1
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Nielsen LBJ, Ærenlund MP, Alouda M, Azzam M, Bjerke T, Burcharth J, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Malik T, Ngo-Stuyt L, Nielsen EØ, Olausson M, Skovsen AP, Tolver MA, Smith HG. Real-world accuracy of computed tomography in patients admitted with small bowel obstruction: a multicentre prospective cohort study. Langenbecks Arch Surg 2023; 408:341. [PMID: 37642708 PMCID: PMC10465641 DOI: 10.1007/s00423-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.
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Affiliation(s)
- L B J Nielsen
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - M P Ærenlund
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - J Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - H G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.
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2
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Kvist M, Henriksen NA, Burcharth J, Nielsen YW, Jensen TK. Rectus diastasis increases risk of burst abdomen in emergency midline laparotomies: a matched case–control study. Hernia 2022; 27:353-361. [PMID: 36422726 DOI: 10.1007/s10029-022-02719-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Burst abdomen is a serious complication requiring immediate surgical treatment. This study aimed to investigate the association between rectus diastasis and burst abdomen in patients undergoing emergency midline laparotomy. METHODS A single-center, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021 was conducted. Cases (patients who suffered from burst abdomen) were matched 1:4 with controls based on age and sex. Rectus diastasis was evaluated on CT imaging and was defined as a distance of at least three centimeters between the rectus abdominis muscles, three centimeters above the umbilicus. Midline laparotomy aponeurosis closure was standardized during the study period, using a slowly absorbable suture, sutured continuously with small bites of five millimeters and a minimum suture-to-wound ratio of 4:1. The primary outcome was the association between rectus diastasis and burst abdomen, evaluated against other suspected risk factors including obesity, liver cirrhosis, previous laparotomy, midline hernias and active smoking in a multivariate analysis. RESULTS A total of 465 patients were included in the study, with 93 cases matched to 372 controls. Eighty-four patients had rectus diastasis (35.5% cases vs. 13.7% controls; p = < 0.001). Multivariate analysis found rectus diastasis significantly associated with burst abdomen (OR 3.06, 95% CI 1.71-5.47; p = < 0.001). No other suspected risk factors showed a significant association with burst abdomen. CONCLUSION Rectus diastasis was highly associated with an increased risk of burst abdomen after emergency midline laparotomy.
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Affiliation(s)
- M Kvist
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
| | - N A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - J Burcharth
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Y W Nielsen
- Department of Radiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - T K Jensen
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
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3
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Tas A, Fosboel E, Butt J, Weeke P, Kristensen S, Burcharth J, Vinding N, Petersen J, Koeber L, Vester-Andersen M, Gundlund A. Perioperative atrial fibrillation in major emergency abdominal surgery: does it affect postoperative outcome? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) in relation to surgery remains a clinical challenge. Major emergency abdominal surgery (e.g. ileus, perforation) is associated with postoperative complications and mortality. However, the prevalence and impact of perioperative AF in this setting is not well examined.
Purpose
We compared 30-days and 1-year outcomes (i.e. hospitalization of any causes, AF-related hospitalization, thromboembolic events and all-cause mortality) in patients who did and did not develop perioperative AF (POAF) in relation to their major emergency abdominal surgery.
Methods
We crosslinked data from Danish nationwide registries and identified all patients who underwent major emergency abdominal surgery (2000–2018) and discharged alive. Patients who developed POAF during hospitalization were matched in a 1:3 ratio on age, sex, year of surgery and category of surgery with those without POAF. Starting follow up at discharge, we examined the rates of outcomes at 30-days and 1-year post-discharge. The cumulative incidences and ratios of outcomes were assessed with the Aalen Johanson estimator together with Kaplan-Meier estimator and multivariable Cox regression analysis, respectively.
Results
We identified 891 patients with POAF and 64,914 patients without POAF. The matched cohort were composed of 889 patients with POAF and 2667 patients without POAF with a median age of 79 years [25th-75th percentile; 72–84 years] and 45.2% males. In general, patients with POAF had higher comorbid burden compared with patients without POAF. The cumulative incidences of a hospitalization of any cause after 30-days post-discharge were 31.2% and 22.3% in patients with and without POAF, respectively. The corresponding numbers for AF-related hospitalization were 20.8% and 1.2%, respectively. In adjusted analyses, POAF was associated with a significantly higher risk of hospitalization of any causes together with AF-related hospitalization (Figure 1 and 2).
