RESUMO
BACKGROUND: Recent reports from western countries have indicated an increased incidence and a decreased mortality in acute pancreatitis. However, the incidence assessment has often been hampered by the inclusion of both first-time and recurrent episodes of acute pancreatitis. METHODS: In this retrospective cohort study, all Swedish residents hospitalized with a first-time episode of acute pancreatitis between 1990 and 2013 were identified using national registers. Sex- and age-standardized incidence rates per 100,000 individuals and year were calculated, as were annual percent changes (APC) from joinpoint regression models. RESULTS: Overall, between 1990 and 2013, 66,131 individuals had a first-time episode of acute pancreatitis in Sweden. Comparing the first five years (1990-1994) to the last four years (2010-2013) of the study period, the overall incidence of acute pancreatitis increased from 25.2 (95% confidence interval (CI): 24.1, 26.3) to 38.3 (95% CI: 37.0, 39.5) cases per 100,000 individuals and year. An increase in incidence was observed irrespective of the subtypes of acute pancreatitis as well as the sex and age of the patients. Although the incidence of complicated acute pancreatitis declined in both men and women between 1990 and 2004, it started to increase in both sexes (APC 3.0; 95% CI: 0.5, 5.5 in men; APC 5.4; 95% CI: 2.6, 8.2 in women) from 2005 onwards. CONCLUSION: Based on nationwide data, the incidence of first-time acute pancreatitis has increased in Sweden over a period of 24 years. The incidence of disease-related complications has also been on the rise during the past few years, after declining for more than 15 years before that.
Assuntos
Hospitalização/tendências , Pancreatite/epidemiologia , Idade de Início , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/diagnóstico , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Suécia/epidemiologiaRESUMO
Common bile duct stones (CBDS) as well as ERCP treatment may cause jaundice, pancreatitis and cholangitis. More than half of the patients with asymptomatic CBDS found on intraoperative cholangiography pass all of their stones spontaneously. The ERCP treatment of asymptomatic common bile duct stones seems to carry a fivefold increased risk for complications, especially pancreatitis. It is unclear what carries the highest complication risk, untreated asymptomatic CBDS or ERCP treatment. The high risk for life-threatening complications combined with high rate of spontaneous stone passage raises the question of whether routine treatment of asymptomatic CBDS is justified.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Cálculos Biliares/terapia , Pancreatite/etiologia , Doenças Assintomáticas/terapia , Cálculos Biliares/complicações , Humanos , Uso Excessivo dos Serviços de SaúdeRESUMO
BACKGROUND: Acute pancreatitis is linked to pancreatic cancer, but the direction of this association is not fully elaborated. METHODS: This was a population-based cohort study including all Swedish residents diagnosed with a first-time episode of acute pancreatitis between 1997 and 2013 and corresponding matched pancreatitis-free individuals from the general population. Hazard ratios for the association between acute pancreatitis and pancreatic cancer were estimated using multivariable Cox regression models. RESULTS: Overall, 49,749 individuals with acute pancreatitis and 138,750 matched individuals without acute pancreatitis were followed up for 1,192,134 person-years (median 5.3 years). A total of 769 individuals developed pancreatic cancer, of whom 536 (69.7%) had a history of acute pancreatitis. The risk of pancreatic cancer was substantially increased during the first few years after a diagnosis of acute pancreatitis but declined gradually over time, reaching a level comparable to the pancreatitis-free population after >10 years of follow-up. In those with non-gallstone-related acute pancreatitis, the risk of pancreatic cancer declined to a level comparable to the pancreatitis-free population only when follow-up time was censored for a second episode of acute pancreatitis or a diagnosis of chronic pancreatitis. Increasing number of recurrent episodes of acute pancreatitis was associated with increased risk of pancreatic cancer. CONCLUSION: These findings imply a delay in the diagnosis of pre-existing pancreatic cancer, if clinically presented as acute pancreatitis. Any association between non-gallstone-related acute pancreatitis and pancreatic cancer in the long-term (>10 years) could be mediated through recurrent acute pancreatitis or chronic pancreatitis.
