Results of cholecystectomies 2003-2010 in a small hospital in Iceland

Tilgangur: Gallblöðrutaka er ein af algengustu aðgerðunum í almennum skurðlækningum. Tilgangur rannsóknarinnar var að meta árangur gallblöðrutöku á Heilbrigðisstofnun Vesturlands (HVE) á Akranesi. Efniviður og aðferðir: Rannsóknin var afturskyggn og tók til allra sjúklinga sem gengust undir gallblöðrutöku á HVE á Akranesi frá 1. janúar 2003 til 31. desember 2010. Upplýsingum var safnað úr sjúkraskrám af á HVE Akranesi, Landspítala og Domus Medica. Niðurstöður: 378 sjúklingar gengust undir gallblöðrutöku á tímabilinu, þar af 280 konur (74%) og var meðalaldur 49,6 ár. Aðgerðirnar voru að meirihluta valaðgerðir (87%) og var aðgerðartími 46 mínútur (miðgildi, bil: 17-240). Legutími var 2 dagar (miðgildi, bil: 1-31). Röntgenmyndataka af gallvegum í aðgerð var framkvæmd hjá 93 af 378 sjúklingum (25%). Röntgenrannsókn á gallvegum og brisgangi með holsjá var síðar framkvæmd hjá 22 af þeim 93 sjúklingum (23%) vegna gallsteina í megingallrás. Tveimur aðgerðum var breytt yfir í opna aðgerð (0,5%).Tíðni alvarlegra fylgikvilla var 2,4%, þar af fengu fjórir (1,1%) sjúklingar djúpa sýkingu og 5 (1,3%) fengu gallleka. Sjúklingar með sögu um gallblöðrubólgu voru marktækt líklegri til að fá alvarlega fylgikvilla (p=0,007). Enduraðgerð var framkvæmd hjá þremur sjúklingum vegna gallleka. Enginn sjúklingur hlaut alvarlegan skaða á gallrás. Enginn sjúklingur lést af völdum aðgerðar. Eftirlit var framkvæmt fjórum vikum eftir aðgerð hjá 254 sjúklingum (67%) en af þeim höfðu 13 (5%) væg einkenni frá kviðarholi. Ályktun: Árangur af gallblöðrutökum á HVE á Akranesi er mjög góður og vel sambærilegur við árangur sem greint er frá í fyrri rannsóknum bæði hérlendis og erlendis. Abstract AIM: Cholecystectomy is a common procedure in general surgery. The aim of this study was to retrospectivly assess the results of cholecystectomies performed in Akranes Hospital (AH), a small hospital in Iceland. MATERIAL AND METHODS: This retrospective study included all patients that underwent a cholecystectomy in AH from 1 January 2003 to 31 December 2010. Patient records were reviewed from AH, as well as from Landspitali University Hospital and Domus Medica. RESULTS: 378 operations were performed. 74% of the patients were women and the mean age was 49.6 years. The majority of operations were elective (87%) and the median operative time was 46 minutes (range: 17-240). The median length of stay was 2 days (range: 1-31). Intra-operative cholangiography (IOC) was performed in 93 of 378 patients (25%). Endoscopic retrograde cholangiopancreatography, ERCP, was performed consecutively in 22 of those 93 patients (23%). The conversion rate to open surgery was 0.5%. The rate of serious complications was 2.4% of which four (1.1%) patients had a deep infection and 5 (1.3%) had a bile leakage postoperatively. Patients with cholecystitis had an increased risk of serious complications (p=0.007). Reoperation was performed on three patients who had bile leakage. No patient had a serious bile duct injury and mortality was 0%. 254 (67%) patients had 4 week control postoperatively where 13 patients (5%) had mild gastrointestinal symptoms. CONCLUSION: The results of cholecystectomies in AH are very good and comparable to the results of national and international studies. Key words: laparoscopic cholecystectomy, intra-operative cholangiography, choledocholithiasis, endoscopic retrograde cholangiopancreatography, complications. Correspondence: Marta Ros Berndsen, [email protected]

Hermt eftir sofandi manni

Sannleikur, heiðarleiki og raunveruleiki hefur verið í hávegum hafður í samfélagi manna um árabil. Tilgangur, sannleikur og viðhorf fólks gagnvart lífinu hafa orsakað hugarangur manna og umfram allt verið vísir að ofbeldi og stríði. Sömu sögu má segja af listum og menningu þar sem listaverk hafa staðið og fallið með trúverðugleika og einlægni listamannsins. Ef tilgangurinn með lífinu er enginn og lífið allt í raun og veru sviðsetning fellur þetta allt hinsvegar um sjálft sig. Í ritgerð þessari verður fjallað um það sviðsetta samfélag sem við búum í, birtingarmyndir sjónarspils í samfélaginu, vísindum og fræðigreinum. Sviðsetning myndlistar verður einnig skoðuð og myndlist höfundar sérstaklega tekin fyrir. Vitnað verður í hugmyndir spekinga á borð við Jean Baudrillard, Guy Dubord og Jean Paul Sartre og þær tengdar við listhugsun höfundar

Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair

Background and Aims. The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods. A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results. There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions. Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor