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E Trondsen

Publications and source records attributed to E Trondsen.

At least 19 recordsLinked to original sources
PubMed2004

Outpatient laparoscopic splenectomy: patient safety and satisfaction.

BACKGROUND: We assessed the feasibility of outpatient laparoscopic splenectomy, as performed by an experienced laparoscopic term and combined with optimal anesthesia. METHODS: Inclusion criteria in the study was limited to patients not hospitalized before the procedure who had hematological or neoplastic indications for splenectomy and were classified as American Society of Anesthesiologists (ASA) I-III. They received general intravenous anesthesia with propofol and remifentanil and were given keterolac, propacetamol, droperidol, and ondansetron as prophylaxis against postoperative pain and nausea. Laparoscopic splenectomy was performed via three trocars. The specimen was removed via an incision in the left iliac fossa. RESULTS: Ten of the 12 patients were discharged 3-6 h postoperatively; the other two were admitted primarily to hospital. One was readmitted due to a fever, which was finally explained by measles. The median operative times was 58 min (range, 45-135). Patient satisfaction was excellent in nine and intermediate in two cases; it was poor in one case, due to postoperative pain. CONCLUSION: Laparoscopic splenectomy can be completed in a relatively short time; therefore, it is feasible, safe, and satisfactory for most patients as an outpatient procedure.

Adolescent↗
PubMed2004

Outpatient laparoscopic surgery: feasibility and consequences for education and health care costs.

BACKGROUND: The purpose of this paper is to describe the outcome of ambulatory laparoscopic cholecystectomy (LC), antireflux surgery, adrenalectomy and splenectomy and possible implications for surgical education and health care costs. METHODS: Prospective, observational study 1994-2003. RESULTS: The success rate of ambulatory treatment was 83.5% in 1060 LC patients, 80% in 113 antireflux procedures, 100% in 22 laparoscopic adrenalectomies, and 75% in 12 laparoscopic splenectomies. In a total number of 1207 patients, health care costs were reduced by almost 700,000 dollars, compared to 1-day hospital stay. The educational potential of same-day surgery is large, due to high numbers of patients, and 80% of our educational potential has been exploited. CONCLUSION: Ambulatory laparoscopic surgery is cost effective, patient friendly, and appropriate for surgical resident training. Strict organization of security rules is mandatory.

Adrenalectomy↗
PubMed2001

[Establishment of routines for elective laparoscopic surgery].

BACKGROUND: During the autumn of 1999, elective laparoscopic cholecystectomy was introduced as a new surgical procedure in the Central Hospital Østfold, Askim. A prospective evaluation of perioperative patient logistics and patient satisfaction was performed. MATERIAL AND METHODS: 214 patients were evaluated in the ambulatory; 116 of them were scheduled for operation. The operations were performed in general anaesthesia with continuous infusion of propofol and short acting opioides. Analgetics and anti-emetics were given pre- and perioperatively as prophylaxis against postoperative pain and nausea. RESULTS: There were three unexpected cancellations. Two patients had serious postoperative bleedings and two had symptoms indicating residual bile duct stones. Twenty-eight patients (24%) were discharged on the same day. 114 patients (98%) were satisfied with their stay in hospital. INTERPRETATION: The established patient logistics proved efficient and rational.

Cholecystectomy, Laparoscopic↗
PubMed2001

Outpatient laparoscopic adrenalectomy in patients with Conn's syndrome.

BACKGROUND: [corrected] We set out to record the operative times of an experienced laparoscopic team and assess the feasibility of outpatient laparoscopic adrenalectomy when optimal anesthesia was also offered to all patients. METHODS: The study included 13 patients with aldosterone/cortisone hypersecretion and/or adrenal gland tumors, excluding those with pheochromocytoma. They had to live within 30 min travel from the hospital, and adult company had to be present at home. All patients received general intravenous anesthesia with propofol and remifentanil and were given keterolac, propacetamol, droperidol, and ondansetron as prophylaxis against postoperative pain and nausea. Laparoscopic adrenalectomy was performed by the transabdominal lateral flank approach. Postoperatively, all patients were contacted by phone in the evening and the next morning. RESULTS: All 13 patients were discharged 3-6 h postoperatively. None were readmitted; thus, the day care success was 100%. The mean operative time was 38 min (range, 35-112). Patient satisfaction was excellent in all but one case, due to pain on the 1st postoperative day. CONCLUSION: Laparoscopic adrenalectomy can be a fast operation. It is feasible and safe and yields satisfactory results for patients as an outpatient procedure when the necessary surgical experience and optimal anesthesia are both available.

