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  • 1.
    Bringman, S.
    et al.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Ek, A.
    Ek, Å., Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Haglind, E.
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Heikkinen, T.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Kald, Anders
    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.
    Kylberg, F.
    Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Ramel, S.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Wallon, Conny
    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.
    Anderberg, B.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study2001In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 15, no 3, p. 266-270Article in journal (Refereed)
    Abstract [en]

    Background: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. Methods: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. Results: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). Conclusion: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.

  • 2.
    Bringman, S
    et al.
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Haglind, E
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Heikkinen, TJ
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Kald, Anders
    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.
    Kylberg, F
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ramel, S
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Wallon, Conny
    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.
    Anderberg, B
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study2001In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, ISSN 1051-7200, E-ISSN 2331-2254, Vol. 11, no 5, p. 322-326Article in journal (Refereed)
    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.

  • 3.
    Frisén, Angelica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Kald, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment.
    Better outcome for female groin hernia patients when using preperitoneal techniquesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: It is not known why women have higher frequencies of postoperative complications and reoperation than men after groin hernia repair. This study analyses postoperative results for female hernia in order to identify the appropriate techniques to attain adequate repair and improve operative outcome.

    Method: A registry-based retrospective cohort study analysing data from 10 971 groin hernia repairs on women from the Swedish Hernia Register, 1992-2006.

    Results: Our data showed that the risk for reoperation was significantly reduced (RR 0.6 95% CI 0.4-0.8) by using a preperitoneal repair, and three times as many femoral hernias were diagnosed in elective repairs. Time to reoperation was increased from a median of 1 year to 3.5 years (p=0.002) when using a preperitoneal repair, and time to reoperation for femoral recurrence after an inguinal primary hernia was increased from 1 year to 5.2 years (p=0.025).

    Conclusions: Operative outcome for groin hernia repair in women was improved and risk for recurrence reduced by the utilisation of a preperitoneal approach. More femoral hernias were diagnosed in elective repairs and time to reoperation for femoral recurrence after an inguinal primary hernia was increased. We believe it is necessary to use a preperitoneal technique that visualizes all three locations for groin hernia in order to identify and adequately repair the hernia.

  • 4.
    Kald , Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Authors reply: Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh (Br J Surg 2008; 952009In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 96, no 2, p. 221-221Article in journal (Refereed)
  • 5.
    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.

  • 6.
    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.
    Juul, Kristian N.
    Coloplast A/S, Clinical Development Global RD, Humlebaek, Denmark.
    Hjortswang, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Sjödahl, Rune
    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.
    Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy2008In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, no 5, p. 627-633Article in journal (Refereed)
    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.

  • 7.
    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.
    Landin, S.
    Masreliez, C.
    Sjödahl, Rune
    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.
    Mesh repair of parastomal hernias: New aspects of the Onlay technique2001In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 5, no 3, p. 169-171Article in journal (Refereed)
    Abstract [en]

    When a hernia becomes symptomatic with pain, obstruction, or mechanical distortion, need for a repair is likely. In this short note are new aspects on the Onlay mesh repair technique of parastomal hernias presented. The satisfactory results achieved in 5 patients are reported. One recurrence required a further successful repair.

  • 8.
    Keita, Åsa V
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Gullberg, Elisabet
    Department of Pharmacy, Uppsala University, BMC, Uppsala, Sweden.
    Ericson, Ann-Charlott
    Linköping University, Department of Clinical and Experimental Medicine, Cellbiology. Linköping University, Faculty of Health Sciences.
    Salim, Sa’ad Y
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Wallon, Conny
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Kald, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Artursson, Per
    Department of Pharmacy, Uppsala University, BMC, Uppsala, Sweden.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Characterization of antigen and bacterial transport in the follicle-associated epithelium of human ileum2006In: Laboratory investigation, ISSN 0023-6837, Vol. 86, no 5, p. 504-516Article in journal (Refereed)
    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.

  • 9.
    Koch Frisén, Angelica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Bringman, S.
    Department of Surgery, Södertälje Hospital, Sweden.
    Myrelid, Pär
    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.
    Smeds, Staffan
    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.
    Kald, Anders
    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.
    Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh2008In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 10, p. 1226-1231Article in journal (Refereed)
    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.

  • 10.
    Koch Frisén, Angelica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Edwards, A.
    Surgical Directorate, Arrowe Park Hospital NHS Trust, Wirral, UK.
    Haapaniemi, Staffan
    Vrinnevi Hospital, Norrköping.
    Nordin, P.
    Östersund Hospital, Östersund, Sweden.
    Kald, Anders
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Prospective evaluation of 6895 groin hernia repairs in women2005In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 12, p. 1553-1558Article in journal (Refereed)
    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.

