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P Wara

Publications and source records attributed to P Wara.

At least 19 recordsLinked to original sources
PubMed2001

Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study.

BACKGROUND: Groin hernia repair is one of the most frequent operations, but there is no consensus about surgical or anaesthetic technique. Furthermore, no nationwide studies have been done. Our aim was to investigate outcome results of groin hernia surgery to improve quality of treatment. METHODS: We prospectively recorded 26304 groin hernia repairs done in Denmark from Jan 1, 1998, to June 30, 2000, in a nationwide Danish hernia database. FINDINGS: 93% of all groin herniorrhaphies done in Denmark in the 30 months of the study were recorded in the database. Kaplan-Meier estimates of reoperation rates 30 months after anterior mesh repair and laparoscopic repair were significantly lower than after sutured posterior wall repairs in primary inguinal hernia (2.2% and 2.6% vs 4.4%; p<0.0001). Reoperation rates were also lower with anterior mesh repair (6.1%; p<0.0001) and laparoscopic repair (3.4%; p<0.0001) than with sutured posterior wall repair (10.6%) after recurrent hernia. Use of Lichtenstein mesh repair increased from 33% in January, 1998, to 62% in June, 2000, whereas use of laparoscopic repair remained constant at about 5%. Kaplan-Meier estimates of reoperation rates were 2.8% in the first 15 months and 1.6% in the second (p=0.03). For elective repairs, only 59% of patients were treated on an outpatient basis, and only 18% had local anaesthesia. INTERPRETATION: Mesh repairs have a lower reoperation rate than conventional open repairs. Systematic prospective recording of treatment and outcome variables in a national clinical database improved the overall quality of surgical care. However, there is a large potential for cost savings and more efficient patient care with extended use of mesh techniques, outpatient surgery, and local anaesthesia.

Adult↗
PubMed2001

[Ogilvie syndrome].

Explore the source record for details and available documents.

Colonic Pseudo-Obstruction↗
PubMed2001

[Complications of cholecystectomy before and after introduction of laparoscopic surgery].

OBJECTIVES: In the University Department of Surgical Gastroenterology, Arhus University Hospital, the frequency of complications to acute and elective cholecystectomy was investigated before and after introduction of laparoscopic cholecystectomy. MATERIAL AND METHODS: A retrospective survey turned up 1768 patients in the period of conventional open surgery (1974-1985) and 1432 patients in the laparoscopic period (1991-1998). All patients with exploration of the common bile duct were excluded. RESULTS: In the open period 12 patients (0.68%) had lesions of the common bile duct requiring reconstruction. In patients operated on with laparoscopic cholecystectomy, lesions of the common bile duct were found in three patients (0.21%) (p = 0.06). Lesions of the cystic duct or an aberrant bile duct occurred in 14 patients (0.79%) during the open period and in 24 patients (1.7%) (p < 0.05) operated on with the laparoscopic technique. Infectious and cardiopulmonary complications were seen in significantly more patients operated on with the open technique. DISCUSSION: It is concluded that laparoscopic cholecystectomy offers a safe procedure, although the technique can still be improved, especially with respect to decreasing leakage from the cystic duct.

Adult↗
PubMed2001

Randomized clinical trial of laparoscopic versus open appendicectomy.

BACKGROUND: Laparoscopy in patients with a clinical suspicion of acute appendicitis has not gained wide acceptance, and its use remains controversial. METHODS: In a randomized controlled trial of laparoscopic versus open appendicectomy, 583 of 828 consecutive patients consented to participate. Three hundred and one patients were allocated to open appendicectomy and 282 patients to laparoscopy, 65 of whom required conversion to open appendicectomy. Length of stay in hospital was the primary endpoint, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secondary endpoints. RESULTS: Intention-to-treat analysis revealed an equally short hospital stay in the two groups (median 2 days). The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections (P < 0.03) and improved cosmesis (P < 0.001), but the operating time was longer (60 versus 40 min). Laparoscopy was associated with more intraperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater number of gangrenous or perforated appendices in this group, the difference failed to reach statistical significance. CONCLUSION: Hospital stay was equally short, whereas laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Adolescent↗
PubMed2000

[MR-cholangiography in patients suspected with choledochus calculi].