The cumulative incidences of a thromboembolic event after 30-days post-discharge were 2.2% and 0.9% in patients with and without POAF, respectively. The corresponding numbers for all-cause mortality were 9.7% and 3.2%, respectively. In adjusted analyses, POAF was associated with a significantly higher risk of a thromboembolic event together with all-cause mortality within 30-days of follow up as well as 1-year of follow up. However, the results regarding thromboembolic events did not reach statistical significance after 1-year of follow up (Figure 1 and 2).
Conclusions
Perioperative atrial fibrillation in relation to major emergency abdominal surgery was associated with higher 30-days and 1-year rates of hospitalizations of any causes, atrial fibrillation related hospitalization, a thromboembolic event and all-cause mortality. These findings suggest that perioperative atrial fibrillation is a strong prognostic marker of increased morbidity following major emergency abdominal surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Tas
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - S Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Burcharth
- Herlev-Gentofte University Hospital, Department of Surgucal Gastroenterology , Gentofte , Denmark
| | - N Vinding
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Petersen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Vester-Andersen
- Herlev-Gentofte University Hospital, Department of Anesthesiology , Gentofte , Denmark
| | - A Gundlund
- Herlev-Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
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4
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Wahlstrøm KL, Bjerrum E, Gögenur I, Burcharth J, Ekeloef S. Effect of remote ischaemic preconditioning on mortality and morbidity after non-cardiac surgery: meta-analysis. BJS Open 2021; 5:6176672. [PMID: 33733660 PMCID: PMC7970092 DOI: 10.1093/bjsopen/zraa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background Remote ischaemic preconditioning (RIPC) has been shown to have a protective role on vital organs exposed to reperfusion injury. The aim of this systematic review was to evaluate the effects of non-invasive RIPC on clinical and biochemical outcomes in patients undergoing non-cardiac surgery Methods A systematic literature search of PubMed, EMBASE, Scopus, and Cochrane databases was carried out in February 2020. RCTs investigating the effect of non-invasive RIPC in adults undergoing non-cardiac surgery were included. Meta-analyses and trial sequential analyses (TSAs) were performed on cardiovascular events, acute kidney injury, and short- and long-term mortality. Results Some 43 RCTs including 3660 patients were included. The surgical areas comprised orthopaedic, vascular, abdominal, pulmonary, neurological, and urological surgery. Meta-analysis showed RIPC to be associated with fewer cardiovascular events in non-cardiac surgery (13 trials, 1968 patients, 421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P = 0.03). Meta-analyses of the effect of RIPC on acute kidney injury (12 trials, 1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P = 0.50; I2 = 9 per cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65, 0.37 to 1.12; P = 0.12; I2 = 0 per cent), and long-term mortality (4 trials, 1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P = 0.56; I2 = 0 per cent) showed no significant differences for RIPC compared with standard perioperative care in non-cardiac surgery. However, TSAs showed that the required information sizes have not yet been reached. Conclusion Application of RIPC to non-cardiac surgery might reduce cardiovascular events, but not acute kidney injury or all-cause mortality, but currently available data are inadequate to confirm or reject an assumed intervention effect.
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Affiliation(s)
- K L Wahlstrøm
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - E Bjerrum
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - I Gögenur
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - J Burcharth
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - S Ekeloef
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
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5
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Friis C, Rothman JP, Burcharth J, Rosenberg J. Optimal Timing for Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review. Scand J Surg 2017; 107:99-106. [DOI: 10.1177/1457496917748224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Aims: Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is often used as definitive treatment for common bile duct stones. The aim of this study was to investigate the optimal time interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Materials and Methods: PubMed and Embase were searched for studies comparing different time delays between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Observational studies and randomized controlled trials were included. Primary outcome was conversion rate from laparoscopic to open cholecystectomy and secondary outcomes were complications, mortality, operating time, and length of stay. Results: A total of 14 studies with a total of 1930 patients were included. The pooled estimate revealed an increase from a 4.2% conversion rate when laparoscopic cholecystectomy was performed within 24 h of endoscopic retrograde cholangiopancreatography to 7.6% for 24–72 h delay to 12.3% when performed within 2 weeks, to 12.3% for 2–6 weeks, and to a 14% conversion rate when operation was delayed more than 6 weeks. Conclusion: According to this systematic review, it is preferable to perform cholecystectomy within 24 h of endoscopic retrograde cholangiopancreatography to reduce conversion rate. Early laparoscopic cholecystectomy does not increase mortality, perioperative complications, or length of stay and on the contrary it reduces the risk of reoccurrence and progression of disease in the delay between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.