Assuntos
Neoplasias Pancreáticas/epidemiologia , Pancreatite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/patologia , Pancreatite/diagnóstico , Pancreatite/patologia , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Suécia/epidemiologia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Assistência ao Convalescente/normas , Cirurgia Bariátrica/normas , Obesidade/cirurgia , Guias de Prática Clínica como Assunto , Cirurgia Bariátrica/efeitos adversos , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/prevenção & controle , Humanos , Complicações Pós-Operatórias/prevenção & controle , Países Escandinavos e NórdicosRESUMO
Mason performed the first gastric bypass (GBP) for obesity in 1967 after having observed substantial weight loss in patients operated for gastric ulcer. The weight loss after GBP is 30 % and 2/3 of patients with type II diabetes can stop their medication. Half of the patients can stop medication for hypertension or hyperlipidemia, 75% are cured from reflux and obstructive sleep apnea. GBP prolongs survival especially among diabetics. Restriction and malabsorption is of minor importance for weight loss. The mechanisms underlying weight loss and diabetes remissions are endocrine. GBP enhances food passage to the distal small bowel where the food contact stimulates release of satiety hormones from endocrine cells. Elevated levels of these hormones cause weight loss, increases insulin secretion and counteracts weight induced decrease in resting metabolic rate, an important starving protection mechanism that activates when fasting and makes traditional weight loss difficult.
Assuntos
Derivação Gástrica/história , Regulação do Apetite/fisiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/métodos , História do Século XX , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Obesidade/cirurgia , Redução de PesoRESUMO
Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
Assuntos
Assistência ao Convalescente/métodos , Cirurgia Bariátrica , Política Nutricional , Apoio Nutricional , Cuidados Pós-Operatórios/métodos , Guias de Prática Clínica como Assunto , Cálcio/administração & dosagem , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Humanos , Ferro/administração & dosagem , Monitorização Fisiológica , Obesidade/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Países Escandinavos e Nórdicos , Tiamina/administração & dosagem , Vitamina B 12/administração & dosagem , Vitamina D/administração & dosagem , Zinco/administração & dosagemRESUMO
Gastric bypass versus sleeve, pros and cons The most commonly performed bariatric procedure today is gastric bypass, while sleeve gastrectomy has become more common in recent years. Little is known about the long-term effects of sleeve gastrectomy and despite several randomized trials it is still unknown which procedure is the most favourable. Two recently published randomized trials show that the two procedures result in comparable weight loss in the short term while gastric bypass could possibly result in better weight loss in the long term. However, gastric bypass tends to lead to a higher incidence of post-operative complications compared to sleeve gastrectomy.
Assuntos
Gastrectomia/normas , Derivação Gástrica/normas , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Obesidade/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: The trade-off between the benefits of surgery for gallstone disease for a large population and the risk of lethal outcome in a small minority requires knowledge of the overall mortality. METHODS: Between 2007 and 2010, 47 912 cholecystectomies for gallstone disease were registered in the Swedish Register for Cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) (GallRiks). By linkage to the Swedish Death Register, the 30-day mortality after surgery was determined. The age- and sex-standardized mortality ratio (SMR) was estimated by dividing the observed mortality with the expected mortality rate in the Swedish general population 2007. The Charlson Comorbidity Index (CCI) was estimated by International Classification of Diseases (ICD) codes retrieved from the National Patient Register. RESULTS: Within 30 days after surgery, 72 (0.15%) patients died. The 30-day mortality was close [SMR = 2.58; 95% confidence interval (CI): 2.02-3.25] to that of the Swedish general population. In multivariable logistic regression analysis, predictors of 30-day mortality were age >70 years [odds ratio (OR) 7.04, CI: 2.23-22.26], CCI > 2 (OR 1.93, CI: 1.06-3.51), American Society of Anesthesiologists (ASA) > 2 (OR 13.28, CI: 4.64-38.02), acute surgery (OR 10.05, CI:2.41-41.95), open surgical approach (OR 2.20, CI: 1.55-4.69) and peri-operative complications (OR 3.27, CI: 1.74-6.15). DISCUSSION: Mortality after cholecystectomy is low. Co-morbidity and peri-operative complications may, however, increase mortality substantially. The increased mortality risk associated with open cholecystectomy could be explained by confounding factors influencing the decision to perform open surgery.
