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  • 1.
    Dahlstrand, Ursula
    et al.
    Karolinska Institutet, Stockholm, Sweden; Enköping Hospital, Enköping, Sweden.
    Gustafsson, Pontus
    Karolinska Institutet, Stockholm, Sweden; Visby Hospital, Visby, Sweden.
    Näsvall, Pia
    Umeå universitet.
    Johansson, Jeaneth
    Luleå University of Technology, Luleå, Sweden; Halmstad University, Halmstad, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindforss, Ulrik
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Costs related to diverting ileostomy after rectal cancer surgery: a population-based healthcare cost analysis based on nationwide registers2023Ingår i: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 60, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P <.001 and in-patient care P =.031). Post-secondary education (P =.003) and younger age (P =.020) was associated with a higher cost for consumables while suffering a surgical complication was associated with increased cost for inpatient care (P <.001). Patients who had their stoma longer had lower monthly costs (consumables P <.001 and in-patient care P <.001). Female gender, longer duration of stoma, young age, and higher education are associated with higher costs for the care of a diverting stoma after rectal cancer surgery. This study does not allow for analyses of causality but the results together with deepened analyses of underlying reasons form a proper basis for decisions in health care planning and allocation of resources. These findings may have implications on the debate of equal care for all.

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  • 2.
    Gkekas, Ioannis
    et al.
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Palmgren, Jonathan
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Näsvall, Pia
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Dahlberg, Michael
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Intra-abdominal organ strangulation during intraoperative endoscopic retrograde cholangiopancreatography with rendezvous cannulation: case report2015Ingår i: Endoscopy, ISSN 0013-726X, E-ISSN 1438-8812, Vol. 47, s. E231-E231Artikel i tidskrift (Refereegranskat)
  • 3.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Parastomal hernia: investigation and treatment2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    Parastomal hernia is a common stoma complication causing the patient considerable inconvenience. The patient becomes aware of a bulge around the stoma, but a bulge is not always a parastomal hernia and diagnostics must be performed to enable differential treatment. It is difficult to distinguish between a bulge and a hernia. Results based on clinical examination and computerised tomography (CT) in the supine position, have not been convincing. Three-dimensional intrastomal ultrasonography (3D US) is a novel technique shown to be promising in the assessment of stoma complaints. Two studies were performed to determine inter- and intra-observer reliability as well as the validity of 3D US as an alternative to CT when assessing stoma complaints.

    There are numerous options for the treatment of parastomal hernia, but none has been shown superior. In the recent decades the use of mesh in the repair of incisional and inguinal hernia has become routine. New materials must be evaluated as there are potential morbidity and even mortality risks with mesh repair. As recurrence of a parastomal hernia is an even greater challenge, the method of choice should have a low risk for recurrence. A prospective multicenter study was performed to evaluate safety and recurrence rate when using Parastomal Hernia Patch BARDTM (PHP), a mesh specially designed for parastomal hernia repair.

    A stoma has a profound impact on the patient´s daily life, both physical and psychological. A parastomal hernia with its associated risk for leakage and incarceration worsens the situation. Patient driven assessment of healthcare outcome is important if we are to improve medical care. A quality of life (QoL) survey was performed to assess the impact of parastomal bulging and hernia on the patient´s daily life.

    Methods

    Forty patients were investigated and the 3D US images were twice evaluated by two or three physicians to assess inter- and intra-observer reliability. Totally 20 patients with stoma complaints requiring surgery were examined with CT and 3D US prior to surgery. The findings were compared with the intraoperative findings – regarded as the true outcome.

    Fifty patients with parastomal hernia requiring surgery were enrolled from three hospitals. Patients were followed up one month and one year after repair using PHP.

    Patients still alive in 2008 who had been operated between1996 and 2004 for rectal cancer in Uppsala/Örebro-, Stockholm/Gotland-, and Northern Regions (986 patients) and registered in the Swedish Rectal Cancer Registry (SRCR) were invited to fill in four QoL questionnaires.

    Results

    Inter-observer agreement using 3D US reached 80% for the last 10 patients examined, with a kappa value of 0.70. Intra-observer agreement for two examiners was 80% and 95%. The learning curve levelled out at 30 patients. Both CT and 3D US showed high sensitivity and specificity when compared with intraoperative findings.

    After surgery for parastomal hernia with a PHP, the complication rate at one month was 30% and recurrence rate at one year was 22%. Twelve patients were reoperated within one year.

    In the QoL study, 31.5% of the patients with a stoma reported a bulging or a hernia. 11.7% had been operated for parastomal hernia. A hernia or a bulge gave rise to significantly more pain and impaired stoma function. Overall QoL was inferior in patients with a permanent stoma compared to a group without a stoma.