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Affiliation(s)
- C. Friis
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J. P. Rothman
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J. Burcharth
- Department of Surgery, Sjællands Universitetshospital, Køge, Køge, Denmark
| | - J. Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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6
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Burcharth J, Pedersen M, Bisgaard T, Pedersen CB, Rosenberg J. Familial clustering and risk of groin hernia in children. BJS Open 2017; 1:46-49. [PMID: 29951605 PMCID: PMC5989964 DOI: 10.1002/bjs5.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/24/2017] [Indexed: 12/01/2022] Open
Abstract
Background The hypothesis was that groin hernias are hereditary. This study was undertaken to establish the degree of familial clustering of groin hernias on a nationwide scale. Methods A register‐based cohort was created consisting of all children in Denmark whose parents were born in 1970 or later by the use of the Danish Civil Registration System. Within this cohort, all groin hernia operations were identified. To establish the risk estimates associated with a positive family history of groin hernia operation, information on groin hernia operations in fathers, mothers and siblings was also assessed. Results In the cohort of 408 381 persons, a total of 4966 were operated on for groin hernia (incidence rate 2·12 per 1000 person‐years at risk). A person with a mother who had undergone surgery for a groin hernia had an increased risk of 2·89 (95 per cent c.i. 2·48 to 3·34) of having a groin hernia operation; a person with a father operated on for a groin hernia had an increased risk of 1·75 (1·58 to 1·94); and a person with a sibling operated on for a groin hernia had an increased risk of 2·54 (2·17 to 2·96). The strongest association was seen between mothers who had been operated on for groin hernia and their daughters (increased risk 6·01, 95 per cent c.i. 4·53 to 7·80), compared with the risk in girls who did not have a mother who had undergone surgery for groin hernia. Conclusion Groin hernias are clustered in families, with the strongest relationship seen between mothers and their daughters.
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Affiliation(s)
- J Burcharth
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital University of Copenhagen Herlev Denmark
| | - M Pedersen
- National Centre for Register-based Research University of Aarhus Aarhus Denmark
| | - T Bisgaard
- Department of Surgical Gastroenterology, Hvidovre Hospital University of Copenhagen Hvidovre Denmark
| | - C B Pedersen
- National Centre for Register-based Research University of Aarhus Aarhus Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital University of Copenhagen Herlev Denmark
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7
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Pommergaard HC, Burcharth J, Andresen K, Fenger AQ, Rosenberg J. No difference in sexual dysfunction after transabdominal preperitoneal (TAPP) approach for inguinal hernia with fibrin sealant or tacks for mesh fixation. Surg Endosc 2016; 31:661-666. [DOI: 10.1007/s00464-016-5017-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
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8
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Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. Advanced age is a risk factor for proximal adenoma recurrence following colonoscopy and polypectomy. Br J Surg 2015; 103:e100-5. [PMID: 26667088 DOI: 10.1002/bjs.10069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/06/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Knowledge of risk factors for recurrence of colorectal adenomas may identify patients who could benefit from individual surveillance strategies. The aim of this study was to identify risk factors for recurrence of colorectal adenomas in a high-risk population. METHODS Data were used from a randomized clinical trial that showed no effect of aspirin-calcitriol-calcium treatment on colorectal adenoma recurrence. Patients at high risk of colorectal cancer who had one or more sporadic colorectal adenomas removed during colonoscopy were followed up for 3 years. Independent risk factors associated with recurrence and characteristics of recurrent adenomas were investigated in a generalized linear model. RESULTS After 3 years, the recurrence rate was 25·8 per cent in 427 patients. For younger subjects (aged 50 years or less), the recurrence rate was 19 per cent; 18 of 20 recurrent adenomas were located in the distal part of the colon. For older subjects (aged over 70 years), the recurrence rate was 35 per cent, and 16 of 25 recurrent adenomas were in the proximal colon. Age (odds ratio (OR) 1·04, 95 per cent c.i. 1·01 to 1·07) and number of adenomas (OR 1·27, 1·11 to 1·46) at the time of inclusion in the study were independent risk factors for recurrence. CONCLUSION In contrast to current guidelines, advanced age is not a reason to discontinue adenoma surveillance in patients with an anticipated live expectancy in which recurrence can arise.
