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Nyström, Per-Olof
Alternative names
Publications (10 of 24) Show all publications
Gerjy, R., Lindhoff-Larson, A. & Nyström, P.-O. (2008). Prolapse grade and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients. Colorectal disease, 10(7), 694-700
Open this publication in new window or tab >>Prolapse grade and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients
2008 (English)In: Colorectal disease, ISSN 1462-8910, Vol. 10, no 7, p. 694-700Article in journal (Refereed) Published
Abstract [en]

Purpose: Haemorrhoid prolapse is an indication for surgery. A correlation between worsening anatomy and increasing symptoms is commonly assumed. We developed a classification algorithm of prolapse and external component, and evaluated its correlation to symptoms before and after surgery.

Method: A study population comprising 180 patients operated for haemorrhoids in a multicentre randomized trial plus a validation set comprising 90 patients operated by us. The classification used three items: (i) patient self-report of prolapse requiring manual reposition; (ii) surgeon assessment of prolapse when patient negated manual reposition; (iii) surgeon assessment of external component. Patient self-reported were rated by frequency (never, 0 points; monthly, 1 point; weekly, 2 points and daily, 3 points). The algorithm yielded three grades: 1, no prolapse; 2, spontaneously reducing prolapse and 3, prolapse needing manual repositioning. The degree of external component was affixed as A, none; B, one or few tags and C, circumferential.

Results: Anatomical grades did not differ between the two sets of patients before or after surgery. Preoperatively, 69% had grade 3 prolapse. Postoperatively, 89% were classified as grades 1A or B. The symptom load was similar for grades 2 and 3; mean 6.5 points preoperatively and 1.8 points postoperatively.

Conclusion: This anatomical classification, based on strict criteria, reliably staged the haemorrhoid prolapse. There was no unique preoperative symptom profile associated with any degree of prolapse with or without an external component. Restored anal anatomy relieved symptoms. The classification also defined recurrence of haemorrhoids.

Keywords
Haemorrhoids, Haemorrhoidopexy, grade, classification, symptoms, prolapse
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13289 (URN)10.1111/j.1463-1318.2008.01498.x (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
Gerjy, R. & Nyström, P.-O. (2007). Excision of residual skin tags during stapled anopexy does not increase postoperative pain. Colorectal Disease, 9(8), 754-757
Open this publication in new window or tab >>Excision of residual skin tags during stapled anopexy does not increase postoperative pain
2007 (English)In: Colorectal Disease, ISSN 1462-8910, Vol. 9, no 8, p. 754-757Article in journal (Refereed) Published
Abstract [en]

Objective: We studied whether excision of residual external skin tags causes additional pain in patients undergoing a stapled anopexy for muco-anal prolapse.

Method: Seventeen patients in whom skin tags had been excised were compared with 24 patients having no excision. The patients were selected from a prospective database of haemorrhoid surgery if they had submitted a diary with self-reported postoperative pain scores as well as a self-reported symptom questionnaire preoperatively and postoperatively. The tags were excised with preservation of the subdermal fascia.

Results: There were 41 patients who fulfilled the criteria for inclusion. Seventeen (group 1) had tags excised and 24 (group 2) did not. Fifty-nine per cent in group 1 and 67% in group 2 experienced preoperative prolapse needing manual reposition. The mean height of the staple line was 2 cm above the dentate line in both groups. Daily average postoperative pain recorded as the sum of a self-reported VAS rating over 14 days was 26 points in both groups. The peak pain experienced was 42 and 43 points respectively (not significant). Resolution of postoperative pain over 14 days was identical. The preoperative and postoperative symptom score was comparable in both groups.

Conclusion: Excision of anal skin tags should be carried out at the time of stapled anopexy.

Keywords
Haemorrhoids, surgery, stapless, postoperative pain, ropivacain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13288 (URN)10.1111/j.1463-1318.2007.01237.x (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
Lund, J., Nyström, P.-O., Coremans, G., Herold, A., Karaitianos, I., Spyrou, M., . . . Pescatori, M. (2006). An evidence-based treatment algorithm for anal fissure. Techniques in Coloproctology, 10(3), 177-180
Open this publication in new window or tab >>An evidence-based treatment algorithm for anal fissure
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2006 (English)In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 10, no 3, p. 177-180Article in journal (Refereed) Published
Abstract [en]

   

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37616 (URN)36745 (Local ID)36745 (Archive number)36745 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Corman, M., Carriero, A., Hager, T., Herold, A., Jayne, D., Lehur, P., . . . Wexner, S. (2006). Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Disease, 8(2), 98-101
Open this publication in new window or tab >>Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation
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2006 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 8, no 2, p. 98-101Article in journal (Refereed) Published
Abstract [en]

An international working party was convened in Rome, Italy on 16–17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37617 (URN)10.1111/j.1463-1318.2005.00941.x (DOI)36746 (Local ID)36746 (Archive number)36746 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Gerjy, R., Derwinger, K. & Nyström, P.-O. (2006). Perianal local block for stapled anopexy. Diseases of the colon and rectum, 49(12), 1914-1921
Open this publication in new window or tab >>Perianal local block for stapled anopexy
2006 (English)In: Diseases of the colon and rectum, ISSN 0012-3706, Vol. 49, no 12, p. 1914-1921Article in journal (Refereed) Published
Abstract [en]

Purpose This study was designed to demonstrate the usefulness of a method of regional anesthesia for circular stapler anopexy for prolapsing hemorrhoids.

