed. Among the patients, similar to 70% had a normal abdominal wall, similar to 25% had bulge score 1, similar to 7% score 2, and similar to 1% score 3. Inter-rater agreement was 73.5%, with Fleiss' Kappa 0.44.

Conclusion: Features of bulge were reduced muscle thickness and ipsilateral gravitational slump affecting part or all of the lateral abdominal wall. The proposed scoring system demonstrated only moderate inter-rater reliability in this pilot setting. Further research on postoperative abdominal wall changes is needed before implementing imaging-based assessments in clinical care.