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Affiliation(s)
- H-C Pommergaard
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Hvidovre
| | - J Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev
| | - H Raskov
- Speciallaegecentret ved Diakonissestiftelsen, Frederiksberg, Denmark
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9
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Shapovalyants SG, Michalev AI, Timofeev ME, Polushkin VG, Volkov VV, Oettinger AP, Lorenz R, Koch A, Köckerling F, Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J, Friis-Andersen H, Li JW, Le F, Zheng MH, Roscio F, Combi F, Frattini P, Clerici F, Scandroglio I, Zhao X, Nie Y, Liu J, Wang M, Kuo L, Tsai CC, Mok KT, Liu SI, Chen IS, Chou NH, Wang BW, Chen YC, Chang BM, Liang TJ, Kang CH, Tsai CY, Dudai M, Zeng YJ, Liu TL, Shi CM, Sun L, Shu R, Kawaguchi M, Takahashi Y, Tochimoto M, Horiguchi Y, Kato H, Tawaraya K, Hosokawa O, Huang C, Sorge A, Masoni L, Maglio R, Di Marzo F, Mosconi C, Gallinella Muzi M, Kato J, Iuamoto L, Meyer A, Almehdi R, Alazri Y, Sahoo B, Ahmed R, Nasser M, Inaba T, Fukuhsima R, Yaguchi Y, Horikawa M, Ogawa E, Kumata Y, Pokorny H, Fischer I, Resinger C, Lorenz V, Podar S, Längue F, Etherson K, Atkinson K, Khan S, Pradeep R, Viswanath Y, Munipalle PC, Chung J, Schuricht A, Magalhães C, Marcos M, Flores A, Sekmen U, Paksoy M, Ceriani F, Cutaia S, Canziani M, Caravati F. Inguinal Hernia: Recurrences, Tailored Surgery & Pubic Inguinal Pain Syndrome (Sportsman Hernia). Hernia 2015; 19 Suppl 1:S167-75. [PMID: 26518795 DOI: 10.1007/bf03355345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S G Shapovalyants
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - A I Michalev
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - M E Timofeev
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - V G Polushkin
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - V V Volkov
- Department of Hospital Surgery 2, Russian National Research Medical University, Moscow, Russia
| | - A P Oettinger
- Institution of Applied Medical Sciences, Russian National Research Medical University, Moscow, Russia
| | - R Lorenz
- Hernia Center 3 Chirurgen, Berlin, Germany
| | - A Koch
- Surgical Practise, Cottbus, Germany
| | - F Köckerling
- Klinik für Allgemein, Viszeral und Gefäβchirurgie, Vivantes Klinikum Spandau, Berlin, Germany
| | - J Burcharth
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - K Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark.,Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H-C Pommergaard
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - T Bisgaard
- Department of Surgery, Hvidovre Hospital, Hvidovre, Denmark.,The Danish Hernia Database, Copenhagen, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark.,The Danish Hernia Database, Copenhagen, Denmark.,Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - J W Li
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | | | - F Roscio
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - F Combi
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - P Frattini
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - F Clerici
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - I Scandroglio
- Department of Surgery - Division of General Surgery, Galmarini Hospital, Tradate, Italy
| | - X Zhao
- Beijing Chao-Yang Hospital, Beijing, China
| | | | | | | | - L Kuo
- Department of General Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | - M Dudai
- Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel
| | - Y J Zeng
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - T L Liu
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - C M Shi
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - L Sun
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - R Shu
- Department of Gastroenterology and Hernia, The first affiliated hospital of Kunming Medical University, Kunming, China
| | - M Kawaguchi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Y Takahashi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - M Tochimoto
