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F Johnsson

Publications and source records attributed to F Johnsson.

At least 19 recordsLinked to original sources
PubMed2000

[Laparoscopic surgery--evidence-based ?].

The literature has been searched for current results in laparoscopic cholecystectomy, hernia repair, appendectomy and fundoplication. This was performed as a systematic review. Laparoscopic cholecystectomy was judged to be safe and cost/effective, with good patient acceptability. However a need for further studies is indicated. Laparoscopic technique in hernia repair has a longer learning curve and is more expensive than open repair, with no major difference in recurrence rates. It is preferable in bilateral repairs. Laparoscopic appendectomy in the hands of experienced surgeons is cost/effective. Time to recovery is shorter and the rate of infectious complications is lower than in conventional procedures. There are still too few results reported from laparoscopic fundoplication to permit reliable conclusions.

Appendectomy↗
PubMed2000

Anastomotic diameters and strictures following esophagectomy and total gastrectomy in 256 patients.

The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n = 107) or total gastrectomy and Roux reconstruction (n = 149). No perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p = 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p = 0.176) nor that in the gastrectomy group (abdomen or chest) (p = 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.

Adult↗
PubMed2000

Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period.

BACKGROUND: There is a widespread belief that introduction of the laparoscopic technique in antireflux surgery has led to easier postoperative recovery. To test this hypothesis a prospective randomized clinical trial with blind evaluation was conducted between laparoscopic and open fundoplication. METHODS: Sixty patients with gastro-oesophageal reflux disease were randomized to open or laparoscopic 360 degrees fundoplication. The type of operation was unknown to the patient and the evaluating nurses after operation. RESULTS: The operating time was longer in the laparoscopy group, median 148 versus 109 min (P < 0.0001). The need for analgesics was less in the laparoscopically operated patients, 33.9 versus 67.5 mg morphine per total hospital stay (P < 0.001). There was no significant difference in postoperative nausea and vomiting. On the first day after operation patients in the laparoscopy group had better respiratory function: forced vital capacity 3.2 versus 2. 2 litres (P = 0.004) and forced expiratory volume 2.6 versus 2.0 litres (P = 0.008). Postoperative hospital stay was shorter in the laparoscopic group, median (range) 3 (2-6) versus 3 (2-10) days (P = 0.021). No difference was found in the duration of sick leave. CONCLUSION: Laparoscopic fundoplication was associated with a longer operating time, better respiratory function, less need for analgesics and a shorter hospital stay, while no reduction in the duration of postoperative sick leave was found compared with open surgery.

Adult↗
PubMed2000

Authors' reply

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Journal Article↗
PubMed2000

Neither low-calorie diet nor vertical banded gastroplasty influence gastro-oesophageal reflux in morbidly obese patients.

OBJECTIVE: Investigate the effect of a liquid diet, and of vertical banded gastroplasty, on gastro-oesophageal reflux in morbidly obese patients. DESIGN: Prospective study, patients being their own controls. SETTING: University hospital, Sweden. SUBJECTS: 25 morbidly obese patients, listed for vertical banded gastroplasty. INTERVENTIONS: 24 hour ambulatory intra-oesophageal pH-monitoring three weeks before operation and repeated after 10-14 days on a liquid very low calorie diet, and finally three weeks after operation, while still on a liquid very low calorie diet. MAIN OUTCOME MEASURES: Percentage of time that pH in the oesophagus was < or =4. RESULTS: There were no changes in the amount of reflux, either after a liquid diet or after vertical banded gastroplasty. CONCLUSIONS: Neither the liquid diet nor vertical banded gastroplasty alone had any appreciable effect on gastro-oesophageal reflux.

Adult↗
PubMed2000

Screening for oesophageal adenocarcinoma: an evaluation of a surveillance program for columnar metaplasia of the oesophagus.

