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  • 1.
    Adell, Gunnar
    et al.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Boeryd, B.
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Frånlund, B.
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Håkansson, L.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes' B colorectal carcinoma: an immunohistochemical study1996In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 162, no 8, p. 637-642Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the incidence and prognostic importance of micrometastatic disease in regional lymph nodes from Dukes' B colorectal carcinomas.

    DESIGN: Retrospective study.

    SETTING: University hospital, Sweden.

    SUBJECTS: 100 patients operated on for primary colorectal carcinoma, classified as Dukes' B lesions.

    INTERVENTIONS: The regional lymph nodes were re-examined immunohistochemically using monoclonal antibodies against cytokeratin.

    OUTCOME MEASURES: Incidence and prognostic importance of micrometastases.

    RESULTS: Micrometastases were found in 39% (39/100) of the patients. The number of positive cells in the lymph nodes examined varied from 1 to over 100. They appeared as single cells or small clusters of cells located within the capsule or in the peripheral sinus of the lymph node. At least three sections from each of three lymph nodes had to be examined to identify 95% of the patients with lymph node micrometastases. The outcome of the patients with micrometastases was not significantly different from that of patients with no epithelial cells in the lymph nodes.

    CONCLUSION: Micrometastases in regional lymph nodes are a interesting phenomenon but clinically seem to be of only weak prognostic value.

  • 2.
    Alberth, Gunnar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Kettissen, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Blood loss in prosthetic hip replacement is not influenced by the AB0 blood group2001In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 167, no 9, p. 652-655Article in journal (Refereed)
    Abstract [en]

    Objective: To find out if there is a correlation between AB0 type and the amount of blood lost at operation. Design: Retrospective study. Setting: One county and one university hospital, Sweden. Subjects: 540 patients who underwent primary prosthetic hip replacement under regional anaesthesia. Albumin (n = 298) or dextran (n = 242) were used as plasma substitutes. Main outcome measures: Estimated blood loss and number of units of red cell concentrates transfused. Results: The characteristics of the study groups were similar. In patients given albumin, the mean (SD) intraoperative loss with blood group 0 (n = 100) was 718 (413) ml and 2.7 (1.9) red cell units were given. Those with other blood groups (n = 198) lost 713 (469) ml and were given 2.5 (2.0) units. In patients given dextran with blood group 0 (n = 82), the intraoperative blood loss was 650 (337) ml, the postoperative loss 480 (222) ml and they received 2.1 (2.1) units. The corresponding values in the patients with other blood groups (n = 160) were 665 (351), 498 (208) and 2.5 (2.1) units. Conclusion: Blood group 0 was not associated with increased blood loss.

  • 3.
    Andersson, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Halldestam, Ingvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Einarsson, Curt
    Borch, Kurt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Bouveret's syndrome followed by gallstone entrapment in the stomach: An uncommon cause of upper gastrointestinal bleeding and gastric retention2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 2, p. 183-185Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 4.
    Andersson, Roland
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Hugander, AP
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ghazi, SH
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ravn, H
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Offenbartl, SK
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Why does the clinical diagnosis fail in suspected appendicitis?2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 10, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Objective: To identify systematic errors in surgeons' estimations of the importance of diagnostic variables in the decision to explore patients with suspected appendicitis. Design: Prospective case series. Setting: Two emergency departments, Sweden. Patients: 496 patients with suspected appendicitis on admission, of whom 194 had a correct operation for appendicitis and 59 had a negative exploration. Main outcome measures: Predictors of a negative exploration expressed as the odds ratio (OR) for negative exploration. Variables influence on the decision to operate, expressed as the OR for operation, compared with the true diagnostic importance, expressed as the OR for appendicitis. Results: Predictors of negative explorations were high ratings in variables describing pain and tenderness (patient's perceived pain, abdominal tenderness, rebound tenderness, guarding or rectal tenderness), weak or absent inflammatory response, female sex, long duration of symptoms and absence of vomiting, with OR of 1.8-3.0. Pain and tenderness had too strong an influence on the decision to operate whereas the lack of an inflammatory response, no vomiting, and long duration of symptoms were not given enough attention. There was no sex difference in the proportion of patients with non-surgical abdominal pain (NSAP) who were operated on, but NSAP was more common and appendicitis less common among women, leading to a larger proportion of negative appendicectomies among women. Conclusion: Negative explorations in patients with suspected appendicitis are related to systematic errors in the clinical diagnosis with too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation. Rectal tenderness is not a sign of appendicitis. The risk of diagnostic errors is similar in men and women.