Adrenalectomy↗
PubMed2000

Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease.

BACKGROUND: Based on a series of successful outpatient laparoscopic cholecystectomies, day-case laparoscopic fundoplication for gastro-oesophageal reflux disease was introduced in January 1997. The initial results are reported. METHODS: Inclusion criteria were American Society of Anesthesiologists grade I-II, living within 30 min travel from the hospital, and adult company at home. Initially only selected patients were offered day-case treatment, but later it was adopted as routine. The patients underwent general intravenous anaesthesia with propofol and remifentanil, and were given ketorolac, propacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea. The surgical procedure was Nissen-Rosetti fundoplication or semifundoplication depending on oesophageal manometric results. RESULTS: Forty-five patients were included. Four patients were admitted; 41 were discharged as planned 3-8 h after operation, and five of these patients were readmitted. One underwent reoperation for necrosis of the gastric fundus. A further five patients visited the outpatient department without need for admission. At follow-up 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pain. If offered a similar operation in the future, 26 patients would have preferred and seven would have accepted day-case treatment, and eight would not. CONCLUSION: Outpatient laparoscopic fundoplication is safe and well tolerated by the majority of patients.

Adult↗
PubMed1999

[Choledochal cysts in adults].

Based on a case report, we describe choledochal cysts in adults. Choledochal cysts are rare, and are often overlooked. The aetiology is unknown. The symptoms are pain or discomfort, episodes of jaundice, cholangitis and pancreatitis. Increased liver function tests and gallstone disease are common. There is an increased risk of malignant tumours in the cysts and adjacent organs. Ultrasonography, computer tomography, endoscopic retrograde cholangiopancreaticography, percutaneous cholangiography and magnetic resonance imaging with magnetic resonance cholangiopancreaticography are relevant diagnostic tools. Extrahepatic cysts should be operated with radical excision, with Roux-Y hepaticojejunostomy or other reconstructions allowing later diagnostic and therapeutic access to the bile ducts. Long term results are good.

Adult↗
PubMed1999

Laparoscopic and open operation in patients with perforated peptic ulcer.

OBJECTIVES: To compare the results of laparoscopic and open operations in patients with perforated peptic ulcer. DESIGN: Retrospective analysis. SETTING: Central hospital, Norway. SUBJECTS: 74 patients (36 men, 38 women, median age 69.5 years (18-86)) admitted with perforated peptic ulcers from November 1991-May 1996. INTERVENTIONS: Suture of the ulcer, patching with the greater omentum and lavage, in 49 by open operation and 25 laparoscopically. MAIN OUTCOME MEASURES: Duration of postoperative hospital stay, operating time, number of doses of analgesic, postoperative body temperature, complications, and mortality. RESULTS: There was a significant difference (p = 0.0001) in median operating time: 100 minutes (range 48-160) in the laparoscopic group and 50 minutes (range 20-160) in the open group. The median hospital stay was 8 days in both groups: range 3-23 days in the laparoscopic group and 2-28 days in the open group. There were no significant differences between the two groups with regard to median number of doses of analgesic, median body temperature, complications or mortality. CONCLUSION: Laparoscopic operation for perforated peptic ulcer can be considered as safe as open operation.

Adolescent↗
PubMed1998

Prediction of common bile duct stones prior to cholecystectomy: a prospective validation of a discriminant analysis function.

BACKGROUND: Selection routines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with symptomatic gallstone disease should give a low frequency of both false-negative ERCP results and residual common bile duct stones (CBDS). OBJECTIVE: To validate a discriminant function (DF) based on retrospectively collected data, for characterization of patients with symptomatic gallstone disease as regards presence of CBDS, and to compare clinical, ultrasonographic, and DF characterization. DESIGN: Prospective registration of CBDS criteria in consecutive patients with symptomatic gallstone disease. SETTING: A department of surgical gastroenterology in a Norwegian central hospital. PATIENTS: One hundred ninety-two patients with gallbladder stones. INTERVENTION: Laparoscopic cholecystectomy or ERCP with or without endoscopic sphincterotomy. MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of the clinical, ultrasonographic, and DF characterizations, and test of the validity of the DF. RESULTS: Thirty-two patients had CBDS. The clinical criteria of CBDS were present in 152 patients (79.2%): 21.1% of these patients had CBDS and there were no false-negative results (sensitivity, 100%; specificity, 25%). The risk of CBDS in patients with normal bile ducts at ultrasonographic examination was 8 of 124, and in patients with dilated ducts or suspected CBDS, 17 of 47 (sensitivity, 68%; specificity, 80%). The DF was positive in 50 patients (26%): 60% of these had CBDS, and there were 2 false-negative results (sensitivity, 94%; specificity, 88%). A discriminant analysis of the prospectively registered data selected the same set of CBDS criteria, and a new DF did not alter the characterization of any patient. CONCLUSIONS: Clinical characterization had a higher sensitivity for CBDS detection than ultrasonography alone, but a lower specificity. The DF analysis was both more sensitive and specific than ultrasonography, and seemed efficient in selecting symptomatic gallstone patients for ERCP. It was reproducible and simple to use.