BACKGROUND: Screening patients with columnar metaplasia of the oesophagus for adenocarcinoma is controversial owing to the low cancer incidence and diverging opinions as to whether screening improves the prognosis of these patients. Our aim was to evaluate a screening program for adenocarcinoma in patients with columnar metaplasia in the oesophagus, with focus on cancer incidence and costs. METHODS: One hundred and ninety-nine patients with columnar metaplasia of the oesophagus were identified through an endoscopy database, and the original patient records were reviewed. RESULTS: The patients were followed up for 797 years in total and during this time were subjected to 1071 upper gastrointestinal endoscopies. During the screening period 5 patients presented with adenocarcinoma; thus the cancer-incidence was 1 in 159 patient-years. The cost of detecting one cancer was 294,950 SEK (US$ 37,815). However, only four of the five patients were suitable for oesophagectomy, and of these, one patient turned out to have an advanced cancer. All patients developing cancer had columnar metaplasia of the oesophagus longer than 3 cm and specialized columnar epithelium (intestinal metaplasia/Barrett oesophagus). CONCLUSIONS: Low cancer incidence, high costs, and the doubtful prognosis for the patients with identified cancer question the benefits and cost-effectiveness of cancer screening among patients with columnar metaplasia in the oesophagus.

Adenocarcinoma↗
PubMed1999

Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses.

OBJECTIVE: Pharyngeal reflux after a gastric pull-up esophagectomy may cause aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric pull-up esophagectomy and evaluates the impact of additional dissection of the esophagus that is necessary for neck anastomoses versus no neck exploration and proximal chest anastomoses. METHODS: Forty-seven patients had circular stapled anastomoses in the apex of the right chest (n = 27 patients) or manually sutured neck anastomoses (n = 20 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent time pH less than 4 was registered 3, 6, and 12 months after the operation. RESULTS: Mean acid exposure to the proximal pH probe ranged between 0.2% and 0.96% and between 1.45% and 6.5% to the distal pH probe during the 3 measurements. Acid exposure was always lower to the proximal than to the distal probe (P =.001). Patients with neck anastomoses had increasing acid exposure to the distal (P =.023) and proximal (P =.002) pH probes during the study year, whereas patients with chest anastomoses had similar acid exposure. CONCLUSIONS: Acid exposure to the esophageal remnant and to the pharynx increased during the first postoperative year in patients with neck anastomoses but not in patients with proximal chest anastomoses. The results suggest a less favorable acid clearance in patients with the neck approach.

Anastomosis, Surgical↗
PubMed1998

Active or passive chest drainage after oesophagectomy in 101 patients: a prospective randomized study.

BACKGROUND: This study evaluates the efficiency and safety of two methods of chest drainage after uncomplicated oesophagectomy. METHODS: A prospective randomized study between active suction drainage and passive chest drainage was carried out in 101 patients who underwent gastric pull-up oesophagectomy. RESULTS: No difference in the prevalence of pneumothorax during treatment was noted between the active (nine of 55) and the passive (four of 46) drainage groups (P=0.20). Nor was there any difference in the size (P=0.46) and duration (P=0.53) of the pneumothorax. There was no significant difference in right (P=0.84) and left (P=0.61) basal atelectases and the amounts of right (P=0.10) and left (P=0.24) pleural effusions. There were significantly more basal atelectases (P < 0.001) and pleural effusions (P<0.001) in the non-operated left side compared with the operated right side. Postoperative hospital stay was the same in both groups (median 13 days; P=0.86). The hospital mortality rate was two of 101, and was not affected by the type of drainage. CONCLUSION: Passive drainage did not reduce hospital stay, but was as safe and effective as the active system in draining the pleural cavity after uncomplicated oesophagectomy.

Anastomosis, Surgical↗
PubMed1998

One-week omeprazole treatment in the diagnosis of gastro-oesophageal reflux disease.

BACKGROUND: Symptoms of gastro-oesophageal reflux are common, and currently available methods for diagnosing reflux disease are expensive and uncomfortable for the patient. The diagnostic value of a treatment test with omeprazole is unclear. METHODS: Patients with dyspepsia including heartburn admitted for upper gastrointestinal endoscopy were studied in a prospective, randomized, double-blind Scandinavian multicentre study. Before entry 188 patients were enrolled, and 160 were randomized to 1-week treatment with 20 mg omeprazole twice daily or placebo. Gastro-oesophageal reflux disease (GERD) was defined as reflux oesophagitis Savary-Miller grades II-III at endoscopy or pH < 4 exceeding 4% of the total time at 24-h oesophageal pH-monitoring and was found in 135 patients. The treatment test was considered positive when the patient's symptoms improved during the treatment week compared with the pretreatment day. RESULTS: The sensitivity in diagnosing reflux disease was 71-81% with omeprazole as a diagnostic test, compared with 36-47% for placebo during treatment days 3-7. The specificity was similar for the two treatment arms during the first days of the study. During the end of the week a larger proportion of the patients with normal endoscopy and pH test responded to omeprazole treatment, giving omeprazole lower specificity than placebo. The investigators' overall evaluation of whether the patient was a responder to the test had a sensitivity of 75% and a specificity of 55% in the omeprazole-treated patients. The corresponding figures in the placebo group were 17% and 92%, respectively. CONCLUSION: One week of omeprazole treatment is a simple diagnostic test with a fairly high sensitivity. The specificity is poor owing to the placebo effect and to the lack of a gold standard in diagnosing reflux disease.

