liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Kald, Anders
Alternative names
Publications (10 of 16) Show all publications
Koch Frisén, A., Starck, J., Smeds, S., Nyström, P. & Kald, A. (2011). Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon. Hernia, 15(3), 281-288
Open this publication in new window or tab >>Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon
Show others...
2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, p. 281-288Article in journal (Refereed) Published
Abstract [en]

Purpose: Groin hernia repair is a common procedure in general surgery, and is taught to and performed by surgeons early in their training. The aim of this observational study was to compare hernia repair performance and results of surgical trainees with those of a specialized surgeon. The further aim sought to identify what factors may influence short and long-term outcome, and areas for improvement in surgical training.

Methods: A non-randomized parallel cohort study was designed to compare a specialized surgeon with surgical trainees, performing the Lichtenstein repair in adult males. Two hundred repairs were included, of which 96 were performed by surgical trainees. Patient characteristics, surgical experience, and operative data including duration of procedural parts and surgical complexity were noted at surgery. Postoperative complications, recurrence, chronic pain and residual symptoms were assessed at longterm follow-up after a median of 34.5 months.

Results: Surgical trainees had longer overall operative time consume, with an unproportionally longer time for mobilising the sac and cord. They perceived exposure and mobilisation as more difficult than the specialist, and also a greater demand on own experience during surgery. The trainee repairs had a higher rate of postoperative complications (14.7% versus 5.0%) but recurrence rate was the same as for specialist repairs. At long-term follow-up, specialist repairs had a higher symptom burden and more chronic pain.

Conclusions: Comparison of a specialized surgeon to surgical trainees in performance and outcome for inguinal hernia surgery shows it was more efficient, but not necessarily better to let a specialized surgeon perform the repairs. The better long-term outcome for surgical trainees stands in contrast to the prejudice that it is better to have an experienced surgeon to perform standard procedures. It seems likely that targeted training in dissection and mobilisation could decrease level of perceived complexity and shorten operative time consume for surgical trainees. We believe that adequately supervised hernia surgery should remain as a part of the surgical training.

Place, publisher, year, edition, pages
Springer, 2011
Keywords
Groin hernia, Surgical trainees, Lichtenstein, Pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63643 (URN)10.1007/s10029-010-0780-y (DOI)000291603300006 ()
Available from: 2010-12-29 Created: 2010-12-29 Last updated: 2017-12-11
Smeds, S., Kald, A. & Lofstrom, L. (2010). Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study. HERNIA, 14(3), 249-252
Open this publication in new window or tab >>Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study
2010 (English)In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 249-252Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to assess the variation of self-reported pain over a period of 2 years in three groups of patients with no, moderate and severe pain at 3 months after primary open inguinal hernia repair. In two cohorts of patients from 2004 (n = 272) and 2005 (n = 292) who had given a self-report of postoperative pain at 3 months, 79 randomly selected patients without pain (box visual analogue scale [VAS] level 10) and all patients with moderate (Box VAS level 7-9) and severe pain (Box VAS level 1-6), 91 and 9, respectively, were included in the case series. The self-assessments were repeated for all patients 1-1.5 and 2-2.5 years after surgery (November 2006). It was observed that moderate pain reappeared among the pain-free patients in 28 and 23% after 1-1.5 and 2-2.5 years, respectively. Of those patients with moderate pain at 3 months, 39 and 49% reported no pain at 1-1.5 and 2-2.5 years, respectively, after surgery. A worsening from moderate pain to severe pain was reported by 22% of patients after 1-1.5 years and by 15% of patients after 2-2.5 years. Hernia recurrence (n = 3) was observed only in patients with increased pain. All nine patients with severe pain at 3 months reported less pain, but only one was pain-free at 2-2.5 years after surgery. The study shows that a significant proportion of the patients developed pain later than 3 months after the operation. It further points to a difference in pain evolvement in patients with moderate pain and those with severe postoperative pain at 3 months. Pain can increase in intensity from moderate to severe, both with and without the presence of a clinical recurrence.

Place, publisher, year, edition, pages
Springer Science Business Media, 2010
Keywords
Inguinal hernia, Surgery, Postoperative pain, Open herniorraphy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-57172 (URN)10.1007/s10029-009-0615-x (DOI)000278153700004 ()
Available from: 2010-06-11 Created: 2010-06-11 Last updated: 2010-06-11
Kald , A. (2009). Authors reply: Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh (Br J Surg 2008; 95. British Journal of Surgery, 96(2), 221-221
Open this publication in new window or tab >>Authors reply: Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh (Br J Surg 2008; 95
2009 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 96, no 2, p. 221-221Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16977 (URN)10.1002/bjs.6562 (DOI)
Available from: 2009-03-01 Created: 2009-02-27 Last updated: 2017-12-13
Smeds, S., Löfström, L. & Kald, A. (2008). Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question. Läkartidningen, 105(21), 1582-1584
Open this publication in new window or tab >>Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question
2008 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 21, p. 1582-1584Article in journal (Refereed) Published
Abstract [en]