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Y Horiguchi
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - H Kato
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - K Tawaraya
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - O Hosokawa
- Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - C Huang
- Cathay medical center, Taipei, Taiwan.,Taipei medical university, Taipei, Taiwan
| | - A Sorge
- Ospedale S. Giovanni Bosco, Napoli, Italy
| | | | - R Maglio
- Ospedale Israelitico, Roma, Italy
| | - F Di Marzo
- Ospedale S. Giovanni Bosco, Napoli, Italy
| | - C Mosconi
- Policlinico Universitario Tor Vergata, Roma, Italy
| | | | - J Kato
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - L Iuamoto
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A Meyer
- Abdominal Wall Repair Center, Samaritano Hospital, Sao Paulo, Brazil
| | | | | | | | | | | | - T Inaba
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - R Fukuhsima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Yaguchi
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - M Horikawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - E Ogawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Kumata
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - H Pokorny
- LK Wiener Neustadt, Wiener Neustadt, Austria
| | | | | | | | | | | | - K Etherson
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - K Atkinson
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - S Khan
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - R Pradeep
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Y Viswanath
- Department of Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - J Chung
- University of Pennsylvania Health System, Philadelphia, USA
| | - A Schuricht
- University of Pennsylvania Health System, Philadelphia, USA
| | | | - M Marcos
- Centro Hospitalar Porto, Porto, Portugal.,Institute Cuf, Porto, Portugal
| | - A Flores
- Centro Hospitalar Porto, Porto, Portugal.,Institute Cuf, Porto, Portugal
| | - U Sekmen
- Acibadem Hospital, Istanbul, Turkey
| | - M Paksoy
- Dept. of Gen. Surg., Istanbul Uni. Cerrahpasa Med. School, Istanbul, Turkey
| | - F Ceriani
- Multimedica Santa Maria, Castellanza, Va, Italy
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10
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Andresen K, Burcharth J, Rosenberg J. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department. Scand J Surg 2015; 104:61-65. [DOI: 10.1177/1457496914529930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background and Aims: A new technique for the repair of inguinal hernia, called Onstep, has been described. This technique places the mesh in the preperitoneal space medially and between the internal and external oblique muscles laterally. The Onstep technique has not yet been described outside the inventors’ departments. This study was based on the first 80 patients operated by the Onstep technique in a general surgical department. The objective of the study was to investigate postoperative pain and complications following the Onstep repair of inguinal hernia. Material and Methods: A total of 80 patients, operated in our department, were followed up in the medical files and contacted by letter. Patients were asked to fill out the Inguinal Pain Questionnaire, Carolinas Comfort Scale, and the Activity Assessment Scale, in order to assess postoperative pain. Results: No perioperative complications occurred. The response rate was 85% on the mailed questionnaires. No patients had any activities they were not able to perform. Activity Assessment Scale results: 80.3% did not have substantial pain-related impairment of daily function. Carolinas Comfort Scale results: 94.8% did not have a symptomatic repair. Inguinal Pain Questionnaire results: 95.5% reported no pain or pain that was easily ignored. Conclusions: It seems from this study that the Onstep technique is a safe method for inguinal hernia repair regarding perioperative and postoperative complications. The postoperative pain seems to be equal to or lower than after the Lichtenstein technique.