Anti-Ulcer Agents↗
PubMed1998

The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease.

BACKGROUND: The diagnosis of gastroesophageal reflux disease (GERD) rests primarily on recognition of symptom patterns that are classical for reflux disease, but little attention has been paid to the use of a formal questionnaire for identifying such symptom patterns. METHODS: A self-administered questionnaire was developed which has seven items that focus on the nature of the symptoms and the precipitating, exacerbating, and relieving factors. The diagnostic validity of the questionnaire was tested against endoscopy and 24-h pH monitoring. A further evaluation was undertaken in patients with symptoms suggestive of GERD and in patients with non-ulcer dyspepsia, to identify factors that might predict symptom relief during treatment with omeprazole. RESULTS: When endoscopic esophageal mucosal breaks and 24-h pH data were used as criteria for the diagnosis of GERD, the questionnaire had a sensitivity of 92% but a very low specificity of 19%. Symptom relief during treatment with omeprazole was predicted by the presence of heartburn, described as 'a burning feeling rising from the stomach or lower chest up towards the neck' (P = 0.004), and 'relief from antacids' (P = 0.02). In non-ulcer dyspepsia a positive response to omeprazole was confined to the subgroup of patients who identified their main discomfort as heartburn as described above. CONCLUSION: The present questionnaire using descriptive language usefully identified heartburn in patients presenting with upper abdominal symptoms, and this symptom predicted symptom resolution during treatment with omeprazole.

Anti-Ulcer Agents↗
PubMed1997

Long-term effects of repeated injection sclerotherapy on esophageal motility and mucosa.

BACKGROUND: Endoscopic sclerotherapy (ST), widely used as treatment of bleeding esophageal varices, might cause motility disturbances of the esophagus as well as mucosal damage. We performed this study to evaluate the long-term effects of repeated sclerotherapy on esophageal motility and mucosa. METHODS: Ten patients with liver cirrhosis and bleeding esophageal varices treated with repeated ST were evaluated after the last ST, median 52 months, by esophageal manometry and gastroscopy where forceps biopsies were taken. RESULTS: We found a significant difference in the distal esophageal sphincter intraabdominal length. The distal esophageal sphincter pressure was somewhat lower in the ST group although the difference did not reach statistical significance. There was infiltration of neutrophil leukocytes in biopsies from four patients and normal findings in the rest. CONCLUSIONS: Long-term follow-up evaluation showed statistically longer distal esophageal intraabdominal length in the ST group. No mucosal alterations were found at the histopathological investigation.

Aged↗
PubMed1997

The effect of cisapride in maintaining symptomatic remission in patients with gastro-oesophageal reflux disease.

BACKGROUND: Successful treatment of gastro-oesophageal reflux disease (GORD) has traditionally been assessed as healing of reflux oesophagitis, which may not be relevant in patients with moderate disease. In these patients symptom relief and patient satisfaction with therapy are of fundamental importance. Cisapride has well-documented prokinetic effects and may be well suited for long-term therapy of GORD, but its effectiveness in purely symptomatic treatment is unknown. We therefore compared two dosage regimens of cisapride with placebo over a period of 6 months in patients with evidence of gastrooesophageal reflux, initially treated with antisecretory medication, with regard to maintaining symptom relief and satisfaction with treatment. METHODS: Five hundred and thirty-five patients with reflux oesophagitis grade 1 (n = 293) or 2 (n = 124) or with no reflux oesophagitis but pathologic 24-h pH-metry (n = 118) achieved satisfactory symptom relief with an H2-receptor antagonist or proton pump inhibitor within 4-8 weeks. In a double-blind randomized, parallel-group study, they were then treated with cisapride, 20 mg at night or 20 mg twice daily, or placebo and followed up for a maximum period of 6 months. Relapse was defined as dissatisfaction with therapy or an average consumption of more than two antacid tablets a day. RESULTS: Median time to relapse was 63 days for cisapride, 20 mg twice daily; 59 days for cisapride, 20 mg at night; and 49 days for placebo. Time to relapse was not significantly different (P = 0.09). Presence and grade of oesophagitis at base line, type of therapy before randomization, and pattern of non-reflux symptoms at base line did not influence these findings significantly. CONCLUSION: The study indicates that cisapride is of limited value in maintenance therapy of GORD in patients in whom symptom relief has been accomplished with potent antisecretory medication. This 'step-down' approach to therapy seems disadvantageous in the long-term therapy of GORD.