Methods Thirty-three patients consented to stapled anopexy under perianal local anesthesia. Eighteen patients with stapled anopexy under general anesthesia were controls. The perianal block was applied with 40 ml of ropivacaine, 4.75 mg/ml, injected immediately peripheral to the external sphincter. A submucosal block with 15 ml of ropivacaine, 2 mg/ml, was added after applying the pursestring suture. Postoperative pain was rated by the patient for 14 days by using a ten-point visual analogue scale. Patients also submitted a preoperative and postoperative (3–6 months) symptom questionnaire to rate anal symptoms.

Results No operation was converted to general anesthesia. Operation time was similar in both groups. All patients in the local anesthesia group were pain free at discharge. The sums of pain scores during 14 days for daily average pain and peak pain were similar in both groups (average pain 23 (local anesthesia) vs. 35 (general anesthesia); peak pain 39 (local anesthesia) vs. 50 (general anesthesia); P > 0.05). The preoperative symptom scores were 7.8 (local anesthesia) vs. 8.9 (general anesthesia) points, and the follow-up scores were 2.2 (local anesthesia) and 2.7 (general anesthesia), a significant improvement (P = 0.001) in both groups but not different between groups.

Conclusions A perianal local block is easy to apply and has a high degree of acceptance among patients. The operation time, postoperative pain, and success rates of the operation equaled those of stapled anopexy performed under general anesthesia. The advantages are quicker turnover between cases and simpler management of pain-free postoperative patients in day surgery.

Keywords
Hemorrhoids, Surgery, Perianal, Anesthesia, Ropivacaine, Anopexy, Stapler
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13286 (URN)10.1007/s10350-006-0750-8 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-05-15
Olaison, G., Runström, B., Hallböök, O., Nyström, P.-O. & Sjödahl, R. (2005). Enterokutana fistlar - krävande tillstånd som kan opereras till läkning. Modern behandling och kirurgisk erfarenhet minskar mortaliteten. Läkartidningen, 102(11), 861-865
Open this publication in new window or tab >>Enterokutana fistlar - krävande tillstånd som kan opereras till läkning. Modern behandling och kirurgisk erfarenhet minskar mortaliteten
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2005 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 11, p. 861-865Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33217 (URN)19204 (Local ID)19204 (Archive number)19204 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Nyström, P.-O. (2004). Difficult to measure results and quality of surgical interventions but length of stay is an important variable. Läkartidningen, 101, 184-189
Open this publication in new window or tab >>Difficult to measure results and quality of surgical interventions but length of stay is an important variable
2004 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 184-189Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28275 (URN)13382 (Local ID)13382 (Archive number)13382 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Nyström, P.-O., Derwinger, K. & Gerjy, R. (2004). Local perianal block for anal surgery. Techniques in Coloproctology, 8(1), 23-26
Open this publication in new window or tab >>Local perianal block for anal surgery
2004 (English)In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 8, no 1, p. 23-26Article in journal (Refereed) Published
Abstract [en]

Background: We refined a technique for local block of all terminal nerve branches to the anus. Methods: A total of 30 consecutive patients with proctological disorders consented to ambulatory (n=29) or hospitalised (n=1) operation with local perianal block for skin tags, Milligan-Morgan haemorrhoidectomy, stapled haemorrhoidopexy or anocutaneous fistulae. Patients were operated prone. A total of 40 ml of a 4.75 mg/ml solution of ropivacaine (Narop, Astra, Sweden) was injected in 8 directions (5 ml each) into the ischiorectal fat immediately peripheral to the external sphincter as anaesthetic columns reaching from the skin to the levator. This injection scheme targets the terminal nerve branches of the anus rather than blocking the trunk of major nerves. The relaxation of a pain-free anus was obtained in 2-3 minutes with exposure similar to a general anaesthetic. Postoperative pain was evaluated on a 0 to 10 visual analogue scale (VAS). Results: Patients were pain-free at discharge. However, mean postoperative VAS score at 24 hours was 3.2 following Milligan-Morgan haemorrhoidectomy, 4.8 following stapled haemorrhoidopexy and skin tags or polyps excision, and 2.7 after fistula lay-open. At telephone follow-up 1-2 weeks later, the patients were satisfied with the method of anaesthesia and would willingly accept it for any further anal surgery. Conclusions: The perianal block is easy to apply and effective as sole method of anaesthesia for proctological operations.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28276 (URN)10.1007/s10151-004-0046-8 (DOI)13383 (Local ID)13383 (Archive number)13383 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Nyström, P.-O. & Wittman, D. (2003). Patient to surgeon infections - Fact or fiction. British Journal of Surgery, 90(11), 1315-1316
Open this publication in new window or tab >>Patient to surgeon infections - Fact or fiction
2003 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 90, no 11, p. 1315-1316Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25300 (URN)10.1002/bjs.4383 (DOI)9741 (Local ID)9741 (Archive number)9741 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Corman, M., Gravié, J.-F., Hager, T., Loudon, M., Mascagni, D., Nyström, P.-O., . . . Longo, A. (2003). Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique. Colorectal Disease, 5, 304-310
Open this publication in new window or tab >>Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique
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2003 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 5, p. 304-310Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25301 (URN)9742 (Local ID)9742 (Archive number)9742 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
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