  • 11.
    Koch Frisén, Angelica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Starck, Joachim
    Department of Surgery, Västervik Hospital, Västervik, Sweden.
    Smeds, Staffan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Nyström, PO
    Department of Surgery, Department of Gastrointestinal Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Kald, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, p. 281-288Article in journal (Refereed)
    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.

  • 12.
    Nordin, Pär
    et al.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Haapaniemi, Staffan
    Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden.
    Kald, Anders
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nilsson, Erik
    Department of Surgery, Motala Hospital, Motala, Sweden.
    Sutures and surgical techniques in herniorrhaphy: an analysis of 18 057 sutured non-mesh repairsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Although mesh techniques are used with increasing frequency sutured repairs will continue to have a place in groin hemia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh techniques on risk for reoperation in open groin hernia repair using data from the Swedish Hernia Register (SHR).

    Methods: The relative risk for reoperation after sutured repairs using nonabsorbable, late absorbable and early absorbable sutures were compared in multivariate analyses taking into account known confounding factors.

    Results: During 1992 -2000, 46,745 hernia repairs were recorded in the SHR. Of these 18,057 repairs were performed with open non-mesh methods and included in the analysis. With nonabsorbable suture as reference the relative risk for reoperation of early absorbable suture and of late absorbable suture was 1.50 (95% CI 1.22-1.83) and 1.03 (95% CI 0.83-1.28), respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk for reoperation 1.22 (95% CI 1.03-1.44).

    Conclusion: For open non-mesh groin hernia repairs a nonabsorbable or a late absorbable suture is recommended. The Shouldice technique was found superior to other open methods.

  • 13.
    Nyström, Per-Olof
    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.
    Kald, Anders
    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 sigmoid resection for diverticular disease1999In: Zentralblatt für Chirurgie, ISSN 0044-409X, E-ISSN 1438-9592, Vol. 124, no 12, p. 1147-1151Article in journal (Refereed)
    Abstract [en]

    It is still difficult to determine the exact indication for a laparoscopic sigmoid resection for diverticular disease. Frequently, the severity of diverticulitis is not sufficiently defined. For this reason a modification of the Hinchey classification is proposed to which a stage II b for fistula formation and a differentiation between acute and chronic disease have been added. Another problem is the lack of criteria which define a "laparoscopic" resection. A sigmoid resection should be called "laparoscopic" if the mobilization of the sigmoid colon, the transsection of the mesenteric vein and artery and the mesentery itself and the distal transsection of the bowel are done laparoscopically. The resection of the bowel and the introduction of the anvil of the stapler device can be done extraabdominally, however, the anastomosis again should be performed laparoscopi- cally. A so defined sigmoid rejection can be done in the chronic stage I. In the chronic stage II a there will be significant problems due to adhesion formation, and in the acute stages II a and II b as well as in the chronic stage II b a laparoscopic resection should not be attempted.

  • 14.
    Smeds, Staffan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kald, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lofstrom, L
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study2010In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 249-252Article in journal (Refereed)
    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.

  • 15.
    Smeds, Staffan
    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.
    Löfström, Lars
    Sergelkliniken Linköping.
    Kald, Anders
    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.
    Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 21, p. 1582-1584Article in journal (Refereed)
    Abstract [en]

       

  • 16.
    Zdolsek, Johann
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Enebog, J.
    Wallon, Conny
    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.
    Kald, Anders
    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.
    A prospective evaluation of the PerFix® Plug technique for groin hernia repair2000In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 4, no 4, p. 311-315Conference paper (Other academic)
    Abstract [en]

    The aim of the study was to prospectively evaluate complication rates, sick-leave, recurrence rate, and chronic post-operative pain after mesh-plug hernia repair. All 385 consecutive inguinal hernias (373 patients) operated at our department with the PerFix® Plug from September 1996 to December 1997 were included in the study. Follow-up included a questionnaire 3 and 12 months after the repair. Replies to the both of these questionnaires were obtained from 363 of 373 patients (98%). All patients who either reported a lump or sensory disturbance in the operated groin were offered a clinical examination. A third questionnaire focusing on chronic post-operative pain was completed by 77 of 90 patients reporting groin pain. The recurrence rate was 2% (9/385). After 25 months (17-36 months) 38 patients (10%) still experienced inguinal pain to some degree. In 7 male patients there was either pain or discomfort during sexual activities. In a patient with poorly controlled ascites the plug was removed. Day-case surgery was performed in 86% of patients with epidural or local anaesthesia, and 64% in general- or spinal anaesthesia. Employed/self-employed patients were off work for a median of 7 days (0-65). The median time to full recovery for all patients was 20 days. Conclusion: Mesh-plug hernia repair has a reasonably low complication rate together with quick recovery in a non-specialised surgical setting. Chronic inguinal pain is, however, still present to some degree in 10% of patients after two years.

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