To test a new non-invasive imaging method, magnetic resonance cholangiography (MRCP), we compared MRCP with intraoperative cholangiography (IOC) or endoscopic retrograde cholangiography (ERC). In 55 patients with 11 common bile duct stones MRCP identified all 11 stones and incorrectly found stones in seven additional patients. Predictive value of positive test was 61%, predictive value of negative test was 100%. As a consequence of MRCP, ERC or IOC can be avoided in 67% of the patients.

Adult↗
PubMed1998

[Laparoscopic adrenalectomy. An alternative to open surgery of minor adrenal tumors].

In the period February 1994 to November 1995 11 laparoscopic adrenalectomies were performed at our institution (seven women, four men). A transperitoneal approach was used in both right- and left-sided operations. Results were collected retrospectively. Indications for surgery were: Conn's syndrome (four), Cushing's syndrome (two), phaecromocytoma (four), and incidentaloma (one). The operations took median 170 minutes (range 105-250 minutes). Median size of the tumour was 4 cm range 1(1/2)-5 cm). No significant peri- or postoperative complications were recorded. The patients were discharged from the surgical unit median two days after surgery. Laparoscopic operation emerges as an alternative to open operation when dealing with smaller adrenal tumours. Because of the small number of patients, these operations have to be restricted to a few centres where both internists, anaesthesiologists and surgeons with expertise in this field are found.

Adrenal Gland Neoplasms↗
PubMed1997

Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer.

BACKGROUND: Although injection treatments for ulcer haemostasis seem to be effective, recurrent bleeding remains a serious problem. Large randomised clinical trials are required to show differences between treatment modalities for gastrointestinal bleeding. The aim of this study was to compare the safety and efficacy of repeated endoscopic injection of fibrin glue (FG) with that of single endoscopic injection of polidocanol in the prevention of recurrent bleeding. METHODS: 854 patients with active gastroduodenal bleeding (spurting, oozing), or ulcers with a visible non-bleeding vessel, were randomly assigned one of three endoscopic treatments: single application of polidocanol 1%, single application of FG, or daily repeated application of FG until the visible vessel had disappeared. All patients were pretreated with local injection of epinephrine (1/10,000), and had daily repeat endoscopies until the vessel observed at initial endoscopy was no longer visible. FINDINGS: Recurrent bleeding rates among the 790 patients in whom the rates could be assessed were 58 (22.8%) of 254 in the polidocranol group, 51 (19.2%) of 266 in the FG-single group, and 41 (15.2%) of 270 in the FG-repeated group. The difference between FG-repeated treatment and polidocanol was significant (p = 0.036). Treatment failed, making other treatments (including surgery) necessary, in 34 (13.0%) of 261 in the polidocanol group, 34 (12.4%) of 274 in the FG-single group, and 21 (7.7%) of 274 in the FG-repeated group. The difference between FG-repeated treatment and polidocanol was significant (p = 0.046). The 30-day-mortality rates were low in all three treatment groups (polidocanol 4.7%; FG-single treatment 5.3%, FG-repeated treatment 4.3%). The safety profiles of the three treatment strategies were similar. INTERPRETATION: Repeated injection with FG glue is significantly more effective than injection with polidocanol 1% in the treatment of bleeding from gastroduodenal ulcers.

Adult↗
PubMed1997

Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series.

BACKGROUND: The risk of bile duct injury in laparoscopic cholecystectomy has been a concern since the procedure became part of the surgical armamentarium. Our study assesses the incidence, types, and treatment for laparoscopic bile duct injury. STUDY DESIGN: Prospective case registration in a national database with participation by all departments of surgery performing laparoscopic cholecystectomy in Denmark since the first operation in January 1991. The case notes for bile duct injury have been reviewed. RESULTS: From 1991 through 1994, 57 of 7,654 patients sustained bile duct injury (0.74 percent; 95 percent confidence interval, 0.55 percent to 0.94 percent), including nine injuries occurring after conversion. The annual incidence did not decrease. Thirty-nine percent of the laparoscopic bile duct injuries were incisions, 39 percent were transections, and 12 percent were clip injuries or strictures. One patient, who sustained transection during open reoperation for bleeding after a converted procedure, died. Bile leaks for reasons other than bile duct injury occurred in 2.1 percent; 71 percent of these were cystic duct leaks. Acute cholecystitis was the indication for laparoscopic cholecystectomy in 968 patients, with 1.3 percent sustaining laparoscopic bile duct injury (95 percent confidence interval, 0.62 percent to 2.08 percent), while the incidence in patients with other indications for laparoscopic cholecystectomy was 0.62 percent (95 percent confidence interval, 0.44 percent to 0.82 percent) (p > 0.05). Preoperative knowledge of bile duct anatomy was available by means of preoperative endoscopic retrograde cholangiopancreatography or intravenous cholangiography in 26 percent of patients undergoing laparoscopic cholecystectomy but this did not reduce the risk of bile duct injury. The frequency of bile duct injury in patients who had intraoperative cholangiography was not significantly different from those who did not. Intraoperative cholangiography was done in 14 cases of injury (diagnostic for injury in 8, misinterpreted in 2, and normal in 4 patients). The case notes described operative difficulties in 11 of 48 cases of laparoscopic bile duct injury, most often because of fibrosis or difficulty delineating the anatomy. CONCLUSIONS: The incidence of bile duct injury in laparoscopic cholecystectomy is higher than previously generally anticipated and did not decrease from 1991 through 1994. Risk factors and possible preventive measures should be evaluated in prospective studies.

