Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

AbstractINTRODUCTIONThe aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) through cholangiotomy with T-tube placement in one séance for common bile duct stones (CBDS).METHODSBetween January 2005 and December 2010, a total of 99 patients with CBDS stones undergoing LCBDE with T-tube insertion at Enköping Hospital, Sweden, were registered prospectively. All patients were followed up by review of the patient records according to a standardised protocol.RESULTS No severe intraoperative complications were registered. Four procedures required conversion to open cholecystectomy due to impacted stones or technical difficulty. The mean operative time was 194 minutes (standard deviation [SD] 57 minutes). The mean postoperative hospital stay was 4.8 days, SD 2.4 days. At secondary cholangiography, 2 (2%) retained stones were found. Two (2%) patients had minor bile leakage, which resolved spontaneously. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No death within thirty days after surgery was seen. No patient was readmitted with clinical signs of stricture.CONCLUSIONIf performed by a surgeon familiar with the technique, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low

Randomised prostate cancer screening trial: 20 year follow-up

Objective To assess whether screening for prostate cancer reduces prostate cancer specific mortality

Mesh hernia repair and male infertility: A retrospective register study.

BACKGROUND: Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. METHODS: Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. RESULTS: Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. CONCLUSION: Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility

Registration of Health-Related Quality of Life in a Cohort of Patients Undergoing Cholecystectomy

Background. Assessment of gallstone surgery's impact on quality of life (QoL) requires a reliable instrument with sufficient responsiveness. The instrument should also enable estimation of each individual's expected condition in an unaffected state. Materials and Methods. The Swedish Register for Gallstone Surgery and ERCP (GallRiks) registers indications, complications, results, and QoL-outcome of gallstone surgery. In 2008, 68 hospitals were registered in GallRiks. Between 2007 and 2008, SF-36 (a short form health survey) was filled in 1-2 weeks pre- and 6–9 months postoperatively at five of the units. Expected scores were determined from an age- and gender-matched Swedish population (AGMSP). Results. Of the 330 patients, 212 responded to SF36 pre- and postoperatively (RR = 64%; 212/330). Standardized response means ranged from 0.20 to 0.93 for the SF-36 subscores. Highest responsiveness was seen for bodily pain. Preoperatively, all subscores were significantly lower than in the AGMSP (all P < .05). Six months postoperatively, there was no significant difference between any of the observed and expected quality of life subscales. Conclusion. SF-36 is a useful instrument for measuring the impact of gallstone surgery on QoL. The postinterventional health status equalled or even exceeded the AGMSP for all subscales

Validity of a virtual reality endoscopic retrograde cholangiopancreatography simulator: can it distinguish experts from novices?

BackgroundThere is a lack of evidence regarding the effectiveness of virtual simulators as a means to acquire hands-on exposure to endoscopic retrograde cholangiopancreatography (ERCP). The present study aimed to assess the outcome and construct validity of virtual ERCP when training on the GI II Mentor simulator.MethodsA group of seven experienced endoscopists were compared with 31 novices. After a short introduction, they were requested to carry out three virtual ERCP procedures: diagnosing and removing a common bile duct (CBD) stone; diagnosing and taking brush cytology from a hilar stenosis; and, finally, diagnosing and treating a cystic leakage with a BD stent. For each task, the total time required to complete the task, time required to correctly view the papilla, total time of irradiation, time to deep cannulation, time to define diagnosis, time to complete sphincterotomy, and time to complete the respective intervention were measured. Cannulation of the BD, correct diagnosis, sphincterotomy, and time to complete intervention were assessed by an assessor blinded to the status of the endoscopist who performed the virtual ERCP.ResultsThe time required to visualize the papilla and to cannulate deeply when removing the BD stone was significantly shorter for the experts (both p &lt; 0.05). The time to visualize the papilla, cannulate deeply, reach a diagnosis, complete sphincterotomy, and complete the intervention was significantly shorter for the experts when managing cystic leakage (all p &lt; 0.05). In diagnosing and taking brush cytology from a hilar stenosis, there was only a trend toward the experts needing less time for the deep cannulation of the BD (p = 0.077).ConclusionThe performance differed between experts and novices, especially in the management of cystic leakage. This corroborates the construct validity of the GI II Mentor simulator

Timing of elective cholecystectomy after acute cholecystitis : a population-based register study

Background: Acute cholecystectomy is standard treatment for acute cholecystitis. However, many patients are still treated conservatively and undergo delayed elective surgery. The aim of this study was to determine the ideal time to perform an elective cholecystectomy after acute cholecystitis. Methods: All patients treated for acute cholecystitis in Sweden between 2006 and 2013 were identified through the Swedish Patient Register. This cohort was cross-linked with the Swedish Register for Gallstone Surgery, GallRiks, where information on surgical outcome was retrieved. The impact of the time interval after discharge from hospital to elective surgery was analysed by multivariate logistic regression adjusting for gender and age. Results: After exclusion of patients not subjected to surgery, not registered in GallRiks and patients treated with acute cholecystectomy, 8532 remained. This cohort was divided into six-time categories. Using the first time interval &lt; 11 days from discharge to elective surgery as the reference category the chance of completing surgery with a minimally invasive technique was increased for all categories (p &lt; 0.05). The risk for perioperative complication and cystic duct leakage was reduced if surgery was undertaken &gt; 30 days after discharge (both p &lt; 0.05). The risk for bile duct injury was significantly increased if the procedure was undertaken &gt; 365 days after discharge (p = 0.030). The chance of completing the procedure within 100 min was not affected by time. Conclusion: For patients undergoing elective cholecystectomy after acute cholecystitis, the safety of the procedure increases if surgery is performed more than 30 days after discharge from the primary admission

Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery - a national population-based cohort study

PurposeParastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period.MethodsThe Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group.ResultsA total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI30 (HR 1.49; 95% CI 1.02-2.17; p&lt;0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p&lt;0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5years was 7.7% (95% CI 6.1-9.2%).ConclusionsThe cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5years was at least 7.7%. Obesity increases the risk of developing parastomal hernia