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  • 4.
    Näsvall, Pia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital/Umeå University, 97180 Luleå, Sweden.
    Dahlstrand, Ursula
    Löwenmark, Thyra
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Quality of life in patients with a permanent stoma after rectal cancer surgery2017Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 1, s. 55-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

    METHODS: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

    RESULTS: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

    CONCLUSION: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

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  • 5.
    Näsvall, Pia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Dahlstrand, Ursula
    Löwenmark, Thyra
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Quality of life with permanent stoma after rectal cancer surgeryManuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Näsvall, Pia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Parastomal hernia repair with intraperitoneal mesh2017Ingår i: Surgery Research and Practice, ISSN 2356-7759, Vol. 2017, s. 51+4artikel-id 8597463Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.

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  • 7.
    Näsvall, Pia
    et al.
    Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Reply to 'Preventing parastomal herniation in 2014 and beyond'2014Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 16, nr 10, s. 831-832Artikel i tidskrift (Refereegranskat)
  • 8.
    Näsvall, Pia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital/Umeå University, 97180, Luleå, Sweden .
    Wikner, F
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A comparison between intrastomal 3D ultrasonography, CT scanning and findings at surgery in patients with stomal complaints2014Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 29, nr 10, s. 1263-1266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Since there are no reliable investigative tools for imaging parastomal hernia, new techniques are needed. The aim of this study was to assess the validity of intrastomal three-dimensional ultrasonography (3D) as an alternative to CT scanning for the assessment of stomal complaints.

    METHOD: Twenty patients with stomal complaints, indicating surgery, were examined preoperatively with a CT scan in the supine position and 3D intrastomal ultrasonography in the supine and erect positions. Comparison with findings at surgery, considered to be the true state, was made.

    RESULTS: Both imaging methods, 3D ultrasonography and CT scanning, showed high sensitivity (ultrasound 15/18, CT scan 15/18) and specificity (ultrasound 2/2, CT scan 1/2) when judged by a dedicated radiologist. Corresponding values for interpretation of CT scans in routine clinical practice was for sensitivity 17/18 and for specificity 1/2.

    CONCLUSION: 3D ultrasonography has a high validity and is a promising alternative to CT scanning in the supine position to distinguish a bulge from a parastomal hernia.

  • 9.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Division of Surgery, Sunderby Hospital, Luleå, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Johansson, Jeaneth
    Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Impact of parastomal hernia on colostomy costs at 1 year: secondary analysis of a randomized clinical trial (STOMAMESH)2024Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 113, nr 1, s. 33-39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care. The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH.

    Methods: Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery.

    Results: Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH.

    Conclusions: PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.

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  • 10.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Johansson, Jeaneth
    Luleå University of Technology, Department of Administration and Industrial Engineering, Luleå, Sweden; Halmstad University, The School of Business, Innovation and Sustainability, Halmstad, Sweden.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Spinord, Linda
    Luleå University of Technology, Department of Health, Education and Technology, Luleå, Sweden.
    Battle of the Bulge: a qualitative analysis of living with a parastomal herniaManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Parastomal hernia (PSH) is a common complication of a colostomy. Approximately one third of patients have a PSH 3 to 5 years after surgery. There is much qualitative research into living with a stoma, less so when it comes to living with a PSH.

    Method: A qualitative study using semi-structured interviews. The participants were participants in a large randomised trial studying the effects of a prophylactic mesh when creating a colostomy. All participants were survivors of rectal cancer. Inductive content analysis was used for data processing. 17 heterogeneous informants (age, gender, geographical location) were interviewed based on a saturated selection.

    Results: A major theme was identified in the interviews; “patients coping with parastomal hernia.” In line with this we identified four core coping strategies; meaningfulness; knowledge-based coping; social-based coping; and problem-based coping. For each category further subcategories were identified. We found that a deep sense of gratitude, for survival rectal cancer impacted the informant’s perception on their general wellbeing. Furthermore, we found the paramount importance of stoma nurses, or similar health care workers, enabling the patient to overcome different problems with a PSH.

    Discussion: There is a need to better understand the patient’s perception of living with PSH and how to cope with this. The purpose is to ease the transition into living with a stoma, and perhaps a PSH. The coping strategies identified in this report may be incorporated into teaching and information material and also be used by nurses and doctors meeting patients.

  • 11.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden; Department of Surgery, Sunderby sjukhus, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Dahlberg, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden .
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden .
    Parastomal hernia repair; seldom performed and seldom reported: Results from a nationwide survey2020Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 109, nr 2, s. 96-101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence.

    METHODS: A broad search of the Swedish National Patient Register 1998-2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed.

    RESULTS: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant.

    CONCLUSION: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.