Abdominal Pain↗
PubMed1997

Effect of fundoplication on transient lower oesophageal sphincter relaxation and gas reflux.

BACKGROUND: Fundoplication is used widely to treat severe gastro-oesophageal reflux disease. Difficulty in belching and increased flatulence are common side-effects. Transient lower oesophageal sphincter (LOS) relaxation is important to help vent gas from the stomach. The effect of fundoplication on LOS function and gas reflux was therefore investigated. METHODS: Oesophageal manometry was performed before operation and 3-15 months after fundoplication in 14 patients with reflux disease who had a total (360 degrees) fundoplication. Five patients also had highly selective vagotomy. Gastric distension was induced by 750 ml carbon dioxide. RESULTS: Fundoplication reduced the median number of episodes of gas reflux during 10 min of gastric distension from 5 (interquartile range (i.q.r.) 3-7) to 0 (i.q.r. 0), and the median number of transient LOS relaxations from 4 (i.q.r. 2-6) to 0 (i.q.r. 0-1). Fundoplication did not affect basal LOS pressure but significantly increased nadir pressure during swallow-induced relaxation. CONCLUSION: Fundoplication controls reflux by inhibiting the triggering of transient LOS relaxation and by preventing the complete ablation of pressure at the gastro-oesophageal junction during LOS relaxation. These effects may also contribute to the side-effects of the operation.

Adult↗
PubMed1996

Adenocarcinoma in the distal esophagus with and without Barrett esophagus. Differences in symptoms and survival rates.

OBJECTIVE: To evaluate differences in clinical appearance and survival rates in patients operated on for adenocarcinoma in the distal esophagus with and without Barrett epithelium. DESIGN: Prospective clinical study. SETTING: University hospital, Sweden. PATIENTS: Fifty-four patients with adenocarcinoma in the distal esophagus with (n = 17) or without (n = 37) Barrett epithelium. INTERVENTION: Esophagectomy or total gastrectomy. MAIN OUTCOME MEASURES: Preoperative symptoms, endoscopic results, and histological findings; postoperative morbidity, mortality, and survival rates. RESULTS: The main indication for the endoscopic examination that revealed tumor in the group with Barrett esophagus was reflex-related symptoms in 6 patients (routine Barrett examination, n = 4; symptoms of reflux, n = 2), symptoms related to upper gastrointestinal tract bleeding in 6, and malignant symptoms in 5 (dysphagia, n = 4; weight loss, n = 1). In contrast, most patients in the cardia cancer group were admitted because of malignant symptoms (dysphagia, n = 26; epigastric pain, n = 9; and anemia, n = 2). Ten of 17 patients in the Barrett esophagus cancer group had tumors limited to the mucosa and submucosa only. In 1 patient the tumor grew into the muscular layer but not through it. In the remaining 6 patients the tumor did grow through the muscular layer and lymph node metastases were found. Wall penetration was found in 30 patients and metastases to lymph nodes in 29 patients in the cardia cancer group. The hospital mortality rate was 0 of 17 patients in the Barrett cancer group and 2 of 37 patients in the cardia cancer group. In the patients operated on for adenocarcinoma in the distal esophagus, a better long-term survival rate was seen in those with Barrett epithelium (50%) than in those without this metaplasia (10%) (log rank P = .005; X2 = 7.80). CONCLUSIONS: Concomitant Barrett epithelium improved the prognosis for patients with adenocarcinoma in the distal esophagus. Probably the reason for this was a higher rate of early-stage disease, because symptoms of gastroesophageal reflux and other benign disorders, not dysphagia, were most common in patients with adenocarcinoma without Barrett epithelium in the distal esophagus.

Adenocarcinoma↗
PubMed1995

Influence of gravity and body position on normal oropharyngeal swallowing.

