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Biomedical subjects

B Hallerbäck

Publications and source records attributed to B Hallerbäck.

At least 19 recordsLinked to original sources
PubMed1999

Prospective randomized multicentre study of laparoscopic versus open appendicectomy.

BACKGROUND: A prospective randomized multicentre study was performed to compare the outcome of laparoscopic and open appendicectomy in patients with suspected acute appendicitis. METHODS: A total of 523 patients was randomized, but because of 23 withdrawals the outcome in 500 patients is reported, 244 in the laparoscopic group and 256 in the open group. RESULTS: Patients having laparoscopic appendicectomy recovered more quickly than those having open surgery (13 versus 21 days, P < 0.001). There was no significant difference in duration of sick leave after operation (laparoscopic group 11 days versus open group 14 days). Postoperative pain (at 24 h, 7 days and 14 days) was less after laparoscopic operations and a functional index 1 week after operation was more favourable in these patients (P < 0.001). Operating time was significantly longer in the laparoscopic group (60 versus 35 min, P < 0.01). Hospital stay and complications did not differ between the groups. Thirty laparoscopic procedures (12 per cent) were converted to open appendicectomy. CONCLUSION: Laparoscopic appendicectomy is as safe as open appendicectomy and has the advantage of allowing a quicker recovery.

Acute Disease↗
PubMed1999

Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study).

OBJECTIVE: To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects. SUMMARY BACKGROUND DATA: Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has been questioned. The laparoscopic technique must be thoroughly compared with the open procedures before its true place in hernia surgery can be defined. METHODS: Six hundred thirteen male patients aged 40 to 75 years were randomized to the conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. RESULTS: Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. Patients who underwent TAPP gained full recovery after 18.4 days, compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 14.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days for the conventional procedure (p = 0.04). They also had significantly less restriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were more common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP group were recorded after 1 year (p = n.s.). CONCLUSION: The laparoscopic technique results in both shorter time to full recovery and shorter time to return to work, at the price of substantially increased costs.

Costs and Cost Analysis↗
PubMed1999

Complications following Swedish adjustable gastric banding: a long-term follow-up.

BACKGROUND: The Swedish adjustable gastric band (SAGB) has been in use since 1985. The aim of this study was to analyze short and long-term complications linked to the SAGB. MATERIALS AND METHODS: Between August 1990 and December 1996, we operated on a series of 326 patients (78 men and 248 women) at the Huddinge University Hospital and the Norra Alvsborg County Hospital. The mean age of patients at surgery was 40 years (range 19-62). The mean preoperative weight was 125 kg (range 81-181). The mean excess weight was 80%. RESULTS: The mean time of follow-up was 28 months (range 6-76). Complications requiring reoperation included two (0.6%) band dislocations, six (1.8%) band leakages, and 16 (4.6%) band migrations-erosions. The most common reason for abdominal reoperation, band migration, was attributed to overfilling of the band system. In the patients in whom migration occurred, the bands had been filled with a mean volume of 12.6 ml fluid. In the remaining patients, the mean volume was 8.7 ml. The most common complication not requiring reoperation was reflux disease (4.7%). In cases with a small pouch, this complication did not seem to be a serious problem. The mean excess weight loss in the 296 patients without complications was 68%. CONCLUSION: The overall long-term complication rate following SAGB is reasonable. With improved operating technique and closer follow-up, it should be possible to reduce the complication rate further. Reoperation because of band migration appears to be related to overfilling of the system and should therefore be avoidable in most cases.

Adult↗
PubMed1998

Gastro-oesophageal reflux symptoms--clinical findings and effect of ranitidine treatment.

BACKGROUND: This study was performed to study the demography, effect of treatment with ranitidine and relapse pattern in patients with reflux symptoms. METHODS: Patients with reflux symptoms were examined by endoscopy and included in a double-blind, comparative trial of placebo and ranitidine 150 mg b.i.d. for two weeks. At two weeks satisfied patients continued the same treatment. Non-satisfied patients were randomised to ranitidine 150 mg b.i.d. or q.i.d for another two weeks. After four weeks medication was stopped and satisfied patients were followed for 24 weeks. No further endoscopy was performed. RESULTS: Four hundred and twenty-seven patients were randomised. At two weeks there was no significant difference between placebo and ranitidine, regarding the proportion of patients with complete relief from symptoms or satisfied with treatment. Ranitidine was superior to placebo in improving symptoms at two weeks. Ranitidine, 150 mg q.i.d. offered no additional advantage in weeks three to four over prolonging treatment with 150 mg b.i.d. after the first two weeks. Patients with oesophagitis at inclusion relapsed more than those with symptoms only, 67% compared with 52%, (p = 0.013). CONCLUSIONS: The effect of ranitidine was marginal compared to placebo. The relapse rate was high after treatment stopped.