Assuntos
Causas de Morte , Colecistectomia/mortalidade , Colelitíase/mortalidade , Colelitíase/cirurgia , Complicações Pós-Operatórias/mortalidade , Adulto , Fatores Etários , Idoso , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia/métodos , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/mortalidade , Colelitíase/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Suécia , Resultado do TratamentoRESUMO
BACKGROUND: The management of acute cholecystitis requires a sound knowledge of the biliary microflora. METHODS: Bile samples were taken for culture according to a standard routine during all cholecystectomies performed from April 2007 to February 2009 in the Department of Surgery at Enköping Hospital. The use of antibiotics within the 3-mo period before surgery, indication for surgery, prophylactic antibiotics, and post-operative complications were recorded prospectively. RESULTS: Altogether, 246 procedures were performed during the study period, of which 149 (62%) were done on women. The mean (±SD) age of the study subjects was 49±16 y. Bacterial growth was seen in cultures from 34 (14%) of the subjects. The mean age of subjects with positive cultures was 64 y and that of subjects with negative cultures was 47 y (p<0.001). Positive culture was seen in 16 (31%) of the 51 patients who underwent operations for acute cholecystitis, whereas positive cultures were obtained in 18 of 195 patients without acute cholecystitis (9%) (p<0.001). Resistance to ampicillin was recorded in three of 34 (9%) of the cultures with bacterial growth, to co-trimoxazole in one of the 34 (3%) cultures, to fluoroquinolones in one of the 34 (3%) cultures, and to cephalosporins in one of the 34 (3%) cultures. Resistance to piperacillin-tazobactam was not observed in any of the cultures. In multivariable logistic regression analysis, a positive culture was the only factor significantly associated with risk for post-operative infectious complications (p<0.05). DISCUSSION: Bacterial growth in the bile is observed more often in patients undergoing surgery for acute cholecystitis. The microflora of the bile is probably important for the outcome of surgery, but further studies are required for assessing the effectiveness of measures for preventing infectious post-operative complications.
Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Bile/microbiologia , Colecistectomia , Vesícula Biliar/microbiologia , Idoso , Bactérias/classificação , Infecções Bacterianas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , SuéciaRESUMO
BACKGROUND: Improvement of quality of life (QoL) is the ultimate goal for inguinal hernia repair. Data on QoL before surgery are scarce, and it is not known whether postoperative improvement of QoL relates to preoperative symptoms. METHODS: Symptoms and self-reported QoL were evaluated and compared with matched control patients from a normal population in 309 male subjects before and 1 year after unilateral open inguinal hernia repair. RESULTS: Before operation, 91 % of patients noted a bulge, whereas 75% had symptoms, most commonly pain (64%); the other 25% were asymptomatic. Physical QoL scores (physical component score) were decreased in patients compared with matched controls (median [interquartile range] PCS 47 [38-53] vs 54 [48-57] P < .05), whereas mental scores (mental component score) were not affected (P = .401). PCS was less in patients with pain compared with those without pain (44 [35-50] vs 53 [48-56] P = .001). In patients without pain, no difference was found compared with control patients (P = .57). At 1 year after surgery, PCS was increased to 55 (53-57) in patients and was slightly greater than control patients (P < .05). The increase was greater in patients who reported preoperative pain (from 44 [35-50] to 55 [52-57] vs from 53 [48-56] to 56 [54-57], P < .00001). MCS did not change after inguinal herniorrhaphy. CONCLUSION: Preoperative affection as well as postoperative improvement in self-reported physical QoL seems to be strongly associated with preoperative inguinal pain. This finding underscores that occurrence of preoperative pain is an important symptom to evaluate before taking the decision to operate for inguinal hernia.
