Umeå University's logo

umu.sePublications
Change search
Refine search result
12 1 - 50 of 56
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Ahlqvist, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Anesthesia and Intensive Care, Region Västernorrland, Härnösand, Sweden.
    Edling, Axel
    Granlo Health Center, Sundsvall, Sweden.
    Alm, Magnus
    Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden.
    Dackhammar, Johan Blixt
    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.
    Cengiz, Yucel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Trocar site hernia after gastric sleeve2022In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 36, no 6, p. 4386-4391Article in journal (Refereed)
    Abstract [en]

    Background: Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.

    Methods: Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011–2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.

    Results: The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.

    Conclusions: The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

    Download full text (pdf)
    fulltext
  • 2.
    Ajiko, Mary Margaret
    et al.
    Surgery, Soroti Regional Referral Hospital, Kampala, Uganda; Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Kressner, Julia
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Matovu, Alphonsus
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Surgery, Mubende Regional Referral Hospital, Kampala, Uganda.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Östersunds Sjukhus, Östersund, Sweden.
    Wladis, Andreas
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Löfgren, Jenny
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Surgical procedures for children in the public healthcare sector: A nationwide, facility-based study in Uganda2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e048540Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.

    Design: The study was a facility-based, record review.

    Setting: The study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector.

    Participants: The subjects were children <18 years who underwent major surgery in the study hospitals during 2013 and 2014.

    Results: The study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases.

    Conclusions: A variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.

    Download full text (pdf)
    fulltext
  • 3.
    Ajiko, Mary Margaret
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden; Soroti Regional Referral Hospital, Box 289, Soroti, Uganda.
    Weidman, Viking
    Uppsala University, Uppsala, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Wladis, Andreas
    Löfgren, Jenny
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden.
    Prevalence of Paediatric Surgical Conditions in Eastern Uganda: A Cross-Sectional Study2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, p. 701-708Article in journal (Refereed)
    Abstract [en]

    Background: The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda.

    Method: A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The children’s caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions.

    Results: The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions.

    Conclusion: Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.

    Download full text (pdf)
    fulltext
  • 4.
    Andresen, Kristoffer
    et al.
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Kroon, Lovisa
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Öberg, Stina
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Rosenberg, Jacob
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    de la Croix, Hanna
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Sweden.
    Collaboration between the Danish and Swedish hernia registers – a study protocol2022In: Danish Medical Journal, E-ISSN 2245-1919, Vol. 69, no 12, article id A06220408Article in journal (Refereed)
    Abstract [en]

    NTRODUCTION: The most common laparo-endoscopic groin hernia repair techniques are TEP (total extraperitoneal) and TAPP (transabdominal preperitoneal) repair. Despite geographic proximity, Swedish surgeons distinctively favour TEP, whereas Danish surgeons prefer TAPP. The aim of this study is to analyse the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair using data from two nationwide registers. We also aim to discuss advantages of international collaboration between nationwide registers.

    METHODS: All groin hernia operations registered as TEP, TAPP or Lichtenstein repair in the Swedish Hernia Register and the Danish Hernia Database between January 2004 and December 2020 will be included. Cumulative hazard rate of reoperation for recurrence will be estimated using Cox-regression analyses adjusted for age and anatomy.

    CONCLUSION: Approximately 400,000 operations are estimated to have been registered prospectively in the inclusion period in the registers. The merging of two nationwide registers was made possible owing to close cooperation between the register steering committees and by obtaining the necessary approvals. This unique collaboration between nationwide registers will make it possible to compare the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair on an international level. In future, similar collaboration may be established to explore other outcomes such as complication rates and chronic pain.

  • 5.
    Ashley, Thomas
    et al.
    Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
    Ashley, Hannah F.
    Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; Upper Eden Medical Practice, Cumbria, United Kingdom.
    Wladis, Andreas
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Ohene-Yeboah, Michael
    Department of Surgery, University of Ghana Medical School, Korle Bu, Accra, Ghana.
    Rukas, Rimantas
    Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Orkdal, Norway.
    Lipnickas, Vytautas
    Department of Abdominal and Oncological Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
    Smalle, Isaac O.
    Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
    Holm, Kristina
    Department of Anaesthesia and Intensive Care, Mälarsjukhuset, Eskilstuna, Sweden.
    Kalsi, Herta
    Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden.
    Palmu, Juuli
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Sahr, Foday
    College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone; Joint Medical Unit (JMU), Republic of Sierra Leone Armed Forces (RSLAF), Freetown, Sierra Leone.
    Beard, Jessica H.
    Department of Surgery, Lewis Katz School of Medicine at Temple University, PA, Philadelphia, United States.
    Löfgren, Jenny
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.
    Bolkan, Håkon A.
    Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Orkdal, Norway; Institute of Nursing and Public Health, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, Norway.
    van Duinen, Alex J.
    Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Orkdal, Norway; Institute of Nursing and Public Health, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, Norway.
    Standardised competency-based training of medical doctors and associate clinicians in inguinal repair with mesh in Sierra Leone2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 10, p. 2330-2337Article in journal (Refereed)
    Abstract [en]

    Introduction: In low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.

    Methods: All trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.

    Results: During three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.

    Discussion and conclusion: Mesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.

    Trial Registration: International Clinical Trial Registry ISRCTN63478884.

    Download full text (pdf)
    fulltext
  • 6. Ashley, Thomas
    et al.
    Ashley, Hannah
    Wladis, Andreas
    Bolkan, Hakon A.
    van Duinen, Alex J.
    Beard, Jessica H.
    Kalsi, Hertta
    Palmu, Juuli
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holm, Kristina
    Ohene-Yeboah, Michael
    Lofgren, Jenny
    Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone: A Randomized Clinical Trial2021In: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, no 1, article id e2032681Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Task sharing of surgical duties with medical doctors (MDs) without formal surgical training and associate clinicians (ACs; health care workers corresponding to an educational level between that of a nurse and an MD) is practiced to provide surgical services to people in low-resource settings. The safety and effectiveness of this has not been fully evaluated through a randomized clinical trial.

    OBJECTIVE: To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone.

    DESIGN, SETTING, AND PARTICIPANTS: This single-blind, noninferiority randomized clinical trial included adult, healthy men with primary inguinal hernia randomized to receiving surgical treatment from an MD or an AC. In Sierra Leone, ACs practicing surgery have received 2 years of surgical training and completed a 1-year internship. The study was conducted between October 2017 and February 2019. Patients were followed up at 2 weeks and 1 year after operations. Observers were blinded to the study arm of the patients. The study was carried out in a first-level hospital in rural Sierra Leone. Data were analyzed from March to June 2019.

    INTERVENTIONS: All patients received an open mesh inguinal hernia repair under local anesthesia. The control group underwent operations performed by MDs, and the intervention group underwent operations performed by ACs.

    MAIN OUTCOMES AND MEASURES: The primary end point was hernia recurrence at 1 year. Outcomes were assessed by blinded observers at 2 weeks and 1 year after operations.

    RESULTS: A total of 230 patients were recruited (mean [SD] age, 43.0 [13.5] years), and all but 1 patient underwent inguinal hernia repair between October 23, 2017, and February 2, 2018, performed by 5 MDs and 6 ACs. A total of 114 patients were operated on by MDs, and 115 patients were operated on by ACs. There were no crossovers between the study arms. The follow-up rate was 100% at 2 weeks and 94.1% at 1 year. At 1 year, hernia recurrence occurred in 7 patients (6.9%) operated on by MDs and 1 patient (0.9%) operated on by ACs (absolute difference, -6.0 [95% CI, -11.2 to 0.7] percentage points; P < .001).