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Affiliation(s)
- K. Andresen
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J. Burcharth
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J. Rosenberg
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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11
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Burcharth J, Pedersen MS, Pommergaard HC, Bisgaard T, Pedersen CB, Rosenberg J. The prevalence of umbilical and epigastric hernia repair: a nationwide epidemiologic study. Hernia 2015; 19:815-9. [DOI: 10.1007/s10029-015-1376-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
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12
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Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2014; 16:662-71. [PMID: 24655784 DOI: 10.1111/codi.12618] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023]
Abstract
AIM Colorectal anastomotic leakage is a serious complication. Despite extensive research, no consensus on the most important preoperative risk factors exists. The aim of this systematic review and meta-analysis was to evaluate risk factors for anastomotic leakage in patients operated with colorectal resection. METHOD The databases MEDLINE, Embase and CINAHL were searched for prospective observational studies on preoperative risk factors for anastomotic leakage. Meta-analyses were performed on outcomes based on odds ratios (OR) from multivariate regression analyses. The Newcastle-Ottawa scale was used for bias assessment within studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS This review included 23 studies evaluating 110,272 patients undergoing colorectal resection for cancer. The meta-analyses found that a low rectal anastomosis [OR = 3.26 (95% CI: 2.31-4.62)], male gender [OR = 1.48 (95% CI: 1.37-1.60)] and preoperative radiotherapy [OR = 1.65 (95% CI: 1.06-2.56)] may be risk factors for anastomotic leakage. Primarily as a result of observational design, the quality of evidence was regarded as moderate or low for these risk factors according to the GRADE approach. CONCLUSION Based on the best available evidence, important preoperative risk factors for colorectal anastomotic leakage have been identified. Knowledge on risk factors may influence treatment and procedure-related decisions, and possibly reduce the leakage rate.
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Affiliation(s)
- H C Pommergaard
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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13
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Farooqui W, Pommergaard HC, Burcharth J, Eriksen JR. The diagnostic value of a panel of serological markers in acute appendicitis. Scand J Surg 2014; 104:72-8. [PMID: 24737847 DOI: 10.1177/1457496914529273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 03/02/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Appendicitis is a frequent reason for hospital admissions. Elevated C-reactive protein, white blood cell count, and serum bilirubin have been suggested as individual markers for appendicitis and appendiceal perforation. The aim of this study was to analyze if a combination of serologic markers could increase the prognostic accuracy of diagnosing non-perforated and perforated appendicitis. MATERIAL AND METHODS Demographic data, histological findings, blood tests, and clinical symptoms were collected on all patients who underwent a diagnostic laparoscopy, a laparoscopic appendectomy, or conventional (open) appendectomy between May 2009 and May 2012 from a surgical department. The patients were grouped into those with either perforated appendicitis, non-perforated appendicitis, or differential diagnosis. Univariate and multivariate models were used to identify which markers were useful in predicting acute and perforated appendicitis, and receiving operating characteristics curves were used to find the specificity, sensitivity, and the negative and positive predictive values. RESULTS A total of 1008 patients were operated under suspicion of appendicitis. From these, 700 patients had a pathologically verified inflamed appendix and 190 had a perforated appendix. Patients with acute appendicitis had significantly higher blood levels of white blood cell, bilirubin, C-reactive protein, and alanine transaminase than patients without appendicitis. Patients with perforated appendicitis had significantly higher levels of white blood cell, bilirubin, and C-reactive protein than patients with non-perforated appendicitis. The highest positive predictive value to discriminate between acute appendicitis and non-appendicitis was of a linear regression model combining white blood cell count, bilirubin, and alanine transaminase. C-reactive protein levels and a linear regression model, including white blood cell count, bilirubin, and C-reactive protein levels as variables, had the highest negative predictive values when discriminating between perforated and non-perforated appendicitis. CONCLUSION Combining blood markers was useful in predicting appendicitis and perforated appendicitis. In addition to C-reactive protein and white cell count, blood levels of bilirubin, and alanine transaminase may be useful.
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Affiliation(s)
- W Farooqui
- Gastroenheden, Kirurgisk Sektion, Herlev Hospital, Herlev, Denmark
| | - H-C Pommergaard
- Gastroenheden, Kirurgisk Sektion, Herlev Hospital, Herlev, Denmark
| | - J Burcharth
- Gastroenheden, Kirurgisk Sektion, Herlev Hospital, Herlev, Denmark
| | - J R Eriksen
- Gastroenheden, Kirurgisk Sektion, Herlev Hospital, Herlev, Denmark
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14
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Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. Oral chemoprevention with acetyl salicylic Acid, vitamin D and calcium reduces the risk of tobacco carcinogen-induced bladder tumors in mice. Cancer Invest 2013; 31:490-3. [PMID: 23915073 DOI: 10.3109/07357907.2013.820316] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Bladder cancer is a common urological malignancy with high recurrence rate, which may be reduced by chemoprevention. The aim was to evaluate chemoprevention in a mouse model of tobacco carcinogen-induced bladder tumors. A total of 60 A/J mice were randomized to normal diet, diet with low calcium, and diet with chemoprevention (acetyl salicylic acid, 1-alpha 25(OH)2-vitamin D3 and calcium). There were significantly fewer tumors (0 (0-0) vs. 0 (0-2), p = .045) and fewer animals with tumors (0/20 vs. 5/20, p = .045) in the chemoprevention group compared with controls. Thus, chemoprevention diet effectively reduced the tumor promoting effect of tobacco carcinogens in the mouse bladder.