Adolescent↗
PubMed1998

Burden of illness in functional gastrointestinal disorder--the consequences for the individual and society.

OBJECTIVE: To review the consequences of functional gastrointestinal disorders (FGD), i.e. heartburn without esophagitis, dyspepsia and IBS for the individual and society. RESULTS: Current publications indicate that functional gastrointestinal disorders are more prevalent than organic gastrointestinal disorders in the population. Symptoms, not the organic finding per se, are most important to the individual. Functional disorders are furthermore linked to somatic symptoms, from other parts of the body, as well as to mental health. Together they constitute a large medical burden on society in terms of consultations, drug consumption and surgery. Social costs are further increased by problems at work and a considerable increase in absenteeism. CONCLUSIONS: Functional gastrointestinal disorders should be taken more seriously by the medical community and society, since the burden of illness seems much larger than earlier anticipated.

Absenteeism↗
PubMed1998

Laparoscopic surgery for morbid obesity.

Morbid obesity, defined as a body mass index (BMI), i.e. weight (kg)/height (m2) over 36 for males and 38 for females, is a common condition and a threat for health, life and individual well being. Hitherto, surgery is the only effective treatment for weight reduction. Surgical methods can be malabsorptive, reducing the patients ability to absorb nutrients, or restrictive, reducing the capacity of food intake. Exclusively malabsorptive methods have been abandoned due to severe side effects. Restrictive methods, gastroplasties, reduces the compliance capacity of the stomach. Two types are performed laparoscopically, the vertical banded gastroplasty and the adjustable gastric banding. The proximal gastric by pass is also performed laparoscopically and is a combination of a restrictive proximal gastroplasty and a malabsorptive Roux-en-Y gastro-jejunal anastomosis. With laparoscopic adjustable gastric banding mean BMI was reduced from 41 kg/m2 to 33 kg/m2 (n = 43) after one year. Two years after surgery mean BMI was 30 kg/m2 (n = 16). The different operative techniques are further discussed in this paper.

Adult↗
PubMed1997

Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair. A randomised controlled trial.

OBJECTIVE: To assess the effect of preoperative local anaesthesia with ropivacaine and find out if there was a dose-response relationship with postoperative pain after inguinal hernia repair. DESIGN: Randomised, double-blind, placebo-controlled trial. SETTING: Two Swedish and two Norwegian hospitals. SUBJECTS: 131 Male patients undergoing elective inguinal hernia repair. INTERVENTION: Infiltration of the inguinal field before operation with 0.5% ropivacaine 40 ml (200 mg), 0.25% ropivacaine 40 ml (100 mg) or saline 40 ml. MAIN OUTCOME MEASURES: Wound pain at rest and during mobilisation, pressure exerted to reach pain threshold and maximum pain tolerance after 3, 6, 10, and 24 hours, and after 7 days; consumption of analgesics; and Quality of Life assessed by two independent questionnaires before and after operation. RESULTS: Pain scores after 3 hours were significantly lower in the ropivacaine groups compared with the saline group for all variables (p < 0.05). At 6 hours pain scores were significantly lower for ropivacaine 0.5% compared with saline for wound pain during mobilisation and pressure exerted to reach maximum pain tolerance. Patients given saline made their first request for analgesics significantly sooner than in the other two groups (p < 0.05), and a significantly larger percentage of them requested analgesics during the first 24 hours (p < 0.05). Evaluation of the Quality of Life questionnaires showed no significant differences between the groups. CONCLUSION: Ropivacaine has a significant, dose-related pain-reducing effect in the immediate postoperative period but we could find no support for the theory that preoperative infiltration analgesia reduces long term pain.

Adolescent↗
PubMed1996

Laparoscopic suture closure of perforated peptic ulcer. A nonrandomized comparison with open surgery.

BACKGROUND: Laparoscopic vs open suture in the surgical treatment of perforated peptic ulcer were compared in a retrospective study. METHODS: The outcome of 10 patients having the laparoscopic procedure was compared with the outcome of 17 patients treated with suture via laparotomy during the same time period. RESULTS: The mortality rate and the complication rate were comparable. The laparoscopic procedure was more time consuming; hospital stay did not differ. CONCLUSIONS: The results indicate that surgery for perforated peptic ulcer can be performed with the laparoscopic technique with an outcome comparable to open surgery. No obvious advantages to the patient were noted with the laparoscopic method.

Aged↗
PubMed1996

Pathophysiology in gastroesophageal reflux disease: the surgeon's view.