    CONCLUSIONS AND RELEVANCE: These findings demonstrate that task sharing of elective mesh inguinal hernia repair with ACs was safe and effective. The task sharing debate should progress to focus on optimizing surgical training programs for nonsurgeons and building capacity for elective surgical care in low- and middle-income countries.

    Download full text (pdf)
    fulltext
  • 7. Axman, Erik
    et al.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nilsson, Hanna
    Chronic pain and risk for reoperation for recurrence after inguinal hernia repair using self-gripping mesh2020In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 167, no 3, p. 609-613Article in journal (Refereed)
    Abstract [en]

    Background: Improved recurrence rates after groin hernia surgery have led to chronic pain becoming the most troublesome postoperative complication. Self-gripping mesh was developed to decrease the risk for development of chronic pain. The aim of this nationwide cohort study was to compare recurrence rate and chronic pain 1 year after an open, anterior mesh repair of inguinal hernias with either a self-gripping mesh or other lightweight mesh.

    Method: All operations registered as open anterior mesh repair (Lichtenstein) in the Swedish Hernia Registry between September 2012 and October 2016 were selected. At 1 year after repair, patients were sent a pain questionnaire assessing chronic pain. We compared the prevalence of chronic pain and reoperation for recurrence using lightweight, sutured mesh or self-gripping mesh.

    Results: We analyzed the 1,803 repairs using self-gripping mesh and 16,567 repairs using lightweight mesh. We found no difference in the prevalence of chronic pain 1 year after the hernia repair between self-gripping mesh and sutured lightweight mesh (OR 0.92, CI 95% 0.80–1.06, P = .257). There was no increase in reoperation for recurrence when using self-gripping mesh (HR 0.71, CI 95% 0.45–1.14, P = .156). Mean operation time was considerably less when using self-gripping mesh (43 vs 70 minutes; P > .001).

    Conclusion: The use of self-gripping mesh does not decrease the incidence of chronic pain and reoperation for recurrence compared with lightweight, sutured mesh for open anterior mesh repair of inguinal hernias. Furthermore, the use of self-gripping mesh is associated with a clinically important, lesser operation time.

  • 8.
    Axman, Erik
    et al.
    Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Modin, Marina
    Department of Research, Development, Education and Innovation, Skaraborg Hospital, Skövde, Sweden.
    de la Croix, Hanna
    Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Assessing the Validity and Cover Rate of the National Swedish Hernia Register2021In: Clinical Epidemiology, E-ISSN 1179-1349, Vol. 13, p. 1129-1134Article in journal (Refereed)
    Abstract [en]

    Aim: To assess the validity and cover rate of the Swedish hernia register.

    Material and Methods: Since the start of the Swedish Hernia register an annual review of randomly selected hospitals has been carried out, and since 2013 in a more standardized form to allow a systematic data collection and evaluation. 10% of all clinics were randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from north to south. Data from 2013 to 2018 were analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics were compared with the Swedish Hernia Register to assess cover rate. Fifty operations were randomly selected at each clinic and data in the Swedish Hernia register were compared with the medical records to evaluate data quality.

    Results: Fifty-five clinics was evaluated and a total of 73,764 variables were compared with the medical records. Cover rate between 2014 and 2018 was 97%. The proportion of correct variables was 98% between 2013 and 2018. Most frequent errors were ASA score, date at which the patient was put on the waiting list and postoperative complications.

    Conclusion: This unique validation of a national hernia register shows a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.

    Download full text (pdf)
    fulltext
  • 9.
    Bayadsi, Haytham
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Brink, Paul Van Den
    Department of Natural Sciences, Design and Sustainable Development, Mid-Sweden University, Östersund Campus, Sweden.
    Erlandsson, Mårten
    Department of Aquatic Resources, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden.
    Gudbjornsdottir, Soffia
    Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sebraoui, Samy
    Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Koorem, Sofi
    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.
    Hennings, Joakim
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Englund, Oskar
    Department of Natural Sciences, Design and Sustainable Development, Mid-Sweden University, ¨Östersund Campus, Sweden.
    The correlation between small papillary thyroid cancers and gamma radionuclides Cs-137, Th-232, U-238 and K-40 using spatially-explicit, register-based methods2023In: Spatial and Spatio-temporal Epidemiology, ISSN 1877-5845, E-ISSN 1877-5853, Vol. 47, article id 100618Article in journal (Refereed)
    Abstract [en]

    A steep increase of small papillary thyroid cancers (sPTCs) has been observed globally. A major risk factor for developing PTC is ionizing radiation. The aim of this study is to investigate the spatial distribution of sPTC in Sweden and the extent to which prevalence is correlated to gamma radiation levels (Caesium-137 (Cs-137), Thorium-232 (Th-232), Uranium-238 (U-238) and Potassium-40 (K-40)) using multiple geospatial and geostatistical methods. The prevalence of metastatic sPTC was associated with significantly higher levels of Gamma radiation from Th-232, U-238 and K-40. The association is, however, inconsistent and the prevalence is higher in densely populated areas. The results clearly indicate that sPTC has causative factors that are neither evenly distributed among the population, nor geographically, calling for further studies with bigger cohorts. Environmental factors are believed to play a major role in the pathogenesis of the disease.

    Download full text (pdf)
    fulltext
  • 10. Beard, Jessica H.
    et al.
    Ohene-Yeboah, Michael
    Tabiri, Stephen
    Amoako, Joachim K. A.
    Abantanga, Francis A.
    Sims, Carrie A.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Harris, Hobart W.
    Löfgren, Jenny
    Outcomes After Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana2019In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 154, no 9, p. 853-859Article in journal (Refereed)
    Abstract [en]

    Question What are the outcomes after mesh inguinal hernia repair performed by medical doctors compared with surgeons in Ghana?

    Findings In this cohort study of 242 men with primary reducible inguinal hernia, there was no significant difference in hernia recurrence at 1 year after inguinal hernia repair with mesh performed by medical doctors compared with surgeons (0.9% vs 2.8%).

    Meaning This study shows that medical doctors can be trained to perform inguinal hernia repair with mesh in men with good results in a low-resource setting and appears to support surgical task sharing to combat the global burden of hernia disease.

    Importance Inguinal hernia is the most common general surgical condition in the world. Although task sharing of surgical care with nonsurgeons represents one method to increase access to essential surgery, the safety and outcomes of this strategy are not well described for hernia repair.

    Objective To compare outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana.

    Design, Setting, and Participants This prospective cohort study was conducted from February 15, 2017, to September 17, 2018, at the Volta Regional Hospital in Ho, Ghana. Following successful completion of a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repair with mesh according to the Lichtenstein technique on 242 men with primary, reducible inguinal hernia.

    Main Outcomes and Measures The primary end point was hernia recurrence at 1 year. The noninferiority limit was set at 5 percentage points. Secondary end points included postoperative complications at 2 weeks and patient satisfaction, pain, and self-assessed health status at 1 year.