Adult↗
PubMed1998

An experimental study on effects of monopolar diathermy on the bile ducts.

OBJECTIVE: To study the effects of monopolar diathermy on the bile ducts in pigs. DESIGN: Experimental study. SETTING: University hospital, Norway. MATERIAL: 18 pigs. INTERVENTIONS: Laparotomy, application of diathermy at standard sites along the cystic duct, the bile ducts, and a cystic duct containing a metal clip, 3 to 12 times of 5 seconds' duration at each site. Temperature was subsequently recorded at standard measurement points on the bile ducts. Twelve pigs were killed after three weeks for assessment of the bile ducts at necropsy. MAIN OUTCOME MEASUREMENTS: Increase in temperature in the bile duct walls and late changes in the bile ducts. RESULTS: Temperature increased by 4-6 degrees C during 6 of 330 diathermy applications along the cystic duct, by 4-18 degrees C in 8 of 126 applications along the common bile duct, and by 4-11 degrees C at the clip in 9 of 54 applications. There were no macroscopic or microscopic changes in the bile ducts. CONCLUSION: Monopolar diathermy induced unexpected distant increases in the temperature of the bile duct walls and at a clip on the cystic duct probably because diathermy current energy was distributed along channels of high current conductivity.

Animals↗
PubMed1997

Outpatient laparoscopic cholecystectomy.

INTRODUCTION: The results of laparoscopic cholecystectomy performed as an outpatient procedure were evaluated in a prospective study. METHODS: Initially, only well motivated and healthy patients were offered outpatient laparoscopic cholecystectomy. After 50 procedures, all patients referred to the hospital, except those with American Society of Anesthesiologists (ASA) grade IV and those living alone, were included. Some 200 procedures were studied. RESULTS: Twelve patients (6 per cent) were admitted, and 188 (94 per cent) were discharged 4-8 h after operation. Fifteen patients (8 per cent) who had early discharge were readmitted, nine with complications; in six no complications were documented. The frequency of minor complications was 2 per cent and of major complications 5 per cent. Some 173 patients who had successful outpatient laparoscopic cholecystectomy completed a questionnaire: 164 (95 per cent) characterized their experience as excellent, five (3 per cent) as good, two (1 per cent) as intermediate and two (1 per cent) as unacceptable. DISCUSSION: This high achievement of day-case treatment, even in patients with ASA grade III, is explained by a new anaesthetic regimen together with good surgical technique and close follow-up.

Adolescent↗
PubMed1997

An experimental study on effects of occlusion of the cystic duct in mice with or without emptying of the gallbladder.

To study consequences of cystic duct occlusion, 121 NMRI mice were operated: 40 had cystic duct ligature (L group), 41 had cystic duct ligature and evacuation of bile from the gallbladder (LE group), and 40 were sham-operated (S group). Ten mice from each group were sacrificed at 1 week, 1, 3 and 6 months, respectively. All but 2 mice showed signs of wellbeing during the observation time, and weight gain was the same in the three groups. Distended gallbladder occurred in 14 animals, 7 each in the L and the LE group, more frequent after 3 and 6 months. In the remainder mice the gallbladders were smaller than at the time of operation (p < 0.0001). Fibrosis and adhesions around the gallbladder were frequent in the L and the LE groups, and more pronounced in the latter (p = 0.0001). At microscopy there were signs of inflammation in the gallbladder wall in 16 cases in the L group, 28 in the LE group and 2 in the S group, and the degree of inflammation was more pronounced in the LE group than in the L group (p = 0.002). Eleven mice in the LE group had empyema, and slight intralumininal inflammation was more frequent in the LE group than in the L group (p < 0.0001). In conclusion, despite a high incidence of microscopic inflammation the study gave no indication that occlusion of the cystic duct did serious harm to the mice in this series.

