Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy:a nationwide register-based cohort study

Background/Objectives: L-RYGB and L-SG are the dominant bariatric procedures worldwide. While L-RYGB is an effective treatment of coexisting gastroesophageal reflux disease (GERD), L-SG is associated with an increased risk of de-novo or worsening of GERD. The study aimed to evaluate the long-term use of proton pump inhibitors (PPI) following laparoscopic Roux-en-Y gastric bypass (L-RYGB) and sleeve gastrectomy (L-SG). Subjects/Methods: This nationwide register-based study included all patients undergoing L-RYGB or L-SG in Denmark between 2008 and 2018. In total, 17,740 patients were included in the study, with 16,096 and 1671 undergoing L-RYGB and L-SG, respectively. The median follow up was 11 years after L-RYGB and 4 years after L-SG. Data were collected through Danish nationwide health registries. The development in PPI use was assessed through postoperative redeemed prescriptions. GERD development was defined by a relevant diagnosis code associated with gastroscopy, 24 h pH measurement, revisional surgery or anti-reflux surgery. The risk of initiation of PPI treatment or GERD diagnosis was evaluated using Kaplan–Meier plots and COX regression models. The risk of continuous PPI treatment was examined using logistic regression modeling. Results: The risk of initiating PPI treatment was significantly higher after L-SG compared with L-RYGB (HR 7.06, 95% CI 6.42–7.77, p &lt; 0.0001). The risk of continuous PPI treatment was likewise significantly higher after L-SG (OR 1.45, 95% CI 1.36–1.54, p &lt; 0.0001). The utilization of PPI consistently increased after both procedures. The risk of GERD diagnosis was also significantly higher after L-SG compared with L-RYGB (HR 1.93, 95% CI 1.27–2.93, p &lt; 0.0001). Conclusions: The risk of initiating and continuing PPI treatment was significantly higher after L-SG compared with L-RYGB, and a continuous increase in the utilization of PPI was observed after both procedures.</p

Chronic inflammation following hernia repair and cancer risk:A nationwide study

PurposeImplantation of mesh in patients undergoing hernia surgery or prolonged inflammation due to postoperative complication may be associated with increased risk of cancer. We aim to test whether implementation of mesh or complicated postoperative course with readmittance was associated with increased risk of cancer. MethodsThis register-based nationwide observational cohort study included 48,392 and 127,756 patients undergoing ventral and inguinal hernia surgery, respectively, during 1996–2004, with follow-up until Dec. 2014. In total, 16,909 patients undergoing ventral hernia repair with mesh, and 31,483 undergoing sutured repair, as well as 106,342 patients undergoing inguinal hernia repair with mesh and 21,414 undergoing sutured repair were included. Patients were matched with a reference cohort from the general Danish population and were followed in the Danish Cancer Registry. ResultsFor ventral hernia surgery, there was a significant association between mesh repair and risk of cancers, [(vs general population), HR 1.09 (95%CI, 1.00–1.18)]. Thirty-day readmission after mesh and sutured repair was associated with developing cancer [HR 1.15 (0.99–1.34) and 1.14 (1.00–1.31), respectively]. However, the association for suture repair (HR 1.14) did not reach statistical significance (p = 0.055). For inguinal hernia surgery, mesh repair was not associated with increased risk of cancer [(vs. general population), HR 1.00 (95%CI, 0.97–1.02)]. For both mesh and sutured repair, there was an increased risk for developing cancer after 30-day readmission, [HR 1.21 (1.12–1.31) and 1.24 (1.07–1.43), respectively]. ConclusionPatients undergoing ventral hernia repair with mesh and patients readmitted after inguinal or ventral hernia repair may have higher risk of developing cancer than the general population. These exploratory findings do not establish causality, but the association warrants further investigations in other populations.</p