  • 5.
    Franzén, Thomas
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Anderberg, Bo
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Tibbling Grahn, Lita
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Johansson, Karl-Erik
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Prospective evaluation of laparoscopic and open 360o fundoplication in mild and severe gastro-oesophageal reflux disease2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 10, p. 539-545Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate the relationship between five-year control of reflux and early postoperative oesophageal function after total fundoplication done either laparoscopically or through a laparotomy in severe and mild reflux disease.

    DESIGN:

    Prospective open study.

    SETTING:

    University hospital, Sweden.

    PATIENTS:

    In the group with severe disease 9 patients had a laparotomy and 7 laparoscopy. The corresponding figures for the group with mild disease were 21 and 34 respectively.

    RESULTS:

    The increase in lower oesophageal sphincter pressure 6 months after operation in patients with recurrent disease was significantly less than that for patients with good reflux control (p < 0.01). In patients who had laparotomy, including 30% (9/30) with severe reflux disease, good long-term reflux control was found in 93% (27/29). In patients operated on laparoscopically including 17% (7/41) with severe reflux disease good long-term reflux control was found in 90% (35/39).

    CONCLUSION:

    The mechanism of recurrence differed between patients with severe disease who had a laparotomy and patients with mild disease operated on laparoscopically. Early postoperative manometry was prognostic for recurrence. Long-term reflux control seems to be similar after laparotomy and laparoscopy. Further randomised studies are needed.

  • 6.
    Franzén, Thomas
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Johansson, Karl-Erik
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Symptoms and reflux competence in relation to anatomical findings at reoperation after laparoscopic total fundoplication2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 12, p. 701-706Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate the mechanisms and anatomical failures after total laparoscopic fundoplication using the symptoms and findings at reoperation.

    DESIGN:

    Prospective open study.

    SETTING:

    University hospital, Sweden.

    PATIENTS:

    Twenty-one patients who were reoperated on a median of 33 (0.5-102) months after laparoscopic fundoplication.

    INTERVENTIONS:

    The patients were divided into three groups according to the mode of presentation. The first group presented with dysphagia and no gastro-oesophageal reflux (GOR) (n = 6). The second group (n = 11) had recurrent GOR and the third group (n = 4) complained of a sense of excessive fullness.

    RESULTS:

    In the dysphagia group the reason for it in 4 patients was severe fibrosis in the hiatal region including the right part of the fundoplication. One patient had correctly located fundoplication but it was too tight. In the last patient the part of the stomach used was too low down. All patients in the GOR group had a slippage and rupture of the fundoplication. Ten patients also had a recurrent hernia. In 6/11 patients the fundal mobilisation was incomplete. In the last group (excessive fullness) one patient had a postoperative leak from the fundal part, one patient a para-oesophageal hernia, and one patient an intact but herniated repair. One further patient had an intact abdominal oesophagus and crural repair, but a large portion of the stomach had herniated through the left part of the fundoplication and acted as a volvulus.

    CONCLUSIONS:

    Dysphagia was caused by hiatal fibrosis or other technical failures rather than a normal tight fundoplication. Using the wrong part of the stomach causes recurrent heartburn. The laparoscopic suturing technique must be improved.

  • 7.
    Haapaniemi, Staffan
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nilsson, Erik
    Motala Hospital, Motala, Sweden.
    Recurrence and pain three years after groin hernia repair: Validation of postal questionnaire and selective physical examination as a method of follow-up2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up.

    Design:

    Prospective cohort study.

    Setting:

    County hospital, Sweden.

    Patients:

    Prospective data were retrieved from the Swedish Hernia Register for patients aged 15–80 years at the time of groin hernia repair, operated on during 1994.