Animals↗
PubMed1997

Randomized controlled trial with sequential design of laparoscopic versus conventional appendicectomy.

BACKGROUND: A prospective study including 272 patients with suspected appendicitis was performed. The aims were to evaluate the representativity of the study group and to compare diagnostic and therapeutic laparoscopy with conventional appendicectomy. METHODS: The study was an open, randomized, single-centre trial with sequential design. One hundred and eight patients were randomized between laparoscopy or conventional appendicectomy, of whom 84 had acute appendicitis. Duration of postoperative convalescence was the major endpoint. RESULTS: The study patients were representative of the eligible population regarding age and stage of appendicitis. The risk of unnecessary appendicectomy was significantly (P = 0.03) lower after laparoscopy. The mean difference in duration of postoperative convalescence was 4.7 days in favour of of laparoscopic appendicectomy (P = 0.07), and 26 min in duration of operation in favour of conventional appendicectomy (P < 0.01). No differences were detected in postoperative hospital stay, pain assessment or complications. CONCLUSION: The laparoscopic procedure is at least as good as conventional appendicectomy. Initial laparoscopy reduces the rate of misdiagnosis.

Adolescent↗
PubMed1997

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group.

BACKGROUND: The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. METHODS: One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. RESULTS: The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. CONCLUSION: The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Adult↗
PubMed1994

Comparison of sequential and fixed-sample designs in a controlled clinical trial with laparoscopic versus conventional cholecystectomy.

BACKGROUND: The aim of this study was to compare a fixed-sample and a sequential design with regard to study duration, sample size, and medical results in a real-life situation. METHODS: A randomized study comparing laparoscopic and conventional cholecystectomy was carried out with a fixed-sample design, parallel with a sequential design. The main variable was duration of postoperative convalescence. RESULTS: In the fixed-sample trial the necessary number of patients was calculated to be 72. The sequential trial was conclusive after inclusion of 24 patients and reduced the duration of the study from 43 to 18 weeks. Additionally, the sequential trial reached the same conclusions as the fixed-sample trial in all the observed variables except for one. CONCLUSION: The present study indicates that sequential design should be used more frequently in clinical trials, to involve the smallest possible number of patients necessary to reach a conclusion.

Adult↗
PubMed1994

Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals.

OBJECTIVE: To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990. DESIGN: Postal collection of prospectively collected data. SETTING: Practices of 26 surgeons in 7 district and university hospitals. SUBJECTS: 527 patients who underwent laparoscopic cholecystectomy. INTERVENTIONS: 133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37. MAIN OUTCOME MEASURES: Morbidity, number converted to open operation, and number who required reoperation. RESULTS: There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury. CONCLUSION: The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.

Bile Ducts↗
PubMed1993

Safety of enoxaparin and dextran-70 in the prevention of venous thromboembolism in digestive surgery. A play-the-winner-designed study.

A total of 327 patients were included in a play-the-winner (PTW)-designed study comparing the safety of prophylaxis with enoxaparin and dextran-70 in patients undergoing digestive surgery. In a PTW-designed study the treatment of any next patient will depend on the outcome of the previous one. If successful, the next patient will receive the same treatment. Excessive bleeding, on the basis of specified criteria, severe adverse effects, or occurrence of clinically detected venous thromboembolism was classified as failure. The PTW design allocates most patients to the superior treatment. In this study 200 patients were given enoxaparin and 127 dextran-70. The success rate was 83% in the enoxaparin group and 74.8% in the dextran-70 group (p = 0.05). The survival analysis of 'Number of patients before change in treatment' shows a significant difference in favour of enoxaparin (p = 0.05). Enoxaparin seems to be superior to dextran-70 as a prophylaxis in digestive surgery. The PTW model is a suitable design in such studies.

Adolescent↗
PubMed1993

[Gastroenterological surgical procedures using a flexible scope].

The past decade has witnessed revolutionary developments in the applications of operative endoscopy, and many new techniques have replaced conventional surgical procedures. With the modern flexible instruments available for gastro-intestinal endoscopy, it is possible to reach the oesophagus, stomach, duodenum, colon and ileum. The range of treatment options has been successively broadened by the combination of endoscopy with such procedures as diathermy, laser, electrohydraulic shock waves and ultrasonography.

Cholecystectomy, Laparoscopic↗