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Affiliation(s)
- H C Pommergaard
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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15
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Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. Topical treatment with diclofenac, calcipotriol (vitamin-D3 analog) and difluoromethylornithine (DFMO) does not prevent nonmelanoma skin cancer in mice. Cancer Invest 2013; 31:92-6. [PMID: 23362949 DOI: 10.3109/07357907.2012.762782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nonmelanoma skin cancer is a common cancer type with increasing incidence. The purpose of this study was to evaluate topical application of diclofenac, calcipotriol, and difluoromethylornithine as chemoprevention in a mouse model of ultraviolet light-induced skin tumors, since these agents have been reported to have tumor inhibiting properties. One hundred twenty eight mice were treated with UVB radiation followed by chemoprevention or placebo. There were no significant effects of the treatments with respect to presence of skin tumors, number of tumors, tumor size, or survival. The investigated drugs were ineffective as chemoprevention in the dose regimens used in this study.
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Affiliation(s)
- H C Pommergaard
- Department of Surgery, Herlev Hospital -University of Copenhagen, Herlev Ringvej, Herlev, Denmark.
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16
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Danielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Colorectal Dis 2013; 15:e276-83. [PMID: 23470040 DOI: 10.1111/codi.12197] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/23/2012] [Indexed: 12/12/2022]
Abstract
AIM A systematic review was performed to assess whether education of patients having stoma formation improves quality of life and whether it is cost effective. METHOD A literature search was performed to identify studies on the structured education of ostomates and outcome using the following databases: MEDLINE, Cinahl, Embase, Cochrane and PsycInfo. Inclusion criteria were: clinical studies reporting effects of educational interventions in relation to patients with a stoma. Commentaries or studies not testing an intervention were excluded. RESULTS Seven articles met the inclusion criteria of having rigorously evaluated an educational programme related to living with a stoma. The programmes were organized in different ways and had explored various interventions. The results showed an increase in health-related quality of life, as measured using a stoma quality of life instrument (P = 0.00001) and with the Short Form 36 (SF-36) (P = 0.000-0.006), an increase in proficiency in management of the stoma (P = 0.0005), two studies pointed to a reduction in postoperative hospital stay (8 days vs 10 days, P = 0.029; and 8 days vs 14 days, P = 0.17), a significant reduction in cost in the intervention group ($US 8570.54) compared with the control group ($US 7396.90) as well as higher effectiveness scores in the intervention group (166.89) compared with the control group (110.98), a significant rise in stoma-related knowledge (P = 0.0000) and an increase in psychosocial adjustment (P = 0.000). CONCLUSION Structured patient education aimed at patients' psychosocial needs seems to have a positive effect on quality of life as well as on cost. The interventions may be performed before, during or after hospital stay. However, the available data come from few studies with differences in interventions and in study design, and further studies are therefore needed before a final conclusion can be drawn.