Symptoms of gastroesophageal reflux are common in the general population. Pathophysiological factors of importance include esophageal and gastric motility, hiatal hernia, acid secretion as well as anatomical and hormonal factors. In the eye of the surgeon several of the most important factors for severe reflux can be corrected surgically. These include lower esophageal sphincter pressure, esophageal intra-abdominal length and hiatal hernia. The result of surgery is dependent on whether the patient has symptoms related to gastroesophageal reflux or not. It is important that disease history symptoms and pathophysiological findings at investigations match. We have found that not all physiological investigations have to be pathological. Symptomatic response to profound acid inhibition is essential, however, and patients not responding to a high dosage of proton-pump inhibitors should be reconsidered.

Fundoplication↗
PubMed1996

Quality of life: a reflection of symptoms and concerns.

BACKGROUND: Upper gastrointestinal complaints are common in the general population. Most patients consulting have no or only minimal markers of disease. It is important to evaluate new methods for the assessment and follow-up of treatment of these new patient groups. METHODS AND RESULTS: Recent publications on Quality of Life (QOL) and upper gastrointestinal disease are reviewed with the specific aim of relating the effect of disease symptoms and patient concerns to the outcome of investigations. We found that QOL is adversely affected in upper gastrointestinal disorders and that effective treatment medically or surgically normalizes the scores. There is a good correlation between degree of symptoms and QOL outcome. Patients' concern affects the outcome. CONCLUSION: QOL assessments are helpful in evaluating the impact of upper gastrointestinal disease.

Gastrointestinal Diseases↗
PubMed1995

Quality-of-life assessments in evaluation of laparoscopic Rosetti fundoplication.

UNLABELLED: It has recently been suggested that quality-of-life investigations should be included in the evaluation of new medical and surgical regimens. We present the quality-of-life evaluations for the first 40 consecutive patients undergoing laparoscopic antireflux surgery at our department. Two well-established and validated questionnaires, the Psychological General Well Being (PGWB) Index, and the Gastrointestinal Symptom Rating Scale (GSRS), were used. The PGWB gives a general measure of patients' well-being while the GSRS concentrates on gastrointestinal complaints. In untreated reflux esophagitis patients, the PGWB score is very low. We found normal PBWB scores preoperatively during optimal medical treatment with potent acid inhibition. The average score became significantly better (than on medical treatment, P < 0.05) 1 month postoperatively, after which it fell off to normal values 3 and 8-12 months after operation. The GSRS scores were good in all subgroups postoperatively, especially regarding reflux syndrome, where scores were significantly (P < 0.05) better than on medical treatment. IN CONCLUSION: After laparoscopic antireflux surgery, patients had good quality-of-life scores, better than untreated patients and as good as or better than on optimal medical treatment. Different treatment regimens could be discriminated by adding the patients' view of the treatment effect. We suggest that quality-of-life effects should be included when evaluating new regimens in laparoscopic surgery.

Esophagitis, Peptic↗
PubMed1995

Thoracic herniation and intrathoracic gastric perforation after laparoscopic fundoplication.

This case report describes a serious complication after laparoscopic Rosetti fundoplication. Two days postoperatively the proximal part of the stomach herniated into the thoracic cavity where a gastric perforation caused leakage. The patient was reoperated and a new fundoplication was constructed. Postoperatively the patient recovered. Possible mechanisms are discussed.

Female↗
PubMed1995

The effect of cisapride and ranitidine as monotherapies and in combination in the treatment of uncomplicated gastric ulceration.

BACKGROUND: Stimulation of gastric motility has been supposed to accelerate the healing of gastric ulcer. The combination of the prokinetic drug cisapride and the H2 blocker ranitidine was tested in the treatment of uncomplicated gastric ulcer. METHODS: Cisapride, 20 mg twice daily (Cis), and ranitidine, 150 mg twice daily (Ran), were given as monotherapies and in the combination 20 mg cisapride and 150 mg ranitidine daily (Cis + Ran) for a maximum of 8 weeks. The study was multicentre, randomized, and double-blind. RESULTS: A total of 197 patients were included. Healing rates in the per-protocol analysis after 4 and 8 weeks' treatment were 61%/84%, 52%/69%, and 61%/92% for the Cis + Ran (n = 56), Cis (n = 58), and Ran (n = 59) treatment groups. No statistically significant difference in healing rates was seen when comparing Cis + Ran with the monotherapies. Symptom relief at the end of treatment was significantly better in the Ran group than in the Cis + Ran group with regard to epigastric pain (p = 0.01) and vomiting (p = 0.05). Patients' global evaluation of treatment was in favour of Ran in comparison with Cis + Ran treatment (p = 0.04). CONCLUSIONS: Combination of cisapride and ranitidine in the treatment of gastric ulcer did not enhance the healing rate or improve symptom relief in patients treated for uncomplicated gastric ulcer when compared with the monotherapies.