    Interventions:

    Three years after operation patients were mailed a three-item questionnaire and invited to have a physical examination. Those examined answered a detailed questionnaire about pain and functional impairment. When appropriate an extended physical examination was undertaken to find out the probable cause of the pain.

    Main outcome measures:

    Recurrence, pain, and functional impairment.

    Results:

    272 hernias were repaired in 264 patients. 24 patients had died and 16 had a recurrence before the follow-up examination. After a median observation time of 44 months, 218 patients with 223 repairs (96%) were examined. Depending on the definition of recurrence and completeness of physical examination (selective or all patients) the recurrence rate varied between 10% (25/239) and 15% (35/239) including recurrences diagnosed before follow-up. 40 patients (18%) reported groin pain at follow-up, which was considered to be caused by a previous hernia repair in 34 (15%), 12 of whom (5%) had moderate or severe pain. Postoperative complications were associated with an increased risk of chronic pain, whereas type of hernia and use of mesh had no influence.

    Conclusions:

    The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.

  • 8.
    Hagman, Monica
    et al.
    Department of Clinical Microbiology & Immunology, Örebro Medical Centre Hospital, Örebro and Värmland University College of Health and Caring Sciences, Karlstad, Sweden.
    Loogna, Peter
    Department of Surgery, Örebro Medical Centre Hospital, Örebro.
    Danielsson, Dan
    Department of Clinical Microbiology & Immunology, Örebro Medical Centre Hospital, Örebro.
    Domellöf, Lennart
    Värmland University College of Health and Caring Sciences, Karlstad, Sweden.
    Mutagenicity from neutrophils after challenge with Helicobacter pylori and bile1997In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 163, no 10, p. 753-759Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study some mechanisms involved in Helicobacter pylori (H. pylori)-induced gastric carcinogenesis.

    DESIGN: In vitro study.

    SETTING: Medical centre hospital, Sweden.

    INTERVENTIONS: Mutagenicity in Ames' test of neutrophils challenged for 2 hours or more by two different strains of H. pylori. One strain designated NCTC 11637 by the National College of Type Cultures activated neutrophils to an oxidative burst and producing vacuolating cytotoxin, the other strain C-7050 lacked these abilities. Mutagenicity was also studied with sterile human gall bladder bile alone added to neutrophils or in combination with both neutrophils and H. pylori.

    RESULTS: There was no increase in the number of revertants with the crude suspension or the supernatant of neutrophils challenged for 1 hour or less with H. pylori, bile, or the combination of both. However, in 5 out of 19 experiments there was significant mutagenicity after challenge of neutrophils for 2 hours or more with either strain of H. pylori, bile, or the combination of the two. The strongest mutagenicity was obtained after challenge over night (18 hours) with the combination of H. pylori and bile.

    CONCLUSION: Mutagenicity occurs when neutrophils are challenged with H. pylori and bile. Factors other than reactive oxygen metabolites seem to be responsible.

  • 9. Hellberg, Anders
    et al.
    Rudberg, Claes
    Enochsson, Lars
    Gudbjartson, Tomas
    Wenner, Jörgen
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Fenyö, György
    Ringqvist, Ivar
    Sörensen, Stefan
    Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?2001In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 167, p. 209-213Article in journal (Refereed)
  • 10. Isaksson, L
    et al.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Prognostic factors for failure of primary patency within a year of bypass to the foot in patients with diabetes and critical ischaemia2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 2, p. 123-128Article in journal (Refereed)
    Abstract [en]