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Affiliation(s)
- A K Danielsen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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17
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Abstract
BACKGROUND Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias. METHODS A literature search in the MEDLINE and Embase databases was performed with the following search terms: genetics, heredity, multifactorial inheritance, inheritance patterns, sibling relations, family relations, and abdominal hernia. Only English human clinical or register-based studies describing the inheritance of groin hernias, family history of groin hernias, or familial accumulation of groin hernias were included. RESULTS Eleven studies evaluating 37,166 persons were included. The overall findings were that a family history of inguinal hernia was a significant risk factor for the development of a primary hernia. A family history of inguinal hernia showed a tendency toward increased hernia recurrence rate and significantly earlier recurrence. The included studies did not agree on the possible inheritance patterns differing between polygenic inheritance, autosomal dominant inheritance, and multifactorial inheritance. Furthermore, the studies did not agree on the degree of penetrance. CONCLUSION The literature on the inheritance of groin hernias indicates that groin hernia is most likely an inherited disease; however, neither the extent of familial accumulation nor a clear inheritance pattern has yet been found. In order to establish whether groin hernias are accumulated in certain families and to what extent, large register studies based on hernia repair data or clinical examinations are needed. Groin hernia repair (inguinal and femoral hernia) is among the most commonly performed gastrointestinal surgical procedures [1]. Emergency groin hernia surgery is associated with increased mortality, increased patient-related morbidity, and increased hospital stay compared with elective groin hernia procedures [2, 3]. Identifying patients at high risk of developing groin hernia would therefore provide the possibility of timely elective surgical intervention, thus reducing the rate of emergency procedures. It could also potentially make way for individualized surgical methods in the future.
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Affiliation(s)
- J Burcharth
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, DK, Copenhagen, Denmark.
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18
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Abstract
BACKGROUND AND AIMS Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum bilirubin as a predictor for appendiceal perforation. MATERIAL AND METHODS Medline, Embase, and Cochrane databases were searched for studies evaluating elevated bilirubin in the diagnosis of perforated appendicitis. Study selection criteria included English language papers evaluating serum bilirubin as a marker of appendiceal perforation in humans. A total of 189 abstracts were screened for eligibility, of which five clinical studies were included in this study. RESULTS Bilirubin was significantly higher in patients with appendiceal perforation compared with patients with appendicitis without perforation. Elevated serum bilirubin had a sensitivity ranging from 0.38 to 0.77 and a specificity ranging from 0.70 to 0.87 in predicting appendiceal perforation. CONCLUSIONS Elevated serum bilirubin for determining the risk of perforation in appendicitis has low sensitivity but higher specificity. This measure can therefore be used as a supplement in the diagnostic process.
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Affiliation(s)
- J Burcharth
- Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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19
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Burcharth J, Pommergaard HC, Klein M, Rosenberg J. An Experimental Animal Model for Abdominal Fascia Healing after Surgery. Eur Surg Res 2013; 51:33-40. [DOI: 10.1159/000353970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 06/21/2013] [Indexed: 12/18/2022]
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Klein M, Krarup PM, Burcharth J, Ågren MS, Gögenur I, Jorgensen LN, Rosenberg J. Effect of diclofenac on cyclooxygenase-2 levels and early breaking strength of experimental colonic anastomoses and skin incisions. ACTA ACUST UNITED AC 2010; 46:26-31. [PMID: 21135559 DOI: 10.1159/000321706] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 09/30/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently, there has been a focus on the effect of the nonsteroidal anti-inflammatory drugs on the anastomotic leakage rate after colorectal surgery. METHODS An experimental, randomized, placebo-controlled prospective study on 32 male Wistar rats was carried out. We examined the effect of diclofenac 4 mg/kg/day on the cyclooxygenase-2 (COX-2) enzyme in the anastomotic tissue and on the breaking strength of anastomotic and incisional wounds. The operation was performed with colonic resection and hand-sewn anastomosis. After 3 days, the rats were sacrificed and the breaking strength and the COX-2 content of the anastomosis were measured. RESULTS There was a significantly reduced level of COX-2 in the rats treated with diclofenac (p = 0.001); no significant differences in any of the breaking strength measurements and no significant correlation between COX-2 levels and breaking strength of the anastomotic or incisional wounds could be found (p = 0.073 and p = 0.727). CONCLUSION This study for the first time showed that a diclofenac dose of 4 mg/kg/24 h was sufficient to reduce the level of COX-2 enzymes in the anastomotic tissue in rats. This inhibition of the inflammatory response did not lead to reduced breaking strength of either anastomotic or incisional wounds. Whether there is a detrimental effect of COX inhibition on colorectal anastomoses in the clinical setting remains controversial.
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Affiliation(s)
- M Klein
- Department of Surgical Gastroenterology D, Center for Perioperative Optimization, University of Copenhagen, Herlev Hospital, Herlev, Denmark.
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