Anti-Ulcer Agents↗
PubMed1995

Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer.

BACKGROUND: Few studies have evaluated quality of of life (QoL) in patients with upper gastrointestinal diseases, and there is a lack of validated measures for use in gastroenterology. METHODS: The applicability and relevance of self-administered questionnaires such as the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptoms referred to endoscopy because of suspected duodenal ulcer were evaluated. RESULTS: In total, 1526 patients with suspected duodenal ulcer were screened for inclusion in a clinical study. On the basis of medical history and endoscopy, 1424 patients who completed the questionnaire before endoscopy were classified in five diagnostic groups: oesophagitis, gastric ulcer, duodenal ulcer, negative endoscopy, and gastritis duodenitis. Irrespective of diagnosis, all patient groups reported a considerable decrease in their general well-being (mean score, 85, compared with 105 in healthy populations) with no significant differences between the groups. The results of the GSRS, however, showed statistically significant differences between the groups in dimensions depicting Abdominal pain, Reflux, Indigestion, and Diarrhoea Syndrome. CONCLUSIONS: The results of the study showed that, irrespective of endoscopic findings, patients complaining of upper gastrointestinal symptoms have a low degree of general well-being. The symptoms profiles in the different diagnostic groups vary considerably.

Duodenal Ulcer↗
PubMed1995

Laparoscopic Rosetti fundoplication.

BACKGROUND: Early experiences with laparoscopic fundoplication using the Rosetti technique are presented and compared with retrospective results from conventional fundoplication procedures. METHODS AND RESULTS: We have performed 70 consecutive laparoscopic procedures. Conversion to open surgery was done in seven cases because of anatomical reasons and in two because of peroperative progressive subcutaneous emphysema and CO2-retention. The complication rate was low. The range of postoperative hospital stay is 1-4 days for non-converted patients. Symptomatic follow-up has hitherto been performed in 41 patients with a follow-up time of 3-9 months. The follow-up results do not differ from those achieved in patients operated upon with the conventional open Nissen (n = 41) and Rosetti (n = 36) techniques. Pre- and postoperative control of 24 h pH and lower esophageal sphincter pressure (LESP) in 19 laparoscopically treated patients showed normalization of LESP in all cases and postoperative 24 h pH < 4 ranging between 0 and 3%. CONCLUSIONS: Laparoscopic and reflux surgery is effective for the treatment of reflux esophagitis. Follow-up results compare well with open surgery.

Adolescent↗
PubMed1995

Quality of Life assessments in the evaluation of gastroesophageal reflux and peptic ulcer disease before, during and after treatment.

BACKGROUND: It has recently been suggested that Quality of Life (QOL) be used in the evaluation of new medical treatment regimens together with cost-benefit, efficacy and safety. In this overview we point out some aspects of use of the Psychological General Well-Being Index (PGWB) in patients with peptic ulcer and reflux disease gained from our own investigations in later years. METHODS: QOL was assessed using questionnaires before diagnosis, during medical healing treatment and at a 1-year follow-up in peptic ulcer disease or before and after surgery in reflux disease. RESULTS: Untreated patients with unknown diagnosis had low QOL scores. With treatment, scores increased rapidly to supernormal values and fell off to normal values during the follow-up year. CONCLUSION: QOL evaluations seem sensitive and reflect the patient's subjective feeling of disease. They add another new aspect of treatment effect not earlier included in treatment evaluations.

Female↗
PubMed1994

Laparoscopic Rosetti fundoplication.

Early experiences with laparoscopic fundoplication using the Rosetti technique are presented and compared with retrospective results from conventional fundoplication procedures. A 360 degrees floppy fundoplication was laparoscopically constructed without division of short gastric vessels. We have performed 60 consecutive procedures. Conversion to open surgery was done in seven cases due to anatomical reasons and in two due to progressive subcutaneous emphysema and CO2-retention. The complication rate was low. The range of postoperative hospital stay is 1-4 days for non-converted patients. Symptomatic follow up has hitherto been performed in 41 patients with a follow-up time of 3-9 months. Regurgitation and heartburn had disappeared in all but one patient. The follow-up results do not differ from those achieved in patients operated upon with the conventional open Nissen (N = 41), Toupét (N = 9) or Rosetti (N = 36) technique. Pre and postoperative control of 24h pH and lower esophageal sphincter pressure (LESP) in 19 laparoscopically treated patients showed normalisation of LESP in all cases and postoperative 24h pH < 4 ranging between 0 and 3%. Assessment of quality of life showed postoperative results in accordance with normal population for all treated groups.

Esophagogastric Junction↗