    Objective: To find out whether we could identify prognostic factors for early failure of bypass to the foot in diabetic patients with critical ischaemia. Design: Retrospective series of consecutive patients. Setting: County hospital, Sweden. Patients: 43 diabetic patients who had 48 reconstructions for critical ischaemia between 1988 and 1994. Interventions: 48 elective vein bypass procedures to the feet. Main Outcome measures: Prognostic factors for primary patency. Results: Primary and secondary patency rates at one year were 72% (95% confidence interval (CI) 58 to 85) and 83% (95% CI 71 to 95), respectively. Limb salvage and survival rates at one year were 85% (95% CI 74 to 96) and 86% (95% CI 75 to 96), respectively. Vein graft of questionable quality, major wound healing problems, use of the reversed vein technique, and a narrow lumen (<1.5 mm) of the recipient artery increased the hazard for failed primary patency by 17.3 (p = 0.003), 6.0 (p = 0.02), 4.7 (p = 0.03), and 3.9 (p = 0.05) times, respectively. Short vein bypass (p = 0.70), translocated or composite veins (p = 0.61), major postoperative oedema of the leg (p = 0.46), or questionable quality of the wall of the recipient artery (p = 0.29), however, had no significant independent effect on the primary patency rate. Conclusion: Early primary patency after bypass to the foot in diabetic patients might improve if veins of questionable quality, major wound healing problems, thin reversed veins from the calf, and narrow recipient arteries can be avoided or handled more proficiently than in the present study.

  • 11.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Skau, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lundgren, F
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Aortoenteric fistula with aortic graft nfection - reconstruction of the abdominal aorta without a graft: a possible approach inb selected cases.1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 1201-1202Article in journal (Refereed)
  • 12.
    Kald, A
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Anderberg, B
    Kir klin Huddinge.
    Wirén, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Carlsson, P
    Ringqvist, I
    Cost-minimisation analysis of laparoscopic and open appendicectomy.1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 579-582Article in journal (Refereed)
  • 13.
    Kald, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Domeij, Erica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Landin, Susanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Wirén, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Anderberg, Bo
    Laparoscopic hernia repair in patients with bilateral groin hernias2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 3, p. 210-212Article in journal (Refereed)
    Abstract [en]

    Objective: To compare outcome of unilateral and bilateral laparoscopic hernia repair. Design: Prospective consecutive trial. Setting: University hospital, Sweden. Subjects: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. Main outcome measures: Operating time, hospital stay, complications, and time to recovery. Results: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. Conclusion: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.

  • 14.
    Kald, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Fridsten, S.
    Nordin, P.
    Nilsson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Outcome of repair of bilateral groin hernias: A prospective evaluation of 1487 patients2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 3, p. 150-153Article in journal (Refereed)
    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.

  • 15.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: endokir.
    Which factors influence the time from submitting of a manuscript to publication?1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 404-406Article in journal (Refereed)
  • 16.
    Norén, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Book Review: Atlas of cross-sectional and projective MR cholangiopancreatography; L van Hoe, D Vanbeckevoort and W Van Seenbergen.2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, p. 349-349Article in journal (Other (popular science, discussion, etc.))
  • 17.
    Persson, Gunnar E.
    et al.
    Department of Surgery, Ryhov Hospital in Jönköping, Sweden.
    Ros, Axel G. B.
    Department of Surgery, Ryhov Hospital in Jönköping, Sweden.
    Thulin, Anders J. G.
    Department of Surgery, Ryhov Hospital in Jönköping, Sweden.
    Surgical treatment of gallstones: changes in a defined population during a 20-year period2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 1, p. 13-17Article in journal (Refereed)
    Abstract [en]

    Objective:

    To study developments in routine gallstone surgery in a defined population over a 20-year period with regard to incidence of operations, implementation of new methods, postoperative complications, and postoperative duration of hospital stay.

    Design:

    Retrospective study of medical records.

    Setting:

    County hospital, Sweden.

    Subjects:

    All patients who were residents of Jönköping during one of the three-year periods 1976–1978, 1986–1988, or 1996–1998 and had their first surgical treatment, either cholecystectomy/choledochotomy or therapeutic endoscopy for gallstone disease.

    Results:

    The overall annual incidence of operations for gallstones decreased from 2.01 to 1.13/1000 inhabitants between the first and second period (p < 0.001). This is explained by a significant reduction in the number of elective operations while the number of urgent operations increased between the first and second periods from 0.39 to 0.53/1000 (p < 0.05) and continued to increase and reached 0.75/1000 during the third period (p < 0.001). New methods were introduced for the treatment of gallstones that gradually made this type of operation more varied and complex in routine practice. The postoperative hospital stay decreased from 7.0 days during the 1970s to 3.9 days during the 1990s. Postoperative morbidity was unchanged.