Robotic Assisted Hernia Repair in Four Nordic Countries - Status and Challenges

Introduction Hernia is a prevalent medical condition affecting millions of individuals globally. The lifetime risk of undergoing inguinal hernia repair is 27% for men and 3% for women [1]. One in 10 patients will develop an incisional hernia after previous surgery, 1 in 20 will develop an umbilical hernia and up to 50% of all patients with a stoma will develop a parastomal hernia. Consequently, hernia repairs are among the most commonly performed surgical procedures worldwide and even minor improvements can significantly impact healthcare [2]. Traditionally, hernia repair surgery has been conducted using open or laparoscopic techniques. However, recent registry and single-centre studies have shown that robotic-assistedhernia repair has emerged as a promising alternative, providing benefits such as improved precision, reduced invasiveness, and better outcomes in terms of less pain, fewer wound complications and a shorter length of stay [3–5]. Therefore, the integration of robotic hernia surgery represents a significant opportunity to improve surgical practice and patient experience. Regardless of how promising the tools are, active surveillance is necessary, and the already established hernia registries such as the Danish and Swedish Hernia Registers provide the basis to do so. In Nordic countries, the adoption of robotic-assisted hernia surgery is increasing, although more slowly compared to other nations. Several challenges persist in the implementation of robotic-assisted hernia repair procedures [6]. To address these challenges a self-organised group of hernia experts from four Nordic countries decided to convene and discuss the future of robotic-assisted hernia surgery from a clinical perspective. The aim of the meetings was to review the current literature and discuss the potential benefits, challenges, and considerations associated with the adoption of robotic-assisted hernia surgery in their countries.Introduction Hernia is a prevalent medical condition affecting millions of individuals globally. The lifetime risk of undergoing inguinal hernia repair is 27% for men and 3% for women [1]. One in 10 patients will develop an incisional hernia after previous surgery, 1 in 20 will develop an umbilical hernia and up to 50% of all patients with a stoma will develop a parastomal hernia. Consequently, hernia repairs are among the most commonly performed surgical procedures worldwide and even minor improvements can significantly impact healthcare [2]. Traditionally, hernia repair surgery has been conducted using open or laparoscopic techniques. However, recent registry and single-centre studies have shown that robotic-assistedhernia repair has emerged as a promising alternative, providing benefits such as improved precision, reduced invasiveness, and better outcomes in terms of less pain, fewer wound complications and a shorter length of stay [3–5]. Therefore, the integration of robotic hernia surgery represents a significant opportunity to improve surgical practice and patient experience. Regardless of how promising the tools are, active surveillance is necessary, and the already established hernia registries such as the Danish and Swedish Hernia Registers provide the basis to do so. In Nordic countries, the adoption of robotic-assisted hernia surgery is increasing, although more slowly compared to other nations. Several challenges persist in the implementation of robotic-assisted hernia repair procedures [6]. To address these challenges a self-organised group of hernia experts from four Nordic countries decided to convene and discuss the future of robotic-assisted hernia surgery from a clinical perspective. The aim of the meetings was to review the current literature and discuss the potential benefits, challenges, and considerations associated with the adoption of robotic-assisted hernia surgery in their countries

Hepatic pseudoaneurysm after traumatic liver injury; is CT follow-up warranted?

INTRODUCTION: Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. The aim of this study was to investigate the occurrence of HPA post liver trauma. METHODS: A retrospective study from 2000-2010 of conservatively treated patients with blunt liver trauma was performed to investigate the incidence and nature of HPA. After the initial CT scan patients were admitted to the department and if not clinically indicated prior a follow-up CT was performed on day 4-5. RESULTS: A total of 259 non-operatively managed patients with liver injury were reviewed. 188 had a follow-up CT or US and in 7 patients a HPA was diagnosed. All aneurysms were treated with angiographic embolization and there were no treatment failures. There was no correlation between the severity of the liver injury and development of HPA. 5 out of 7 patients were asymptomatic and would have been discharged without treatment if the protocol did not include a default follow-up CT. CONCLUSIONS: In conclusion, this study shows that HPA is not correlated to the severity of liver injury and it develops in 4% of patients after traumatic liver injury. In order to avoid potentially life-threatening haemorrhage from a post trauma hepatic pseudoaneurysm, it seems appropriate to do follow-up CT as part of the conservative management of blunt and penetrating liver injuries

Robotic Assisted Hernia Repair in Four Nordic Countries - Status and Challenges

Peer reviewe

National clinical practice guidelines for the treatment of symptomatic gallstone disease:2021 recommendations from the Danish Surgical Society

Background and objective: Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS). Methods: An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences. Results: For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation). Conclusions: Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed. Endorsement: The Danish Surgical Society. </jats:sec

Treatment of incisional and parastomal hernias in Denmark

Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department for diagnosis and indication for surgery. Patients with giant and parastomal hernias are referred to one of the five Danish regional hernia centres. Patients with parastomal hernias often benefit from being referred to a stoma nurse. The most frequent complications after hernia repair are wound complications and recurrence. In case of severe wound infection, incarceration, or strangulation the patient must always be referred acutely, as argued in this review

Treatment of incisional and parastomal hernias in Denmark

Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department for diagnosis and indication for surgery. Patients with giant and parastomal hernias are referred to one of the five Danish regional hernia centres. Patients with parastomal hernias often benefit from being referred to a stoma nurse. The most frequent complications after hernia repair are wound complications and recurrence. In case of severe wound infection, incarceration, or strangulation the patient must always be referred acutely, as argued in this review