   

Keywords
Age Factors Clinical Competence Follow-Up Studies Hernia, Inguinal/*surgery Humans Postoperative Complications/diagnosis/etiology Questionnaires Recurrence Risk Factors Self Concept Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43421 (URN)73821 (Local ID)73821 (Archive number)73821 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Kald, A., Juul, K. N., Hjortswang, H. & Sjödahl, R. (2008). Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scandinavian Journal of Gastroenterology, 43(5), 627-633
Open this publication in new window or tab >>Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy
2008 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, no 5, p. 627-633Article in journal (Refereed) Published
Abstract [en]

Objective. Peristomal bulging caused by hernia or prolapse is common in patients with a sigmoidostomy. It is not known whether and to what extent peristomal bulging influences various daily activities. The purpose of this study was to evaluate the effects of bulging by using a general and disease-specific health scale (Short Health Scale, SHS) and a stoma-specific quality of life (Stoma-QoL) questionnaire in patients with and without peristomal bulging. Material and methods. Seventy patients with sigmoidostomies were examined to identify peristomal bulging. The mean (SD) age was 71.7 (13.7) years and the patients had had their sigmoidostomies for a mean of 8.1 (7.9) years. Bulging was noticed in 46 patients (66%) while 24 had no bulging. Results. It was found that patients with bulging were at a disadvantage. In the SHS, patients with bulging reported significantly impaired QoL in 3 out of 4 scales regarding symptom load, worry and general sense of well-being. Also, in the Stoma-QoL questionnaire there was a significant difference between patients with and those without bulging. Conclusions. QoL evaluated with a general and disease-specific instrument (SHS) was significantly impaired in patients with bulging around a sigmoidostomy. The Stoma-QoL questionnaire showed a small but statistically significant difference between patients with and those without bulging but the clinical significance is uncertain. Further studies are required to evaluate the role of some of the individual items in the Stoma-QoL questionnaire. © 2008 Taylor & Francis.

Keywords
Aged Colostomy/*adverse effects Female Humans Male *Quality of Life Questionnaires Surgical Stomas/*pathology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43365 (URN)10.1080/00365520701858470 (DOI)73649 (Local ID)73649 (Archive number)73649 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Koch Frisén, A., Bringman, S., Myrelid, P., Smeds, S. & Kald, A. (2008). Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. British Journal of Surgery, 95(10), 1226-1231
Open this publication in new window or tab >>Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh
Show others...
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 10, p. 1226-1231Article in journal (Refereed) Published
Abstract [en]

Background: Groin hernia repair is one of the commonest operations in general surgery. Existing techniques have very low and acceptable recurrence rates, but chronic pain and discomfort remain a problem for many patients. New mesh materials are being developed to increase biocompatibility, and the aim of this study was to compare a new titanium-coated lightweight mesh with a standard polypropylene mesh.

Methods: A randomized controlled single-centre clinical trial was designed, with the basic principle of one unit, one surgeon, one technique (Lichtenstein under general anaesthesia) and two meshes. Pain before and after surgery, and during convalescence (primary outcomes) was estimated in 317 patients. At 1-year clinical follow-up, recurrence, pain, discomfort and quality of life (secondary outcomes) were evaluated.

Results: Patients with the lightweight mesh returned to work after 4 days, compared with 6.5 days for the standard mesh (P = 0.040). The lightweight group returned to normal activity after 7 days, versus 10 days for the standard group (P = 0.005). There was no difference in postoperative pain or recurrence at the 1-year follow-up.

Conclusion: Patients with the lightweight mesh had a shorter convalescence than those with the standard heavyweight mesh. Registration number: ISRCTN36979348 (http://www.controlled-trials.com). Copyright © 2008 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd.

Keywords
Adult Aged Hernia, Inguinal/*surgery Humans Male Middle Aged Pain Measurement Pain, Postoperative/etiology Polypropylenes/*therapeutic use Quality of Life Recurrence *Surgical Mesh Titanium/*administration & dosage Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43370 (URN)10.1002/bjs.6325 (DOI)73656 (Local ID)73656 (Archive number)73656 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Keita, Å. V., Gullberg, E., Ericson, A.-C., Salim, S. Y., Wallon, C., Kald, A., . . . Söderholm, J. D. (2006). Characterization of antigen and bacterial transport in the follicle-associated epithelium of human ileum. Laboratory investigation, 86(5), 504-516
Open this publication in new window or tab >>Characterization of antigen and bacterial transport in the follicle-associated epithelium of human ileum
Show others...
2006 (English)In: Laboratory investigation, ISSN 0023-6837, Vol. 86, no 5, p. 504-516Article in journal (Refereed) Published
Abstract [en]