Bile Ducts↗
PubMed1996

[Laparoscopy in suspected acute appendicitis. Experiences with the first 233 laparoscopies at a university hospital department].

In an initial stage of introducing laparoscopic appendicectomy, 233 patients with indication for surgical treatment were evaluated in an open prospective trial. Surgery was done by a total of 39 trainees on duty. The procedure was started as a diagnostic laparoscopy followed by laparoscopic appendicectomy if the appendix was macroscopically inflamed. If the appendix was normal, it was left in place. There were 51 patients with a macroscopically normal appendix. Subsequently, none of them suffered from appendicitis or any other disorder requiring surgery. In 182 patients with laparoscopically assessed inflamed appendix, laparoscopic appendicectomy was attempted. One hundred and forty-eight proved successful, whereas 34 were converted to an open operation, mainly because of limited experience with the laparoscopic technique. Wound infection occurred in two and intraperitoneal abscess in four patients (0.9% and 1.7%), respectively. There was only one complication (0.4%) directly related to the laparoscopic procedure, namely a coecal leak. In conclusion, in a teaching hospital, laparoscopic appendicectomy can be safely offered to patients where surgery is indicated due to suspicion of appendicitis.

Abdomen, Acute↗
PubMed1996

Bleeding ulcer.

A review is presented on theory and practice in the handling of gastroduodenal bleeding in the presurgical era with emphasis on the Meulengracht treatment. A description is thereafter given of the development of criteria for emergency surgery in the preendoscopic period with special mention of the circulatory evaluation using measurements of central venous pressure. A survey is given on the development in endoscopic diagnosis and treatment with a critical evaluation of the predictive value of clinical factors and endoscopic stigmata of haemorrhage. Finally the sparse knowledge on the haemostatic mechanisms of current endoscopic therapies is presented.

Blood Transfusion↗
PubMed1996

Endoscopic treatment of oesophagoairway fistula with oesophageal balloon prosthesis.

OBJECTIVE: To describe our experience with a cuffed oesophageal prosthesis in the management of malignant oesophagoairway fistulas. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: Nine patients treated with a balloon cuffed oesophageal prosthesis during the period 1987-93. MAIN OUTCOME MEASURES: Endoscopic assessment of the fistula compared with the results and complications of treatment. RESULTS: The prosthesis were inserted without complications. Eight patients had total relief of aspiration and were able to eat a semisolid diet. Three patients needed reintervention. Patients with little or no stenosis of the tumour seemed to be at considerable risk of dislodgement of the tube and those with large fistulas developed protrusion of the balloon into the tracheal lumen. CONCLUSION: Intubation with the cuffed oesophageal prosthesis is safe and relatively inexpensive. Other treatments should be considered in patients with minor stenosis of the tumour or a large fistula.

Adult↗
PubMed1995

[Non-surgical treatment of bleeding gastric ulcer. A follow-up after 5-8 years].