    Results Two-hundred forty-two patients were included; 119 men underwent operations performed by medical doctors and 123 men underwent operations performed by surgeons. Preoperative patient characteristics were similar in both groups. Two-hundred thirty-seven patients (97.9%) were seen at follow-up at 2 weeks, and 223 patients (92.1%) were seen at follow-up at 1 year. The absolute difference in recurrence rate between the medical doctor group (1 [0.9%]) and the surgeon group (3 [2.8%]) was -1.9 (1-tailed 95% CI, -4.8; P<.001), demonstrating noninferiority of the medical doctors. There were no statistically significant differences in postoperative complications (34 [29.1%] vs 29 [24.2%]), patient satisfaction (112 [98.2%] vs 108 [99.1%]), severe chronic pain (1 [0.9%] vs 4 [3.7%]), or self-assessed health (85.9 vs 83.7 of 100) for medical doctors and surgeons.

    Conclusions and Relevance This study shows that medical doctors can be trained to perform elective inguinal hernia repair with mesh in men with good results and high patient satisfaction in a low-resource setting. This finding supports surgical task sharing to combat the global burden of hernia disease. This cohort study compares the outcomes associated with inguinal hernia repair performed by medical doctors vs surgeons in Ghana.

  • 11. Berghog, J
    et al.
    Nillson, H
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmberg, H
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Women and groin hernia repair2015In: 1ST World Conference on Abdominal Wall Hernia Surgery, Milan, April, 2015, 2015, Vol. 19, p. S285-S285Conference paper (Refereed)
    Abstract [en]

    The lifetime risk of having a groin hernia repair is estimated to be 27% for men and 3% for women. Recently published register data showing an increased recurrence rate in women compared to men raises questions concerning method of choice for female groin hernia.

  • 12. Dahlstrand, Ursula
    et al.
    Sandblom, Gabriel
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wollert, Staffan
    Gunnarsson, Ulf
    CLINTEC, Karolinska Institute, Stockholm, Sweden and Gastro Center Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Chronic pain after femoral hernia repair: a cross-sectional study2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 254, no 6, p. 1017-1021Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia.

    Background: Chronic pain has become a very important outcome in quality assessment of inguinal hernia surgery. There are no studies on the risk for chronic pain after femoral hernia surgery. Methods: The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen. Answers from 1461 patients were matched with data recorded in the Swedish Hernia Register and analyzed.

    Results: Some degree of pain during the previous week was reported by 24.2% (354) of patients. Pain interfered with daily activities in 5.5% (81) of patients. Emergency surgery (OR = 0.54; 95% CI = 0.40-0.74) and longer time since surgery (OR = 0.93; 95% CI = 0.89-0.98 for each year added) were associated with lower risk for chronic postoperative pain, whereas a high level of preoperative pain was associated with a higher risk for chronic pain (OR = 1.17; 95% CI = 1.10-1.25). Surgical technique was not found to influence the risk for chronic pain in multivariate logistic regression analysis.

    Conclusions: Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.

  • 13.
    Dahlstrand, Ursula
    et al.
    Department of Surgery, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden.
    Wollert, Staffan
    Department of Surgery, Uppsala University, Uppsala, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, Gabriel
    Division of Surgery, CLINTEC, Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden.
    Gunnarsson, Ulf
    Division of Surgery, CLINTEC, Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden.
    Emergency femoral hernia repair: a study based on a national register.2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 4, p. 672-676Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. BACKGROUND: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. METHODS: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. RESULTS: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. CONCLUSIONS: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

  • 14.
    Ekdahl, Tove
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Löfgren, Jenny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Myggnät vid ljumskbråckskirurgi ett alternativ i låginkomstländer: interimsanalys av kontrollerad randomiserad studie visar goda resultat2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 34-35, p. 1358-1361Article in journal (Refereed)
    Abstract [sv]

    Behovet av förbättrade kirurgiska insatser i låginkomstländer är stort. 

    Ljumskbråck är en vanlig kirurgisk åkomma och opereras i höginkomstländer nästan uteslutande med nätteknik. I låginkomstmiljöer är kommersiella nät för dyra. 

    En randomiserad studie i Uganda undersöker om myggnät med liknande material som de kommersiella näten är jämförbara med kommersiella nät vid ljumskbråckskirurgi. 

    En interimsstudie har utförts för att tidigt påvisa om det föreligger allvarliga komplikationer i någon av behandlingsarmarna. Patienterna följdes upp 14 dagar och 1 år postoperativt.

    Interimsanalysen påvisade inga skillnader mellan behandlingsarmarna eller allvarliga komplikationer som skulle föranleda avbrott av studien.

  • 15. Gutlic, Nihad
    et al.
    Rogmark, Peder
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Petersson, Ulf
    Montgomery, Agneta
    Impact of mesh fixation on chronic pain in total extraperitoneal inguinal hernia repair (TEP): a nationwide register-based study2016In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, no 6, p. 1199-1206Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mesh fixation is used to prevent recurrence at the potential risk for chronic pain in TEP. The aim was to compare the impact of permanent fixation (PF) with no fixation (NF)/nonpermanent fixation (NPF) of mesh on chronic pain after TEP repair for primary inguinal hernia.

    METHODS: Men, 30 to 75 years old, consecutively registered in the Swedish Hernia Register for a TEP primary repair in 2005 to 2009, were included in a mail survey using SF-36 and the Inguinal Pain Questionnaire (IPQ). Primary endpoint was IPQ question "Did you have pain during past week that could not be ignored." Risk factors for chronic pain and recurrent operations were analyzed.

    RESULTS: A total of 1110 patients were included (325 PF, 785 NF/NPF) with 7.7% reporting pain at median 33 months follow-up. No difference regarding primary endpoint pain (P < 0.462), IPQ and SF-36 subscales were seen. Recurrent operation was carried out in 1.4% during 7.5 years follow-up with no difference between PF- and NF-groups including subgroups of medial hernias. All SF-36 subscale-scores were equal to or better than the Swedish norm. A postoperative complication was a risk factor for chronic pain (OR 2.44, 95% CI 1.23-5.25, P < 0.023).

    CONCLUSIONS: The TEP procedure for primary inguinal hernia repair in men is associated with a low frequency of chronic pain and recurrent operations, with no difference between permanent fixation and no/nonpermanent fixation of mesh in a nationwide population-based study. TEP without fixation reduces costs and is safe for all patients.

  • 16. Hemberg, A.
    et al.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmberg, H.
    Tobacco use as a risk factor for groin hernia repair2015In: lSI World Conference on Abdominal Wall Hernia Surgery, april 25, 2015., 2015, Vol. 19, p. S278-S278Conference paper (Refereed)
    Abstract [en]

    The pathogenesis and etiology of groin hernias are not fully understood. Some risk factors are unknown and some are debated. Tobacco has been speculated as a possible risk factor for groin hernias. Some studies have not showed any connection, whereas other has showed that smokers have primary hernias at a younger age and that recurrences of hernias are more common among smokers. There have also been several studies showing a connection between smoking and changes in collagen metabolism. Present study evaluates the connection between groin hernia repair and tobacco use.

  • 17.
    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.

    Download full text (pdf)
    fulltext
  • 18.
    Hemberg, Anders
    et al.
    Charlotte, Helsingborg, Sweden.
    Landén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Montgomery, Agneta
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Management of groin hernia repair in Sweden: a register-based comparative analysis of public and private healthcare providers2024In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267Article in journal (Refereed)
    Abstract [en]

    Background: Swedish healthcare is in a period of transition with an expanding private sector. This study compares quality of outcome after groin hernia repair performed in a public or private healthcare setting.