The influence of gravity, if any, on pharyngeal bolus transport is unknown. The aim of the present study was to evaluate the effect of gravity and body position on the radiological and manometric events during the normal oropharyngeal swallow. In eight healthy male volunteers, we performed simultaneous videoradiography and manometry, using a manometry catheter incorporating a perfused sleeve measuring upper esophageal sphincter pressure and three solid-state transducers recording pharyngeal pressures. Swallows of 5 and 10 ml of barium were performed in three different body positions: upright, horizontal, and 30 degrees head down (inverted). Hypopharyngeal intrabolus pressure increased significantly in the horizontal and inverted positions compared with upright, P = 0.0001. This resulted in increased maximal sphincter diameters during bolus flow (P = 0.0001) and shorter duration of sphincter opening (P = 0.03). As a result, transsphincteric flow increased in the horizontal and inverted positions, P = 0.04. Total swallowing duration, oral and pharyngeal transit time, pharyngeal peristaltic amplitude and duration, the length of the bolus in the pharynx, and excursions of the hyoid and larynx were unaffected by body position. We conclude that intrabolus pressure is an important determinant of upper esophageal sphincter opening in the healthy oropharynx and that gravity does not influence pharyngeal bolus transport. The healthy upper esophageal sphincter has residual opening capacity that can be demonstrated by altering body posture.

Adult↗
PubMed1995

Anastomotic diameter of circular stapled oesophagojejunal anastomoses and its implication for weight development. A clinical and experimental study.

OBJECTIVE: To investigate the increase in diameter of the oesophagojejunal anastomosis after total gastrectomy with a circular stapler, and to assess experimentally the influence of oesophageal diameter on weight. DESIGN: Open prospective clinical and experimental studies. SETTING: University department of surgery, Sweden. SUBJECTS AND MATERIAL: 36 Consecutive patients who underwent total gastrectomy, and 13 domestic pigs. INTERVENTIONS: Clinical study: the end to side oesophagojejunal anastomoses were made with EEA staplers size 25 or 28, and the increase in diameter over a 12 month period was studied by by fibreoptic endoscopy. Experimental study: Each pig had 0.5 cm of the distal oesophagus resected; in 7 the oesophagus was anastomosed with one layer of continuous 3/0 polyglycolic acid, and in 6 an ILS21 stapler was used. Animals were weighed and killed at 4 1/2 months, and the width of the oesophagus at and below the anastomosis was measured. MAIN OUTCOME MEASURES: Clinical study: width of the oesophagus at 12 months. Experimental study: correlation between weight and oesophageal width at time of death. RESULTS: Clinical study: The median increase in size after 12 months with the size 25 cartridge was 8.45 mm (range 6.5-22), and for the size 28 cartridge 12 mm (2.3-30.2). The larger cartridge gave a significantly larger anastomosis (p = 0.007), but the comparative increases were similar. Experimental study: There was a significant correlation between increase in weight and anastomotic width in the 10 pigs that completed the study (r = 0.86, p < 0.001). CONCLUSION: A stapled oesophagojejunal anastomosis has the ability to dilate as necessary, and this ability is not prejudiced by the presence of the staples.

Adult↗
PubMed1994

Effect of intraoperative manipulation and anaesthesia on lower oesophageal sphincter function during fundoplication.

The variables influencing the intraoperative measurement of lower oesophageal sphincter (LOS) pressure and a new method of assessing the effect of a fundal wrap on LOS function were investigated in 13 patients undergoing fundoplication. All patients had a 360 degrees wrap fashioned around a 50-Fr bougie; four also underwent highly selective vagotomy. The effect of the fundal wrap, independent of LOS pressure, was assessed by inducing LOS relaxation with balloon distension. Preoperative mean(s.e.m.) LOS pressure (14.1(2.6) mmHg) did not correlate with that at the start of operation (11.5(1.5) mmHg). After mobilization of the oesophagus mean(s.e.m.) LOS pressure increased significantly (to 19.8(2.0) mmHg; P < 0.0005) and oesophageal distension elicited LOS relaxation on 16 of 33 occasions. After completion of the wrap there was no further increase in LOS pressure, but LOS relaxation occurred after only five of 33 distensions (P < 0.01). These findings indicate that anaesthesia and intraoperative manipulation during fundoplication have significant effects on LOS function that detract from the validity of intraoperative assessment. They question the rationale of current approaches to intraoperative manometry for the assessment of antireflux surgery.

Adult↗