  • 12.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Response to: "Follow-up of the STOMAMESH Cohort"2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. e31-e31Artikel i tidskrift (Refereegranskat)
  • 13.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive"2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. E30-E30Artikel i tidskrift (Refereegranskat)
  • 14.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 3, s. 427-431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

    Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

    Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

    Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

    Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

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  • 15.
    Renman, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Edin-Liljegren, Anette
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Attitudes to and Experiences of Physical Activity After Colon Cancer Diagnosis Amongst Physically Active Individuals: A Qualitative Study2022Ingår i: Cancer Control: Journal of the Moffitt Cancer Cente, ISSN 1073-2748, E-ISSN 1526-2359, Vol. 29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Physical activity improves survival, reduces postoperative complications, and reduces the risk of developing colon cancer. It is important to maintain physical activity after receiving a diagnosis of colon cancer to improve postoperative recovery. Individuals who are physically active and diagnosed with colon cancer presumably have different motivations to maintain physical activity compared to their sedentary counterparts.

    OBJECTIVE: Enlighten how the diagnosis of colon cancer might affect physically active individuals in their attitude and experiences towards physical activity.

    METHODS: A qualitative study using content analysis was conducted in northern Sweden based on semi-structured telephone interviews of twenty patients diagnosed with colon cancer. All participants met the recommendations for physical activity issued by the World Health Organization.

    RESULTS: Participants were between 50 and 88 years and 50% were male. Three main categories were identified: I'll fight the cancer and come out stronger; The diagnosis makes no difference; and The diagnosis is an obstacle for physical activity. These main categories represent the ways the individuals reacted to the diagnosis of colon cancer regarding their physical activity.

    CONCLUSION: Attitudes to and experience of physical activity after colon cancer diagnosis varied from a will to increase physical activity and fight the cancer, to the diagnosis putting a stop to physical activity. It is important that healthcare professionals recommend physical activity even in already physically active individuals, to encourage continued physical activity after diagnosis of colon cancer.

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  • 16.
    Ringblom, Christian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from stomamesh-a multicenter double-blind randomized controlled trial2023Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, nr 1, s. 38-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The primary objective was to compare rates of parastomal hernia (PSH) 3 years after stoma construction with prophylactic mesh or no mesh. A secondary objective was to compare complications requiring reintervention within 3 years.

    BACKGROUND: Recent studies have shown that a prophylactic mesh does not reduce the rate of PSH contrary to older studies. Long-term data on efficacy and safety is however scarce.

    METHODS: A randomized controlled double-blind multicenter trial. Patients planned for permanent end colostomy were randomized to either prophylactic mesh in the retromuscular position around the stoma site or no mesh. They were evaluated for PSH clinically and with computed tomography (CT) 3 years after stoma construction. Medical records of all patients included were also reviewed at 3 years to detect any abdominal or abdominal wall surgery during that period.

    RESULTS: A total of 232 patients were randomized. At 3 years, 154 patients were available for clinical evaluation and 137 underwent a CT scan. No significant difference in PSH rates was seen between the treatment allocation arms (clinical: P=0.829 and CT: P=0.761, respectively), nor was there a significant difference in the number of reinterventions, but 2 patients had their mesh removed at emergency surgery.

    CONCLUSIONS: Prophylactic mesh does not reduce the rate of PSH and cannot be recommended for routine use.

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  • 17.
    Strigård, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gurmu, A.
    Department of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital/Umeå University, Luleå, Sweden.
    Pahlman, P.
    Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Intrastomal 3D ultrasound: an inter- and intra-observer evaluation2013Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 28, nr 1, s. 43-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to determine intra- and interobserver reliability in 3D intrastomal ultrasound imaging of parastomal hernia and protrusion. A total of 40 patients were investigated. Two or three physicians evaluated the images twice, 1 month apart. Inter-observer agreement was 72 % with a kappa value 0.59. For the last 10 patients there was an agreement of 80 % with a kappa value of 0.70. Intraobserver agreement was 80 % for one observer and 95 % for the other. The learning curve levelled out at around 30 patients. Considering the learning curve of 30 patients, 3D intrastomal ultrasound is a reliable investigation method. 3D intrastomal ultrasonography has the potential to be the investigation of choice to differentiate between a bulge, a hernia, or a protrusion.

  • 18. Tivenius, Mathilda
    et al.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Reasearch Unit, Umeå University, Luleå, Sweden.
    Sandblom, Gabriel
    Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery - a national population-based cohort study2019Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, nr 7, s. 1267-1272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeParastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period.MethodsThe Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group.ResultsA total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI30 (HR 1.49; 95% CI 1.02-2.17; p<0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p<0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5years was 7.7% (95% CI 6.1-9.2%).ConclusionsThe cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.

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