    Methods: A cohort study based on data from the Swedish National Hernia Register combined with Patient-Reported Outcome Measures (PROMs) 1 year after groin hernia repair. Between September 2012 and December 2018, a questionnaire was sent to all patients registered in the hernia register 1 year after surgery. Endpoints were reoperation for recurrence, chronic pain, and patient satisfaction.

    Results: From a total of 87,650 patients with unilateral groin hernia repair, 61,337 PROM answers (70%) were received from 71 public and 28 private healthcare providers. More females, acute and recurrent cases, and patients with high American Society of Anesthesiology (ASA) scores were operated under the national healthcare system. The private sector had more experience surgeons with higher annual volume per surgeon, shorter time on waiting lists, and shorter operation times. No difference was seen in patient satisfaction. Groin hernia repair performed in a private clinic was associated with less postoperative chronic pain (OR 0.85, 95% CI 0.8–0.91) but a higher recurrence rate (HR 1.41; 95% CI 1.26–1.59) in a multivariable logistic regression analysis.

    Conclusion: Despite private clinics having a higher proportion of experienced surgeons and fewer complex cases, the recurrence rate was higher, whereas the risk for chronic postoperative pain was higher among patients treated in the public sector.

    Download full text (pdf)
    fulltext
  • 19.
    Hemberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Helsingborgs Lasarett, KirurgenHelsingborg, Sweden.
    Montgomery, A.
    Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Waist Circumference is not Superior to Body Mass Index in Predicting Groin Hernia Repair in Either Men or Women2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, p. 401-408Article in journal (Refereed)
    Abstract [en]

    Background and aims: A high body mass index (BMI) is considered a risk factor for ventral abdominal wall hernias but protective for the development of groin hernias. The reason for this is unclear. The surrounding abdominal fat in obesity might “protect” and limit the passage through the inguinal canal. The aim was to compare two different methods used for obesity registration in groin hernia patients and to investigate the hypothesis of high BMI/low groin hernia risk phenomenon.

    Methods: This was a population-based observational study comparing BMI to waist circumference (WC) as well as their correlations to the quantity of groin hernia repair performed in either sex. Two national registers were crosslinked to a large regional register including information on WC.

    Results: A larger WC and a higher BMI were associated with a lower risk of having groin hernia repair in both sexes. There was no difference using either WC or BMI as a risk factor for groin hernia repair in either sex. There was no advantage to using body composition based on WC rather than BMI for surgery indication.

    Conclusions: Overweight patients, both men and women, have a lower risk of undergoing groin hernia repair regardless of fat distribution. BMI is a well-established method for obesity registration and is recommended in the evaluation of hernia patients.

    Download full text (pdf)
    fulltext
  • 20.
    Huber, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Larsson, Charlotta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Harrysson, Mathilda
    Department of Obstetrics and Gynecology, Östersund Hospital, Östersund, Sweden.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Lehmann, Jan-P.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Tunón, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth2023In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, no 3, p. 389-395Article in journal (Refereed)
    Abstract [en]

    Introduction: Obstetric anal sphincter injury (OASI) complicates around 5% of deliveries in primiparas. The study objective was to assess the utility of three-dimensional endoanal ultrasonography (3D-EAUS) in the diagnosis of OASI.

    Material and methods: The present study was designed to mirror screening settings with an unselected cohort of nulliparous women. All enrolled patients underwent clinical examination of the perineum by the caregiver, and 3D-EAUS was conducted. Post-processing of ultrasonography volume data was performed by an experienced colorectal surgeon who was blinded to all other data. The sensitivity, specificity, negative predictive value, and positive predictive value of 3D-EAUS in the diagnosis of OASI was evaluated. The trial is registered at ISCRTN: 18006769.

    Results: A total of 680 scans were performed, of which 18.5% were judged as “non-assessable”, resulting in 554 assessable recordings. Sphincter defects were observed in 12.8% of all assessable recordings on 3D-EAUS (n = 71). With clinical examination set as the reference standard, ultrasound sensitivity in the diagnosis of OASI was 30.4%, whereas its specificity was 87.9%. The negative predictive value was 96.7% and the positive predictive value was only 9.9%. Comments were left on 175 examinations, of which 74% referred to the management of the examination.

    Conclusions: Using 3D-EAUS in a maternity ward is demanding because staff generally have little experience in endoanal ultrasound, which contributes to difficulties in obtaining good image quality. When 3D-EAUS is performed to mirror screening settings, it adds no convincing diagnostic power to clinical examination in the diagnosis of OASI.

    Download full text (pdf)
    fulltext
  • 21.
    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.

  • 22.
    Jakobsson, Ebbe
    et al.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Lundström, Karl-Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Northern Registry Center.
    De La Croix, Hanna
    Sahlgrenska University Hospital, Östra Hospital, Department of Surgery, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Chronic Pain After Groin Hernia Surgery in Women: A Patient-reported Outcome Study Based on Data From the Swedish Hernia Register2022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 275, no 2, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Objective:The aim of this study was to evaluate chronic pain 1 year after surgery, and risk factors for chronic pain after groin hernia repair in women.Background:Groin hernia surgery in women is less frequently studied than in men. Chronic pain is common after groin hernia surgery and remains an important area with room for improvement. Previous studies are small or inconclusive. Guidelines recommend timely repair of all female groin hernias.

    Methods:From the Swedish Hernia Register 4021 female and 37,542 male patients operated between September 1, 2012 and August 30, 2017 responded to a patient-reported outcome questionnaire (response rate 70.0%) 1 year after primary groin hernia surgery. Multivariable analysis was performed to compare chronic postoperative pain in women with men as a control group, and to evaluate risk factors for chronic pain in women.

    Results:Among women operated for groin hernia, 18% suffered chronic postoperative pain. The risk for chronic pain was significantly higher for women [odds ratio 1.3 (95% confidence interval 1.16-1.46). Three risk factors for chronic pain in women were found: High body mass index, high American Society of Anesthesiologists classification, and femoral hernia. No differences in chronic pain in women were seen when comparing surgical methods or emergency versus elective surgery.

    Conclusions:Almost one-fifth of women suffered of chronic pain affecting daily activity after groin hernia repair. Chronic pain was more common for women than men. In view of the high-rate chronic postoperative pain, further research on management strategies in female groin hernia is warranted.

  • 23.
    Larsson, Charlotta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Hospital of Östersund, Östersund, Sweden.
    Hedberg, Charlotta Linder
    Lundgren, Ewa
    Söderström, Lars
    Tunón, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study2019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10177, p. 1233-1239Article in journal (Refereed)
    Abstract [en]

    Background: Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).

    Methods: In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.

    Findings: 3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0.22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0.37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1 center dot 65 (95% CI 1 center dot 49-1 center dot 82; p<0.0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2 center dot 05 (1 center dot 92-2 center dot 19; p<0.0001). For the nulliparous women compared with men, the OR for anal incontinence was 1 center dot 89 (1 center dot 75-2 center dot 05; p<0.0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.

    Interpretation: The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed. Copyright (c) 2019 Elsevier Ltd. All rights reserved.

