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  • 1.
    Hemmingsson, Oskar
    et al.
    Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Binnermark, Felix
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå University Educational Unit at Sunderby Hospital, Sunderby, Sweden.
    Rutegård, Martin
    Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haapamäki, Markku M
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Author response to: Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial2022Ingår i: BJS Open, E-ISSN 2474-9842, Vol. 6, nr 4, artikel-id zrac106Artikel i tidskrift (Övrigt vetenskapligt)
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  • 2.
    Hemmingsson, Oskar
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
    Binnermark, Felix
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå University Educational Unit at Sunderby Hospital, Sunderby, Sweden.
    Rutegård, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
    Franklin, Karl A.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haapamäki, Markku M.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial2022Ingår i: BJS Open, E-ISSN 2474-9842, Vol. 6, nr 2, artikel-id zrac007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are several surgical options for the management of pilonidal disease, including midline and off midline closure, but prospective studies are rare. The study hypothesis was that Karydakis flap surgery would result in shorter wound healing and fewer recurrences than excision of pilonidal sinus and suture in the midline.

    METHODS: A randomized clinical trial was conducted in two hospitals in Sweden between 2006 and 2015 to compare excision and suture in the midline with Karydakis flap surgery. Adult patients with a chronic pilonidal sinus disease were randomized 1:1 at the outpatient clinic without blinding. Power calculation based on recurrence of 2 per cent for Karydakis flap and 10 per cent for excision and primary closure in the midline required 400 patients with 90 per cent statistical power at 5 per cent significance assuming 10 per cent loss during follow-up. Participants were followed up until complete wound healing; late follow-up after 6-13 years was performed by telephone by two blinded assessors. The two co-primary outcomes were time to complete wound healing and recurrence rate.

    RESULTS: The study was terminated early at a planned interim analysis due slow recruitment and a significant difference in primary outcome. In total, 125 patients were randomized, of whom 116 were available for the present analysis. Median wound healing time was 49 days (95 per cent confidence interval (c.i.) 32 to 66) for excision with suture in the midline and 14 days (95 per cent c.i. 12 to 20) for Karydakis flap surgery (P < 0.001). There were five recurrences in each group, after a median follow-up of 11 years (P = 0.753).

    CONCLUSION: Karydakis flap surgery for pilonidal sinus disease led to a shorter wound healing time than excision and suture in the midline but no difference in recurrence rates.Registration number: NCT00412659 (http://www.clinicaltrials.gov).

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  • 3.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Aspects of parastomal hernia2023Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Parastomal hernia (PSH) is a common complication to all ostomies, and all too well known to colorectal surgeons. Up to half of all stomates get a PSH. PSH may present itself as a protrusion or a bulge of the stoma that contains bowel or other content of the abdominal cavity. The symptom load varies from none to debilitating. An unknown fraction of patients with PSH receives correctional surgery. The overall aim of this thesis was to investigate prevalence and treatment of PSH in Sweden, explore whether prophylactic mesh when constructing a colostomy is a viable option for prevention, investigate the health economic impact of PSH and probe into the patient’s own experiences of living with a PSH. The thesis is based on both qualitative and quantitative research. Paper I and III are a randomised controlled multicentre trial, paper II is retrospective audit of the treatment of PSH in Sweden, paper IV is a health economic analysis of colostomy costs and paper V is an interview of survivors of colorectal cancer, with a colostomy and PSH.

    The conclusions are as follows: The frequency of PSH surgery was much lower than expected, no specific risk factor could be identified, and perhaps centralisation of surgery should be considered. Most common cause for surgery was cosmetic. Prophylactic mesh in a sublay position don’t prevent PSH but doesn’t seem to add significant complications. PSH cost no more than a colostomy with no PSH, regarding appliances and stoma nurse visits. The common theme of long-time rectal cancer survivors with PSH is coping and a deep sense of gratitude being a survivor.

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  • 4.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Division of Surgery, Sunderby Hospital, Luleå, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Johansson, Jeaneth
    Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Impact of parastomal hernia on colostomy costs at 1 year: secondary analysis of a randomized clinical trial (STOMAMESH)2024Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 113, nr 1, s. 33-39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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  • 5.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Johansson, Jeaneth
    Luleå University of Technology, Department of Administration and Industrial Engineering, Luleå, Sweden; Halmstad University, The School of Business, Innovation and Sustainability, Halmstad, Sweden.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Spinord, Linda
    Luleå University of Technology, Department of Health, Education and Technology, Luleå, Sweden.
    Battle of the Bulge: a qualitative analysis of living with a parastomal herniaManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

  • 6.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden; Department of Surgery, Sunderby sjukhus, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Dahlberg, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden .
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Umeå, Sweden .
    Parastomal hernia repair; seldom performed and seldom reported: Results from a nationwide survey2020Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 109, nr 2, s. 96-101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 7.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Response to: "Follow-up of the STOMAMESH Cohort"2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. e31-e31Artikel i tidskrift (Refereegranskat)
  • 8.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive"2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. E30-E30Artikel i tidskrift (Refereegranskat)
  • 9.
    Odensten, Christoffer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 3, s. 427-431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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  • 10.
    Ringblom, Christian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Näsvall, Pia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Sunderby Research Unit, Umeå University, Luleå, Sweden.
    No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from stomamesh-a multicenter double-blind randomized controlled trial2023Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, nr 1, s. 38-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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  • 11.
    Stenberg, K.
    et al.
    Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Södra Sunderbyn, Sweden.
    Eriksson, A.
    Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Södra Sunderbyn, Sweden.
    Odensten, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Darehed, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study2022Ingår i: BMC Gastroenterology, E-ISSN 1471-230X, Vol. 22, nr 1, artikel-id 361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Percutaneous endoscopic gastrostomy (PEG) is the method of choice for patients in need of long-term nutritional support or gastric decompression. Although it is considered safe, complications and relatively high mortality rates have been reported. We aimed to identify risk factors for complications and mortality after PEG in routine healthcare.

    Methods: This retrospective study included all adult patients who received a PEG between 2013 and 2019 in Region Norrbotten, Sweden.

    Results: 389 patients were included. The median age was 72 years, 176 (45%) were women and 281 (72%) patients received their PEG due to neurological disease. All-cause mortality was 15% at 30 days and 28% at 90 days. Malignancy as the indication for PEG was associated with increased mortality at 90 days (OR 4.41, 95% CI 2.20–8.88). Other factors significantly associated with increased mortality were older age, female sex, diabetes mellitus, heart failure, lower body mass index and higher C-reactive protein levels. Minor and major complications within 30 days occurred in 11% and 15% of the patients, respectively. Diabetes increased the risk of minor complications (OR 2.61, 95% CI 1.04–6.55), while those aged 75 + years were at an increased risk of major complications, compared to those younger than 65 years (OR 2.23, 95% CI 1.02–4.85).

    Conclusions: The increased risk of death among women and patients with malignancy indicate that these patients could benefit from earlier referral for PEG. Additionally, we found that age, diabetes, heart failure, C-reactive protein and body mass index all impact the risk of adverse outcomes.

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