Assuntos
Hérnia Inguinal/psicologia , Herniorrafia/psicologia , Estudos de Casos e Controles , Contraindicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de VidaRESUMO
BACKGROUND: The aim of this study was to assess the benefit from antibiotic prophylaxis (AP) during cholecystectomy in a population-based cohort study. METHODS: All cholecystectomies performed in Uppsala County, 2003-2005, were registered prospectively according to a standardized protocol. High-risk procedures (HP) were defined as operations for acute cholecystitis and procedures including exploration of the common bile duct. Infections requiring surgical or percutaneous drainage and non-surgical infections that prolonged hospital stay were defined as major infectious complications (IC). RESULTS: Altogether 1171 patients underwent cholecystectomy. AP was given to 130 of 867 (15%) of the patients undergoing low-risk procedures (LP) and 205 of 304 (67%) of those undergoing H-R P. Major IC were seen in 6 of 205 (3%) of the patients undergoing H-R P with AP and 1 of 99 of the patients undergoing H-R P without AP. No major IC was seen after L-R P. Minor IC were seen after 5 of 205 (2%) HP with AP, 1 of 99 (1%) HP without AP, 0 of 130 (0%) LP with AP, and 2 of 737 (0.3%) LP without AP. In univariate logistic analysis, the overall risk for IC was found to be higher with AP (p < 0.05), but the increase did not remain significant if adjusting for age, gender, ASA class, H-R P/L-R P and surgical approach or limiting the analysis to major IC. CONCLUSION: There is no benefit from AP in uncomplicated procedures. The effectiveness of antibiotic prophylaxis in complicated cholecystectomy must be evaluated in randomized controlled trials.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Infecções Bacterianas/prevenção & controle , Colecistectomia , Colecistite Aguda/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Infecções Bacterianas/classificação , Infecções Bacterianas/etiologia , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS). METHODS: All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302,564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS. RESULTS: A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis. CONCLUSIONS: Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.
Assuntos
Colecistectomia , Colecistite/cirurgia , Cálculos Biliares/diagnóstico , Testes de Função Hepática , Pancreatite/epidemiologia , Adulto , Fatores Etários , Fosfatase Alcalina/sangue , Bilirrubina/sangue , Biomarcadores/sangue , Colangiografia , Colecistite/diagnóstico , Colecistite/epidemiologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pancreatite/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologiaRESUMO
OBJECTIVE: The aim of the present study was to validate a Swedish translation of the Gastrointestinal Quality of Life Index (GIQLI) questionnaire in patients with gallstone disease. METHODS: Sensitivity to change, internal consistency, and test-retest stability were tested in 187 consecutive patients who underwent planned cholecystectomy. Construct validity was assessed by comparing the GIQLI score with the bodily pain scale of SF-36 and four single-item questions in a separate group of 104 patients. RESULTS: A significant increase in all five domains as well as in the overall GIQLI score 6 months after surgery (all P < 0.05) was seen. All five domains correlated significantly with other measures of gallstone-related symptoms except one single-item question. Intraclass correlations ranged from 0.62 to 0.87. Cronbach's alpha ranged from 0.77 to 0.89. CONCLUSION: The Swedish translation of GIQLI has a high validity and reliability for assessing the impact of gallstones on quality of life.
Assuntos
Efeitos Psicossociais da Doença , Cálculos Biliares , Qualidade de Vida , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Suécia , Adulto JovemAssuntos
Hérnia Inguinal/cirurgia , Telas Cirúrgicas , Infecção da Ferida Cirúrgica , Antibacterianos/administração & dosagem , Humanos , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios , Estudos Prospectivos , Recidiva , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura , Resultado do TratamentoRESUMO
BACKGROUND: Although intraoperative cholangiography (IOC) is a widely used method for detecting common bile duct stones (CBDS), its accuracy has not been fully evaluated in large nonselected patient samples. The purpose of this study was to assess the sensitivity, specificity and predictive value of dynamic IOC regarding its ability to diagnose CBDS in a population-based setting, and to assess the morbidity associated with the investigation. METHODS: All patients operated on for gallstone disease between 2003 and 2005 in the county of Uppsala in Sweden, a county with a population of 302,000 in December 2004, were registered prospectively. The outcome of cholangiography was validated against the postoperative clinical course. RESULTS: 1171 patients were registered, and among these IOC was performed in 1117 patients (95%). Common bile duct stones were found in 134 patients (11%). One perforation of the common bile duct caused by the IOC catheter was recorded. Sensitivity was 97%, specificity 99%, negative predictive value 99%, positive predictive value 95%, and overall accuracy 99%. In 7 of the 134 cases where IOC indicated CBDS, no stones could be verified on exploration. In 4 of the 979 cases where IOC was normal, the clinical course indicated overlooked CBDS. CONCLUSION: Intraoperative cholangiography is a safe and accurate method for detecting common bile duct stones.