  • 24.
    Larsson, Charlotta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Östersund Hospital, Östersund, Sweden.
    Matsson, Anton
    Hospital of Östersund, Östersund, Sweden.
    Mooe, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Söderström, Lars
    Department of Research and Development, Hospital of Östersund, Östersund, Sweden.
    Tunón, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Östersund Hospital, Östersund, Sweden.
    Cardiovascular complications following cesarean section and vaginal delivery: a national population-based study2022In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 35, no 25, p. 8072-8079Article in journal (Refereed)
    Abstract [en]

    Introduction: Rates of cesarean section are rising in both developed and developing countries and while pregnancy and cesarean section are established as risk factors for thromboembolism and stroke, large population-based investigations focusing on all types of cardiovascular complication after delivery is missing. The aim was to analyze the risk of severe cardiovascular complications in the post-partum period following delivery by cesarean section. We also had a control group of vaginal deliveries and a reference group with nulliparas.

    Materials and Methods: This Swedish population-based study used three national registers between 2005 and 2017 and comprised a total of 1 165 684 individuals. Unselected register data was cross-linked and cardiovascular adverse events were identified by ICD diagnosis codes. 140 128 women (209 391 deliveries) were included in the cesarean group and 614 355 women (973 429 deliveries) in the vaginal control group. The reference group comprised 411 201 age-matched nulliparous women. The primary analysis was the risk of severe cardiovascular complications within 42 days of cesarean section or vaginal delivery. The secondary analysis evaluated risk factors for cardiovascular complications.

    Results: In the cesarean section group, 410 (0.20%) had a serious cardiovascular event within 42 days after delivery, and in the vaginal control group the number was 857 (0.09%). The risk of having an adverse cardiovascular event was significantly greater in the cesarean group (OR 2.23, CI 1.98 to 2.51) for all types of cardiovascular events. Risk factors were high BMI, preeclampsia, greater maternal age, tobacco use and acute cesarean delivery.

    Conclusions: The absolute numbers on severe maternal morbidity after delivery are low. However, since almost half of the world’s population are affected and the frequency of elective cesarean section continues to rise, a doubling of the risk for a severe cardiovascular event within 42 days of delivery is important to consider globally.

    Download full text (pdf)
    fulltext
  • 25.
    Lindmark, Mikael
    et al.
    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.
    Nordin, Pär
    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.
    Patient Reported Injuries After Ventral Hernia Repair2019In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 108, no 1, p. 30-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: The Swedish National Patient Insurance Company (LÖF) can compensate patients who believe they have been exposed to an avoidable injury or malpractice in healthcare. Its register covers 95% of Swedish healthcare providers.

    MATERIAL AND METHODS: Data on patients operated for primary or incisional ventral hernia in Sweden between 2010 and 2015 and who had filed a claim, were retrieved from LÖF. A total of 290 cases were identified and included. Files include a copy of records, relevant imaging, and an expert advisor's opinion.

    RESULTS: Inadvertent enterotomy occurred during 25 repairs and in these cases, laparoscopic repair was clearly overrepresented ( p  < 0.001). Complications related to the surgical site (infection and ugly scar) were predominantly related to open repairs ( p  < 0.001). Twenty percentage (57/290) of the claims were directly related to an anesthetic mishap. Univariate ordinal regression showed that the odds of receiving a high reimbursement was significantly increased if laparoscopic repair was performed p  < 0.001 (odds ratio: 0.37; 95% confidence interval: 0.21-0.65). Sixty-three percentage of claims were filed by women.

    CONCLUSION: Inadvertent enterotomy is overrepresented, and the probability that a claim filed for an avoidable injury leads to high reimbursement is greater if laparoscopic repair is performed rather than open ventral hernia repair. The high amount of injuries related to general anesthesia during umbilical hernia repair may be reduced with an increased proportion executed in local anesthesia.

  • 26.
    Lindqvist, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Andersson, Andreas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Österberg, Johanna
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Department of Surgery, Mora Hospital, Mora, Sweden.
    Sandblom, Gabriel
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Hemmingsson, Oskar
    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.
    Enochsson, Lars
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    The Impact of Hospital Level of Care on the Management of Acute Cholecystitis: a Population-Based Study2022In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 26, p. 2551-2558Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital.

    METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals.

    RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075).

    CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

    Download full text (pdf)
    fulltext
  • 27.
    Lindqvist, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, G.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Hemmingsson, Oskar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Enochsson, Lars
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Regional variations in the treatment of gallstone disease may affect patient outcome: A large, population-based register study in sweden2021In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 110, no 3, p. 335-343Article in journal (Refereed)
    Abstract [en]

    Background: The lack of studies showing benefit from surgery in patients with symptoms of gallstone disease has led to a divergence in local practices and standards of care. This study aimed to explore regional differences in management and complications in Sweden. Furthermore, to study whether population density had an impact on management.

    Methods: Data were collected from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Cholecystectomies undertaken for gallstone disease between January 2006 and December 2017 were included. Age, sex, American Society of Anesthesiologists (ASA) classification, intra- and post-operative complications, and the proportion of patients with acute cholecystitis who underwent surgery within 2 days of hospital admission were analyzed. The 21 different geographical regions in Sweden were compared, and each variable was analyzed according to population density.

    Results: A total of 139,444 cholecystectomies cases were included in this study. There were large differences between regions regarding indications for surgery and intra- and post-operative complications. In the analyses, there were greater divergences than would be expected by chance for most of the variables analyzed. Age of the cholecystectomized patients correlated with population density of the regions (R2 = 0.310; p = 0.0088).

    Conclusion: There are major differences between the different regions in Sweden in terms of the treatment of gallstone disease and outcome, but these did not correlate to population density, suggesting that local routines are more likely to have an impact on treatment strategies rather than demographic factors. These differences need further investigation to reveal the underlying causes.

    Download full text (pdf)
    fulltext
  • 28.
    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

  • 29.
    Lundström, Karl-Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Folkvaljon, Yasin
    Loeb, Stacy
    Axelson, Anna Bill
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy2016In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 3, p. 155-159Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions. Materials and methods In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005-2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively. Results During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14-3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86-1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50-3.33) but not after 5 years (HR 1.23, 95% CI 0.92-1.63). Conclusion Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP.

  • 30.
    Lundström, Karl-Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Montgomery, A.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Patient-reported rates of chronic pain and recurrence after groin hernia repair2018In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 1, p. 106-112Article in journal (Refereed)
    Abstract [en]

    Background: The effectiveness of different procedures in routine surgical practice for hernia repair with respect to chronic postoperative pain and reoperation rates is not clear.

    Methods: This was prospective cohort study based on a unique combination of patient-reported outcomes and national registry data. Virtually all patients with a groin hernia repair in Sweden between September 2012 and April 2015 were sent a questionnaire 1 year after surgery. Persistent pain, defined as at least "pain present, cannot be ignored, and interferes with concentration on everyday activities' in the past week was the primary outcome. Reoperation for recurrence recorded in the register was the secondary outcome.

    Results: In total, 22 917 patients (response rate 75.5 per cent) who had an elective unilateral groin hernia repair were analysed. Persistent pain present 1 year after hernia repair was reported by 15.2 per cent of patients. The risk was least for endoscopic total extraperitoneal (TEP) repair (adjusted odds ratio (OR) 0.84, 95 per cent c.i. 0.74 to 0.96), compared with open anterior mesh repair. TEP repair had an increased risk of reoperation for recurrence (adjusted OR 2.14, 1.52 to 2.98), as did open preperitoneal mesh repair (adjusted OR 2.34, 1.42 to 3.71) at 2.5-year follow-up. No other methods of repair differed significantly from open anterior mesh repair.