The follicle-associated epithelium (FAE), covering Peyer's patches, provides a route of entry for antigens and microorganisms. Animal studies showed enhanced antigen and bacterial uptake in FAE, but no study on barrier function of human FAE has been reported. Our aim was to characterize the normal barrier properties of human FAE. Specimens of normal ileum were taken from 30 patients with noninflammatory colonic disease. Villus epithelium (VE) and FAE were identified and mounted in Ussing chambers. Permeability to 51Cr-EDTA, transmucosal flux of the protein antigen, horseradish peroxidase (HRP), and transport of fluorescent Escherichia coli (chemically killed K-12 and live HB101) were measured. Uptake mechanisms were studied by confocal- and transmission electron microscopy, and by using pharmacological inhibitors in an in vitro coculture model of FAE and in human ileal FAE. HRP flux was substantially higher in FAE than in VE, and was reduced by an amiloride analog. Electron microscopy showed HRP-containing endosomes. Transport of E. coli K-12 and HB101 was also augmented in FAE and was confirmed by confocal microscopy. In vitro coculture experiments and electron microscopy revealed actin-dependent, mainly transcellular, uptake of E. coli K-12 into FAE. 51Cr-EDTA permeability was equal in FAE and VE. Augmented HRP flux and bacterial uptake but similar paracellular permeability, suggest functional variations of transcellular transport in the FAE. We show for the first time that FAE of human ileum is functionally distinct from regular VE, rendering the FAE more prone to bacterial–epithelial cell interactions and delivery of antigens to the mucosal immune system.

Keywords
E. coli, horseradish peroxidase, M cell, permeability, Peyer's patches
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14563 (URN)10.1038/labinvest.3700397 (DOI)
Available from: 2007-07-03 Created: 2007-07-03
Koch Frisén, A., Edwards, A., Haapaniemi, S., Nordin, P. & Kald, A. (2005). Prospective evaluation of 6895 groin hernia repairs in women. British Journal of Surgery, 92(12), 1553-1558
Open this publication in new window or tab >>Prospective evaluation of 6895 groin hernia repairs in women
Show others...
2005 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 12, p. 1553-1558Article in journal (Refereed) Published
Abstract [en]

Background: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair.

Methods: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men.

Results: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women.

Conclusion: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33238 (URN)10.1002/bjs.5156 (DOI)19237 (Local ID)19237 (Archive number)19237 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
Kald, A., Fridsten, S., Nordin, P. & Nilsson, E. (2002). Outcome of repair of bilateral groin hernias: A prospective evaluation of 1487 patients. European Journal of Surgery, 168(3), 150-153
Open this publication in new window or tab >>Outcome of repair of bilateral groin hernias: A prospective evaluation of 1487 patients
2002 (English)In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 3, p. 150-153Article in journal (Refereed) Published
Abstract [en]

Objective: To find out whether simultaneous repair of bilateral hernias increases the risk of recurrence compared with unilateral repair. Design: Prospective study. Setting: Swedish hospitals participating in the Swedish Hernia Register (SHR). Interventions: Prospective collection of data from the SHR, 1992-1999 inclusive. The Cox proportional hazard test was used for calculating odds ratio (OR). Main outcome measures: Hernia repairs were followed up in a life table fashion until re-operation for recurrence or death of the patient. Results: 33416 unilateral and 1487 bilateral operations on 2974 groin hernias were found. Direct hernias were more common in the bilateral than in the unilateral group, 1825, 61% compared with 13 336, 40%, (p < 0.0001). A laparoscopic method was used for 1774 (60%) of bilateral and 3285 (10%) unilateral repairs, and 455 bilateral operations (31%) were done as day cases compared with 18 376 (55%) unilateral ones (p < 0.0001 for both comparisons). The cumulative incidence of reoperation at three years for groin hernias after bilateral and unilateral repair was 4.1% (95% confidence interval 3.1% to 5.1%) and 3.4% (95% CI 3.1% to 3.7%, respectively. After adjustment for other risk factors, the OR for reoperation for recurrence after bilateral repair was 1.2 (95% C1 0.9 to 1.5) with unilateral repair as reference. The OR for reoperation after laparoscopic bilateral repair compared with open bilateral repair was 0.9 (95% CI 0.6 to 1.4). Conclusions: Simultaneous repair of bilateral hernias does not increase the risk of reoperation for recurrence and there is no significant difference in the risk of reoperration after bilateral repair using open or laparoscopic techniques.

Keywords
Bilateral, Groin hernia, Laparoscopy, Mesh, Repair
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47146 (URN)10.1080/110241502320127757 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Bringman, S., Ek, A.-C., Haglind, E., Heikkinen, T., Kald, A., Kylberg, F., . . . Anderberg, B. (2001). Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, 11(5), 322-326
Open this publication in new window or tab >>Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study
Show others...
2001 (English)In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, ISSN 1051-7200, E-ISSN 2331-2254, Vol. 11, no 5, p. 322-326Article in journal (Refereed) Published
Abstract [en]

Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon, There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups, Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.

Keywords
bilateral inguinal hernia, laparoscopic surgery, dissection balloon, totally extraperitoneal, conversion rate
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49103 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Organisations

Search in DiVA

Show all publications