UNLABELLED: Gastric ulcer haemorrhage is associated with a high immediate mortality, but few data exist on the late prognosis of these patients. The aim of this study was to determine the long-term recurrence rate and late outcome in patients with gastric ulcer complicated by bleeding. In a prospective follow-up study 90 consecutive patients with a bleeding gastric ulcer discharged after non-operative treatment (bleeding controlled by endoscopic electrocoagulation or ceased spontaneously) were followed up once every year for five to eight years (median 6.5 years). Recurrent ulcer was seen in 17 patients, repeat haemorrhage being the presenting symptom in 13. The estimated cumulative recurrence rate after two, five and eight years was 10%, 19% and 33%, respectively. Recurrence rate was unaffected by sex, complicating disease, and NSAID ingestion before and after the index bleeding episode. The recurrence rate of patients with a history of ulcer before the index bleeding episode did not differ from that of patients with no previous ulcer history. A significantly increased risk of recurrence was seen in patients with previous bleed as opposed to patients with previous non-bleeding ulcer (p < 0.05). The cumulative survival rate was significantly reduced compared to the expected survival rate of the sex- and age-matched background population (p < 0.01), primarily due to diseases not related to the ulcer disease. CONCLUSION: Bleeding gastric ulcer is associated with a relatively low long-term recurrence rate, except in a few patients with a history of previous bleeding ulcer, who have an increased risk of recurrence. Patients with bleeding gastric ulcer have an excess mortality not related to the ulcer disease.

Adult↗
PubMed1995

[Laparoscopic cholecystectomy in Denmark. A prospective registration].

Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.

Adolescent↗
PubMed1994

Late outcome of bleeding gastric ulcer. Five to eight years' follow-up.

BACKGROUND: Gastric ulcer haemorrhage is associated with a high immediate mortality, but few data exist on the late prognosis of these patients. The aim of this study was to determine the long-term recurrence rate and late outcome in patients with gastric ulcer complicated with bleeding. METHODS: In a prospective follow-up study 90 consecutive patients with a bleeding gastric ulcer discharged after non-operative treatment (bleeding controlled by endoscopic electrocoagulation or ceased spontaneously) were followed up once every year for 5-8 years (median, 6.5 years). RESULTS: Recurrent ulcer was seen in 17 patients, repeat haemorrhage being the presenting symptom in 13 of them. The estimated cumulative recurrence rate after 2, 5, and 8 years was 10%, 19% and 33%, respectively. Recurrence rate was unaffected by sex, complicating disease, and non-steroidal anti-inflammatory drugs (NSAIDs) ingestion before and after the index bleeding episode. The recurrence rate of patients with a history of ulcer before the index bleeding episode did not differ from that of patients with no previous ulcer history. A significantly increased risk of recurrence was seen in patients with previous bleed as opposed to patients with previous non-bleeding ulcer (p < 0.05). The cumulative survival rate was significantly reduced compared with the expected survival rate of the sex- and age-matched background population (p < 0.01), primarily because of diseases not related to the ulcer disease. CONCLUSION: Bleeding gastric ulcer is associated with a relatively low long-term recurrence rate, except in a few patients with a history of previous bleeding ulcer, who have an increased risk of recurrence. Patients with bleeding gastric ulcer have an excess mortality not related to the ulcer disease.

Aged↗
PubMed1994

Peptic ulcer hemorrhage: factors predisposing to recurrence.

Two hundred and eighty patients with stigmata of recent or active bleeding from a peptic ulcer were followed up after endoscopic or conservative medical treatment. Of the patients 53% had no history of dyspeptic symptoms, but 17% and 10% had a history of uncomplicated ulcer or bleeding ulcer, respectively, before the index admission. After 8 years of follow-up the estimated recurrence rate was 29% (95% confidence limits, 12-47%). At recurrence 65% of the patients presented with a rebleed and 12% with a perforation. By means of a logistic regression analysis, a previous history of ulcer haemorrhage was identified as the only predictor associated with a significantly increased risk of recurrence. The recurrence rate in 253 patients presenting with a first bleed at the index admission was 23%, compared with 73% in 27 patients with a history of bleeding before the index admission (p = 0.001). The rate of recurrence was not influenced by a history of previous uncomplicated ulcer disease or dyspeptic symptoms, the severity of the index bleed, the methods of management of the index bleed, age, use of non-steroidal anti-inflammatory drugs, or long-term treatment with cimetidine.

Adult↗
PubMed1993

[Laparoscopic parietal cell vagotomy. Preliminary results].

The results from 11 laparoscopic parietal cell vagotomies are presented. The procedure could be carried out in all patients. The median day of discharge after the procedure was day 1 (range 1-16), median convalescence time 7 (range 4-50) days. One patient required re-operation due to a perforation at the lesser curvature. This complication is ascribed to the learning phase. If a sufficient reduction in gastric acid secretion can be documented in a larger series of patients, laparoscopic parietal cell vagotomy should be considered a serious alternative to conservative treatment.

Adult↗