    Conclusion: The risk of significant pain 1year after groin hernia repair in routine surgical practice was 15.2 per cent. This figure was lower in patients who had surgery by an endoscopic technique, but at the price of a significantly higher risk of reoperation for recurrence.

  • 31.
    Lundström, Karl-Johan
    et al.
    Östersunds Hosp, Dept Surg, S-83183 Östersund, Sweden.
    Sandblom, Gabriel
    Karolinska Inst, Huddinge Univ Hosp, Dept Surg, Stockholm, Sweden.
    Smedberg, Sam
    Helsingborg Hosp, Dept Surg, Helsingborg, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Risk factors for complications in Groin Hernia surgery: A National register study2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 255, no 4, p. 784-788Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to analyze and identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Background: The outcome of groin hernia surgery is evaluated mostly by comparing recurrence rates and long-term pain. The aim of this observational population-based registry study was to identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Methods: Using data from the nationwide Swedish Hernia Register between 1998 and 2009, 150,514 herniorrhaphies were analyzed with respect to postoperative complications occurring within 30 days of surgery. Results: Risk factors significantly affecting the rate of postoperative complications were laparoscopic repair (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.24-1.47) and open preperitoneal techniques (OR: 1.31, 95% CI: 1.15-1.49), with open anterior mesh as reference category. Other significant risk factors were general (OR: 1.30, 95% CI: 1.23-1.37) and regional anesthesia (OR: 1.53, 95% CI: 1.43-1.63), with local anesthesia as reference category, emergency procedures (OR: 1.53, 95% CI: 1.43-1.63); recurrent hernia repair (OR: 1.39, 95% CI: 1.27-1.52); femoral hernia (OR: 1.30, 95% CI: 1.14-1.48); aged older than 65 years (OR: 1.26, 95% CI: 1.21-1.31); and duration of surgery exceeding 50 minutes (OR: 1.27, 95% CI: 1.22-1.33). Conclusions: Open anterior approach and surgery under local anesthesia are associated with less risk of postoperative complications.

  • 32.
    Lundström, Karl-Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Söderstrom, Lars
    Jernow, Henning
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Nordin, Pär
    Epidemiology of hydrocele and spermatocele; incidence, treatment and complications2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 2-3, p. 134-138Article in journal (Refereed)
    Abstract [en]

    Objectives: To estimate the incidence of men seeking specialized care and receiving treatment for hydro or spermatocele complaints. Also, to determine the risk of complications of treatment.

    Materials and methods: The total number of men living in Sweden each year from 2005 to 2014 was used to calculate incidence and age distribution of adult (≥18 years) men seeking specialized healthcare with either hydro or spermatocele. This was done by using nationwide registries, mandatory by law. They contain information on primary or discharge diagnosis, procedure codes and antibiotic prescriptions. Also, complication rates comparing aspiration (with or without sclerotherapy) and conventional surgery were analysed.

    Results: The incidence of men with either hydro or spermatocele diagnosis in specialized healthcare was ∼100/100,000 men. The treatment incidence was 17/100,000 men. Orchiectomy was used as primary treatment in 2.4% of cases. The risk of experiencing a complication was clinically and statistically significantly increased with conventional surgery as compared with aspiration, 17.5% (1607/9174) vs 4.6% (181/3920), corresponding to relative risk of 3.79 (95% CI = 3.27–4.40). Hematoma and infections were the most common complications.

    Conclusion: Hydro and spermatoceles are common, affecting elderly men. Aspiration seems advantageous with respect to complications and can be recommended due to the benign course of the disease. The indication for conventional surgery might be questioned such as the use of orchiectomy as primary treatment.

  • 33.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University Hospital, Umeå, Sweden.
    Kadobera, Daniel
    Forsberg, Birger C.
    Mulowooza, Jude
    Wladis, Andreas
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University Hospital, Umeå, Sweden.
    District-level surgery in Uganda: Indications, interventions and perioperative mortality2015In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 158, no 1, p. 7-16Article in journal (Refereed)
    Abstract [en]

    Background: The world's poorest 2 billion people, benefit from no more than about 3.5% of the world's operative procedures. The burden of surgical disease is greatest in Africa, where operations could save many lives. Previous facility-based studies have described operative procedure caseloads, but prospective studies investigating interventions, indications and perioperative mortality rates (POMR), are rare.

    Methods: A prospective, questionnaire-based collection of data on all major and minor operative procedures was undertaken at 2 hospitals in rural Uganda covering 4 and 3 months in 2011, respectively. Data included patient characteristics, indications for the interventions performed, and outcome after surgery.

    Results: We recorded 2,790 operative procedures on 2,701 patients. The rate of major operative procedures per 100,000 population per year was 225. Patients undergoing major operative procedures (n = 1,051) were mostly women (n = 923; 88%) because most interventions were performed owing to pregnancy-related complications (n = 747; 67%) or gynecologic conditions (n = 114; 10%). General operative interventions registered included herniorrhaphy (n = 103; 9%), exploratory laparotomy (n = 60; 5%), and appendectomy (n = 31; 3%). The POMR for major operative procedures was 1 % (n = 14) and was greatest after exploratory laparotomy (13%; n = 8) and caesarean delivery (1%; n = 4). Most deaths = 16) were a result of sepsis (n = 10-11) or hemorrhage (n = 3-5).

    Conclusion: The volume of surgery was low relative to the size of the catchment population. The POMR was high. Exploratory laparotomy and caesarean section were identified as high-risk procedures. Increased availability of blood, improved pen operative monitoring, and early intervention could be part of a solution to reduce the POMR

  • 34.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Kadobera, Daniel
    Forsberg, Birger C.
    Mulowooza, Jude
    Wladis, Andreas
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Surgery in district hospitals in rural Uganda-indications, interventions, and outcomes2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, p. 18-18Article in journal (Other academic)
    Abstract [en]

    Background: There is a vast unmet need for surgical interventions in resource scarce settings. The poorest 2 billion people share 3·5% of the world's operations. The highest burden of surgical disease is seen in Africa where surgery could avert many deaths. Prospective studies investigating interventions, indications, and outcomes including perioperative mortality rates (POMR) after surgery are scant. The aim of the study was to describe the situation of surgery in a low-income setting in sub-Saharan Africa. Methods: In this descriptive, facility-based study, data were prospectively collected in questionnaires by 41 staff employed at two hospitals (Iganga General Hospital and Buluba Mission Hospital) in eastern Uganda during 4 months (major surgeries) and 3 months (minor surgeries) in 2011. Data included patient characteristics, interventions, indications for surgery, and in-hospital mortality after surgery. Descriptive statistical methods were used to analyse the data. Findings: 2701 patients underwent 2790 surgical interventions. Of these, 1051 patients underwent major surgery, which corresponds to a major surgery rate of 224·8 per 100 000 population. Most patients undergoing major surgery were women (n=923, 88%). Pregnancy related complications (n=747, 66%) leading to caesarean section (n=496, 47%) and evacuation (n=244, 22%) or gynaecological conditions (n=114, 10%) were common indications for surgery. General surgery interventions registered were herniorrhaphy (n=103, 9%), explorative laparotomy (n=60, 5%), and appendicectomy (n=31, 3%). Overall, the POMR was 0·6% (16 deaths); for major surgery it was 1·3% (14 deaths) and for minor surgeries it was 0·1% (two of 1650 patients). High POMR were seen following explorative laparotomy (13·3%, eight deaths) and caesarean section (0·8%, four deaths). Of the 510 babies delivered through caesarean section, 59 (12%) were still born or died before discharge. Interpretation: Rates of surgery are low in the study setting compared with in high-income settings where surgical rates exceed 11 000 per 100 000 population. POMR are high after exploratory laparotomy and caesarean section. Although very detailed, a larger study could be undertaken to investigate the situation in other settings. Underlying reasons leading to death and quality of surgical care should be investigated further so that POMR can be reduced in this setting.