    Conclusions:

    The decreasing rate of gallstone surgery noted between the 1970s and 1980s did not continue through the 1990s. Urgent surgery for gallstone disease has gradually become more common and now predominates over elective surgery in routine practice. The introduction of less traumatic surgical techniques contributed to the significant decrease in hospital stay after gallstone surgery. However, morbidity has not decreased and the diversification of surgical techniques used for treatment of gallstones requires continuous evaluation in routine practice.

  • 18.
    Ros, Axel
    et al.
    Department of Surgery, County Hospital of Ryhov, Jönköping, Sweden.
    Haglund, Bengt
    National Board of Health and Welfare in Sweden, Stockholm, Sweden.
    Nilsson, Erik
    Department of Surgery, Motala Hospital, Motala, Sweden.
    Reintervention after laparoscopic and open cholecystectomy in Sweden 1987-1995: analysis of data from a hospital discharge register2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 12, p. 695-700Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To find out the incidence of cholecystectomy and of reintervention after cholecystectomy in Sweden 1987 to 1995, and to compare mortality and reintervention after simple laparoscopic and conventional open cholecystectomy (without exploration of the common bile duct or simultaneous operation).

    DESIGN:

    Analysis of data from Swedish national registers.

    SETTING:

    Two hospitals and government department, Sweden.

    MAIN OUTCOME MEASURES:

    Mortality and reintervention during readmission within one year after cholecystectomy classified as: reoperation on bile duct, endoscopic or percutaneous reintervention, or reoperation for wound complication, bleeding, or unspecified cause.

    RESULTS:

    Incidence of cholecystectomy rose between 1987-89 and 1993-95 from 0.97 to 1.04 for men and from 1.70 to 2.05 operations/1000 inhabitants for women. Reoperation on the bile ducts declined from 1987 to 1991 but returned to previous levels thereafter. Endoscopic reinterventions increased tenfold from 1987 to 1995, whereas those for general complications and mortality did not change significantly. Among simple cholecystectomies laparoscopic surgery was associated with an increased risk of endoscopic reintervention, odds ratio 1.8 (95% CI 1.2 to 2.6), and with a lower risk for postoperative mortality, odds ratio 0.5 (95% CI 0.3 to 0.8).

    CONCLUSIONS:

    Incidence, mortality, and readmission with reintervention are important endpoints in gallbladder surgery. Significant changes in these variables were identified after the introduction of laparoscopic cholecystectomy.

  • 19. Sandblom, Gabriel
    et al.
    Gruber, Göran
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Nilsson, Erik
    Audit and recurrence rates after hernia surgery2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 2, p. 154-158Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effect of quality assurance on the recurrence rate after hernia repair. Design: A prospective longitudinal cohort study. Setting: District hospital, Sweden. Subjects: All (n = 1232) patients aged 15-80 years operated upon for inguinal or femoral hernia in Motala 1984, 1986-1988, 1990, and 1992-1994. Intervention: A questionnaire enquiring about pain or a lump in the operated area was sent 3-6 years postoperatively to all patients, excluding those who had already been operated on for recurrence and those who had died. Selected cases were examined depending on the answers to the questionnaire. Main outcome measures: Recurrence rate estimated by adding already confirmed recurrences to those found at the clinical examination, reoperation for recurrence, hospital stay, and number of day cases. Cumulative incidence of reoperation was analysed by actuarial analysis of all patients operated on from 1986-1997. Results: The recurrence rate decreased from 18% in 1984 and 1986 to 3% in 1993 and 1994. The reoperation rate for recurrence at three years was 10.8% (95% confidence interval, CI: 9.3 to 12.2%), 3.6% (2.6 to 4.4%) and 2.2% (1.7 to 2.7%) for patients operated on between 1986-1988, 1989-1991 and 1992-1997, respectively. Differences between the first and the second and between the first and the third period were both highly significant (p < 0.001) whereas the difference between the second and third period was not (p = 0.09). Mean hospital stay decreased from 3.5 days in 1984 to 0.9 days in 1994. Conclusion: By recording recurrence rate or its surrogate endpoint, reoperation rate for recurrence, or both, hospital stay, and number of day cases, and presenting these results to participating surgeons, we provided incentives to improve outcome. This has resulted in a rapid decrease in recurrence rate and a shortened hospital stay, thereby improving cost-effectiveness.