  • 35.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Makumbi, F.
    Galiwango, E.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ibingira, C.
    Forsberg, B. C.
    Wladis, A.
    Prevalence of treated and untreated groin hernia in eastern Uganda2014In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, no 6, p. 728-734Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hernia repair is the most commonly performed general surgical procedure worldwide. The prevalence is poorly described in many areas, and access to surgery may not be met in low- and middle-income countries. The objectives of this study were to investigate the prevalence of groin hernia and the surgical repair rate in a defined sub-Saharan region of Africa. METHODS: A two-part study on hernia prevalence was carried out in eastern Uganda. The first was a population-based prevalence study with 900 randomly selected men in a Health and Demographic Surveillance Site. The second was a prospective facility-based study of all surgical procedures performed in the two hospitals providing surgical care in the region. RESULTS: The overall prevalence of groin hernia (current hernia or scar after groin hernia surgery) in men was 9·4 per cent. Less than one-third of men with a hernia had been operated on. More than half had no pain symptoms. The youngest age group had an overall prevalence of 2·4 per cent, which increased to 7·9 per cent in the age range 35-54 years, and to 37 per cent among those aged 55 years and above. The groin hernia surgery rate at the hospitals investigated was 17 per 100 000 population per year, which corresponds to a surgical correction rate of less than 1 per cent per year. Based on hospital records, a considerable number of patients having surgery for groin hernia were women (20 of 84 patients, 24 per cent). CONCLUSION: Groin hernia is a common condition in men in this east Ugandan cohort and the annual surgical correction rate is low. Investment is needed to increase surgical capacity in this healthcare system.

  • 36.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Matovu, A.
    Wladis, A.
    Ibingira, C.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Galiwango, E.
    Forsberg, B. C.
    Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country2017In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 6, p. 695-703Article in journal (Refereed)
    Abstract [en]

    BackgroundOver 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource-scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low-cost alternative is needed. The objective of this study was to calculate and compare costs and cost-effectiveness of inguinal hernia mesh repair using a low-cost versus a commercial mesh in a rural setting in Uganda. MethodsThis is a cost-effectiveness analysis of a double-blinded RCT comparing outcomes from groin hernia mesh repair using a low-cost mesh and a commercially available mesh. Cost-effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained. ResultsThe cost difference resulting from the choice of mesh was $1247 (Euro1181). In the low-cost mesh group, the cost per DALY averted and QALY gained were $168 (Euro159) and $76 (Euro72) respectively. The corresponding costs were $582 (Euro551) and $333 (Euro315) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $1484 (Euro1405) and $847 (Euro802) respectively. ConclusionRepair using both meshes was highly cost-effective in the study setting. A potential cost reduction of over $120 (nearly Euro120) per operation with use of the low-cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources. Trial registration number: ISRCTN20596933 (). Mosquito mesh is cost-efficient

  • 37.
    Löfgren, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mulowooza, Jude
    Iganga, Uganda.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Stockholm, Sweden.
    Forsberg, Birger C.
    Solna, Sweden.
    Cost of surgery in a low-income setting in eastern Uganda2015In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 157, no 6, p. 983-991Article in journal (Refereed)
    Abstract [en]

    Background. Operative interventions have traditionally been seen as expensive; therefore, surgery has been given low priority in global health care planning in low-income countries. A growing body of evidence indicates that surgery can also be highly cost effective in low-income settings, but our current knowledge of the actual cost of surgery in such settings is limited. This study was carried out to obtain data on the costs of commonly performed operative procedures in a rural/semiurban setting in eastern Uganda. Methods. A prospective, facility-based study carried out at a general district hospital (public) and a mission hospital (private, not-for-profit) in the Iganga and Mayuge districts in eastern Uganda. Items included in the cost calculations were staff time, materials and medicines, overhead costs, and capital costs. Results. The cost of surgery was higher at the mission hospital, with higher expenditure and lower productivity than the public hospital. The most commonly performed major procedures were caesarean section, uterine evacuation, and herniorrhaphy for groin hernia. The costs for these interventions varied between $68.4 and $74.4, $25.0 and $32.6, and $58.6 and $66.0, respectively. The most commonly performed minor procedures were circumcision, suture of cuts and lacerations, and incision and drainage of abscess. The costs for these interventions varied between $16.2 and $24.6, $15.8 and $24.3, and $10.1 and $18.6, respectively. Conclusion. The cost of surgery in the study setting compares favorably with other prioritized health care interventions, such as treatment for tuberculosis, human immunodeficiency virus/AIDS, and childhood immunization. Surgery in low-income settings can be made more cost effective, leading to increased quantity and improved quality of surgical services.

  • 38.
    Löfgren, Jenny
    et al.
    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.
    Ibingira, Charles
    Makerere University.
    Matovu, Alphonsus
    Makerere University.
    Galiwango, Edward
    Makerere University.
    Wladis, Andreas
    Karolinska Institutet.
    A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair2016In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 374, no 2, p. 146-153Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The most effective method for repair of a groin hernia involves the use of a syn-thetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes have been used as a lower-cost alternative but have not been rigorously studied.METHODS: We performed a double-blind, randomized, controlled trial comparing low-cost mesh with commercial mesh (both lightweight) for the repair of a groin hernia in adult men in eastern Uganda who had primary, unilateral, reducible groin hernias. Surgery was performed by four qualified surgeons. The primary outcomes were hernia recurrence at 1 year and postoperative complications.RESULTS: A total of 302 patients were included in the study. The follow-up rate was 97.3% after 2 weeks and 95.6% after 1 year. Hernia recurred in 1 patient (0.7%) assigned to the low-cost mesh and in no patients assigned to the commercial mesh (abso-lute risk difference, 0.7 percentage points; 95% confidence interval [CI], −1.2 to 2.6; P = 1.0). Postoperative complications occurred in 44 patients (30.8%) assigned to the low-cost mesh and in 44 patients (29.7%) assigned to the commercial mesh (absolute risk difference, 1.0 percentage point; 95% CI, −9.5 to 11.6; P = 1.0).CONCLUSIONS: Rates of hernia recurrence and postoperative complications did not differ signifi-cantly between men undergoing hernia repair with low-cost mesh and those un-dergoing hernia repair with commercial mesh.

    Download full text (pdf)
    fulltext
  • 39.
    Löfgren, Jenny
    et al.
    Institutionen för molekylär medicin och kirurgi, Karolinska institutet, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Wladis, Andreas
    Institutionen för klinisk och experimentell medicin, Linköpings universitet, Sweden.
    Från pek till patientnytta2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 35-36, article id ESAFArticle in journal (Other academic)
  • 40. 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.

  • 41.
    Matovu, A.
    et al.
    Mubende Regional Referral Hospital, Plot 6, Kakumiro Road, Mubende, Uganda; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Löfgren, J.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Wladis, A.
    Linköping University, Linköping, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, G.
    Department of Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Pettersson, H.J.
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 19832024In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.