  • 20.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Laparoscopic cholecystectomy for acute cholecystitis2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 16-17Article in journal (Refereed)
    Abstract [en]

    Acute cholecystitis was initially considered a contra-indication for laparoscopic cholecystectomy, but today the laparoscopic route is generally used even for severe acute cholecystitis. Several studies have shown that this is possible, although the conversion and complication rates are high, but there are no randomised controlled trials that evaluate the complications and costs of this technique compared with conventional open techniques. The timing of a laparoscopic cholecystectomy for acute cholecystitis is also a matter of debate as well as its use in elderly patients with this condition.

  • 21.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Laparoscopic cholecystectomy for acute cholecystitis1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no Suppl. 585, p. 16-17Article in journal (Refereed)
    Abstract [en]

    Acute cholecystitis was initially considered a contra-indication for laparoscopic cholecystectomy, but today the laparoscopic route is generally used even for severe acute cholecystitis. Several studies have shown that this is possible, although the conversion and complication rates are high, but there are no randomised controlled trials that evaluate the complications and costs of this technique compared with conventional open techniques. The timing of a laparoscopic cholecystectomy for acute cholecystitis is also a matter of debate as well as its use in elderly patients with this condition.

  • 22.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Results of laparoscopic compared with open cholecystectomy2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 12-15Article in journal (Refereed)
    Abstract [en]

    Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout the world. The avalanche-like spread resulted in this procedure not being scientifically supported by results of controlled clinical trials. By 1997 there were just 13 randomised controlled trials and 150 prospective studies that followed a research protocol, while there were more than 1500 retrospective analyses of series of operations in a country, in a specific hospital, or by a specific surgeon. Comparisons with the conventional laparotomy technique and with minilaparotomy techniques are complicated by the fact that the variables compared, such as operation times, complication rates, and costs, varied over time.

  • 23.
    Svanvik, Joar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Arvidsson, Dag
    Evaluation of laparoscopic procedures in the treatment of biliary disease, gastro-eosophageal reflux and inguinal hernia. State-of-the-art-konferens.2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166Article in journal (Refereed)
  • 24.
    Uranus, S.
    et al.
    Uranüs, S., Department of Surgery, Karl-Franzens Univ. Sch. of Medicine, Graz, Austria, Department of Surgery, Karl-Franzens Univ. Sch. of Medicine, Auenbruggerplatz 29, AT-8036 Graz, Austria.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Trauma management and education in Europe: A survey of twelve geographically and socioeconomically diverse European countries2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 12, p. 730-735Article in journal (Refereed)
    Abstract [en]

    Objective: To record the current standards of management and education in trauma surgery in 12 geographically and socioeconomically diverse countries in Europe. Design: Questionnaire study. Setting: Teaching hospital, Austria. Intervention: Questionnaire sent to experts on trauma in Austria, France, Germany, Italy, The Netherlands, Norway, Portugal, Romania, Spain, Sweden, Turkey, and the United Kingdom. Main outcome measure: Comparison of management of patients before, during, and after admission to hospital, and opportunities for initial and in-service training. Results: Management of patients and opportunities for training varied considerably from country to country, ranging from an organised trauma service throughout with specialised training to a haphazard and variable service that depended more on individual hospitals, doctors and patients. Conclusions: Standardisation of management and training would be desirable, and should be possible at least in countries that are members of the European Union.

  • 25.
    Wahlter, Sten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Wenyao, S
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: endokir.
    Pulmonary dynamics of radiolabelled erythrocytes and leucocytes in early gram-negative sepsis in pigs.1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 979-985Article in journal (Refereed)
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