    Method: This study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.

    Results: A total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23–1.40) among women registered for two deliveries, 1.70 (1.58–1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14–1.49) and 1.70 (1.49–1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively.

    Conclusion: In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.

    Download full text (pdf)
    fulltext
  • 42. Matovu, Alphonsus
    et al.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wladis, Andreas
    Ajiko, Mary Margaret
    Löfgren, Jenny
    Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sector2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, p. 3277-3283Article in journal (Refereed)
    Abstract [en]

    Background: Groin hernia is a major public health problem with over 200 million people affected. The unmet need for surgery is greatest in Sub-Saharan Africa where specialist surgeons are few. This study was carried out in Uganda to investigate caseloads and practices of groin hernia surgery at publicly funded hospitals.

    Methods: The study employed mixed methods covering 29 hospitals: the National Referral Hospital (NRH), 14 Regional Referral Hospitals (RRH) and 14 General Hospitals (GH). In part one of the study, surgeons and medical doctors performing hernia repair were interviewed about their practices and experiences of groin hernia surgery. In part two, operating theater records from 2013 to 2014 from the participating hospitals were reviewed and information about groin hernia operations collected.

    Results: All respondents reported that sutured repair was the first-choice method. A total of 5518 groin hernia repairs were performed at the participating hospitals, i.e., an annual hernia repair rate of 7/100 000 population. Of the patients operated, almost 16% were women and 24% were children. Local anesthesia (LA) was used in 40% of the cases, and non-surgeon physicians performed 70.3% of the groin hernia repairs.

    Conclusion: Groin hernia repair outputs need to increase along with the training of surgical providers in modern hernia repair methods. Methods and outcomes for hernia repair in women and children should be investigated to improve the quality of care.

    Download full text (pdf)
    fulltext
  • 43. Miserez, M.
    et al.
    Peeters, E.
    Aufenacker, T.
    Bouillot, J.L.
    Campanelli, G.
    Conze, J.
    Fortelny, R.
    Heikkinen, T.
    Jorgensen, L.N.
    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, M.P.
    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.

  • 44.
    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.

  • 45. Nilsson, Hanna
    et al.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Groin hernia repair in women - A nationwide register study2018In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 216, no 2, p. 274-279Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to investigate reoperation for recurrence in men and women with respect to method of repair, hernia anatomy and year of operation. Method: Since 1992, groin hernia repairs performed in Sweden are prospectively registered in the Swedish Hernia Register, (SHR). Reoperations are noted, regardless of where the reoperation is performed. Risk of reoperation for recurrence is calculated for men and women with respect of method of repair, hernia anatomy and year of operation. Results: Out of 221 108 eligible operations registered between 1992-2013,17 545 (8%) were performed on women. The risk of being operated for recurrence after laparoscopic surgery was lowered in women, RR 0,4(95%CI 0.3-0.7) and increased in men, RR 2.3(95% CI 2.0-2.7), compared to the Lichtenstein technique. Discussion: The reoperation for recurrence rate differed significantly between men and women. As regards the technique used for primary repair, laparoscopic groin hernia repair lowered the risk of reoperation for recurrence in women whereas it doubled the risk in men.

  • 46.
    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.

  • 47.
    Nilsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stranne, Johan
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Incidence of groin hernia repair after radical prostatectomy: a population-based nationwide study2014In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 259, no 6, p. 1223-1227Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the incidence of groin hernia repair after radical prostatectomy for prostate cancer compared with the incidence in a control population without prostate cancer in a nationwide, population-based study.

    Background: Recent reports indicate an increase in the incidence of groin hernia repair after radical prostatectomy. Inadequate knowledge of the incidence of groin hernia in the general population makes this information hard to interpret.

    Methods: Information was retrieved from the Prostate Cancer Database (PCBaSe) and Swedish Hernia Register for events between 1998 and 2010. The incidence of groin hernia surgery was calculated for a group of men treated with radical prostatectomy (open and minimally invasive) and for a group treated with radiation therapy, and these were compared with the incidence in a control cohort of men matched for age and county of residence. Multivariate analysis was used to assess the hazard ratio (HR) of groin hernia repair according to age, tumor risk category, and Charlson Comorbidity Index.

    Results: A total of 28,608 cases and 105,422 controls were included in the study. Men treated with radical prostatectomy and radiation therapy had a significantly higher incidence of groin hernia repair than the control cohort: HR: 3.95 (95% confidence interval: 3.70-4.21) for retropubic prostatectomy, HR: 3.37 (95% confidence interval: 2.95-3.87) for minimally invasive prostatectomy, and HR: 1.84 (95% confidence interval: 1.66-2.04) for radiation therapy.

    Conclusions: An almost 4-fold increase in groin hernia repair was observed after radical prostatectomy compared with controls, and men who received radiation therapy had an almost 2-fold increase in incidence. As well as postoperative changes in the abdominal wall, increased vigilance for groin hernia seems to be important for the increased incidence of groin hernia repair seen after radical prostatectomy or radiation therapy for prostate cancer.

  • 48.
    Nilsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sahlgrenska University Hospitalt, Göteborg, Sweden.
    Stylianidis, Georgios
    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.
    Nilsson, Erik
    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.
    Mortality after groin hernia surgery2007In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 245, no 4, p. 656-660Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze mortality following groin hernia operations.

    Summary Background Data: It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail.

    Methods: The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden.

    Results: A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2-1.6) for men and 4.2 (95% confidence interval, 3.2-5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%.

    Conclusions: Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.

  • 49.
    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.

    Download full text (pdf)
    fulltext
  • 50. Novik, Bengt
    et al.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Skullman, Stefan
    Dalenbäck, Jan
    Enochsson, Lars
    More recurrences after hernia mesh fixation with short-term absorbable sutures: A registry study of 82 015 Lichtenstein repairs2011In: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, Vol. 146, no 1, p. 12-17Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the effects of different mesh fixation suture materials on the risk of recurrence after Lichtenstein inguinal hernioplasty.

    DESIGN: Observational, population-based registry study.

    SETTING: Data from the nationwide Swedish Hernia Registry.

    PATIENTS: All 82 015 Lichtenstein inguinal hernioplasties with sutured mesh fixation in adolescents and adults (15 years or older) from January 1, 2002, to December 31, 2009, at surgical units enrolled in the Swedish Hernia Registry.

    INTERVENTIONS: Mesh fixation with nonabsorbable, long-term absorbable, or short-term absorbable sutures. Main Outcome Measure Relative risk (RR) for reoperation due to recurrence of a hernia in the same groin during the study period, based on cumulative reoperation rates adjusted for time and confounding variables.

    RESULTS: For each study group, RR was calculated with multiregression analysis. There was no significant difference in risk for reoperation after mesh fixation with standard nonabsorbable sutures (RR, 1) or with long-term absorbable sutures (RR, 1.12; 95% confidence interval, 0.81-1.55; P = .49). Short-term absorbable sutures, however, more than doubled that risk (RR, 2.23; 95% confidence interval, 1.67-2.99; P < .001).

    CONCLUSIONS: With regard to recurrence risk, long-term absorbable sutures are an excellent alternative to permanent sutures for mesh fixation in Lichtenstein inguinal hernioplasty. Short-term absorbable sutures entail an independent risk factor for recurrence and should therefore be avoided.

12 1 - 50 of 56
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf