Does tumor size influence the outcome of laparoscopic distal pancreatectomy?

Background: Laparoscopic distal pancreatectomy (LDP) is a safe procedure, but its role in resection of large pancreatic lesions has been questioned.

Methods: Patients who underwent LDP for pancreatic solitary tumors in 1997-2017 were included in this study. The patients were divided into three groups in accordance with tumor size: <3.

Hospitalisations during the final three years of life.

Bakgrunn: Kunnskap om sykehusbruk i livets sluttfase er nyttig for å forstå behovet for sykehustjenester.

Materiale Og Metode: Registeropplysninger fra Statistisk sentralbyrå og Norsk pasientregister er brukt for å analysere tallet på innleggelser ved somatiske sykehus de siste tre leveårene blant individer som døde i alderen 56-95 år.

Resultater: Analyseutvalget besto av 35 954 individer som hadde 136 484 innleggelser i observasjonsperioden.

Efficacy and safety assessment of ERCP in patients with malignant biliary obstruction.

Background: To assess the efficacy and safety of Endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO).

Material And Methods: A review of all ERCP-procedures performed at Akershus University Hospital during the six year period between 2009-2014 was analysed. Data for the period 2009- 2013 were obtained retrospectively and prospectively for 2014.

Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: a randomized trial.

Aim: Parastomal hernia (PSH) is the most common complication of an end-colostomy and about one-quarter of patients need operative repair, which is often unsuccessful. A randomized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome.

Method: In this two-centre randomized trial (Oslo University Hospital and Sykehuset Innlandet Hospital Trust, Norway), patients with rectal cancer undergoing open pelvic surgery were randomized to receive a retromuscular synthetic mesh (study group, n = 32) or no mesh (control group, n = 26) at the time of end-colostomy formation.

Best practice in placement of percutaneous endoscopic gastrostomy with jejunal extension tube for continuous infusion of levodopa carbidopa intestinal gel in the treatment of selected patients with Parkinson's disease in the Nordic region.

Objective: Continuous infusion of levodopa carbidopa intestinal gel (LCIG) is associated with a significant improvement in the symptoms and quality of life of selected patients with advanced Parkinson's disease. Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the most common and standard technique for fixing the tubing in place for LCIG infusion.

Material And Methods: A workshop was held in Stockholm, Sweden, to discuss the PEG/J placement for the delivery of LCIG in Parkinson's disease patients with the primary goal of providing guidance on best practice for the Nordic countries.

Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

Purpose: Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques.

Methods: 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures.

Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients.

Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care.

Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer.

Purpose: This prospective study was designed to assess the outcome through the first five years after the introduction of total mesorectal excision in 1993 in a Norwegian central hospital, with special regard to the difference between low (< or =6 cm from anal verge) and high (>6 cm) rectal cancers.

Methods: A total of 140 patients (81 males; median age, 64 (range, 29-87) years) underwent surgery for rectal cancer under curative intention.

Results: Local recurrence rates were 8 of 44 (18 percent) for the low cancers and 5 of 96 (5 percent) for the high, a statistically significant difference (P = 0.

[Continuous treatment with levodopa of Parkinson disease].

Background: The advanced stage of Parkinson's disease is characterised by motor fluctuations which are often difficult to control on traditional, peroral levodopa medication. We present our experience and a literature search regarding a method for continuous intraduodenal administration of a levodopa/carbidopa gel (Duodopa).

Methods: In a pilot study based on the compassionate use of continuous intraduodenal levodopa, patients were tested via nasoduodenal administration of the gel and on-off registration.

Gut perforation caused by biliary endoprosthesis.

Two cases are reported of perforation of the gut caused by biliary endoprosthesies in the three-year period 1993-1995. The first patient was an 81-year-old man who had perforation of the terminal ileum caused by a straight 10 French/7 cm stent which had been dislodged from the bile duct; he underwent laparotomy but did not recover. The second patient was an 86-year-old man who had perforation of the sigmoid colon caused by a straight 7 French/5 cm stent left in the duodenum during a stent exchange procedure; he was successfully treated laparoscopically.

[Laparoscopic splenectomy].

From 1995 to 1998, 14 patients have been treated with laparoscopic splenectomy. Seven patients had immune thrombocytopenic purpura (ITP), six hereditary spherocytosis and one chronic myelomonocytic leukaemia with trombocytopenia. 12 of the patients had normal or nearly normal sized spleen.

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.

[Laparoscopic colorectal surgery. The first experiences from the Central Hospital of Akershus].

Between November 1993 and August 1997, 49 patients (29 women and 20 men) were selected to 51 laparoscopic and laparoscopic-assisted colonic or rectal operations. Five operations were converted to open surgery because of technical problems and adhesions. 46 operations could be performed as planned.

Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis.

Objective: To evaluate the efficacy of diagnostic laparoscopy in patients with suspected acute appendicitis, the number of complications associated with the laparoscopic technique, and the effect of leaving a macroscopically normal-looking appendix in place.

Design: Three prospective protocols.

Setting: Three departments of surgery, one in Norway and two in Sweden.

Development of play-the-winner design: weighting and accumulation of information.

Background: Play-the-Winner (PTW) design was compared with Weighted-Play-the-Winner (WPW) design with regard to sensitivity to discriminate between treatments.

Methods: In total, 231 patients undergoing digestive surgery were included in a PTW study comparing safety of enoxaparin and dextran-70 in the prevention of venous thrombo-embolism. In the PTW model each patient was classified as a 'winner' or 'loser'.

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.

Evaluation of enoxaparin given before and after operation to prevent venous thromboembolism during digestive surgery: play-the-winner designed study.

A total of 316 patients were included in a play-the-winner (PTW) designed study comparing the safety of enoxaparin started preoperatively versus postoperatively as prophylaxis against venous thromboembolism for digestive surgery. In a PTW-designed study the treatment of any next patient depends on the outcome of the previous patient. If successful, the next patient receives the same treatment, if not, the comparative regimen is given.

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.

Characterization of 'winners' to enoxaparin in the prevention of postoperative venous thromboembolism in digestive surgery.

Background: A total of 826 patients were included in three 'play-the-winner' studies to investigate the safety of prophylaxis against venous thromboembolism in digestive surgery. To characterize patients benefiting from prophylaxis with low-molecular heparin, the 445 patients allocated to enoxaparin were investigated.

Methods: A training set consisting of 292 patients from 2 of the studies was analysed by using a linear discriminant model.

Selection criteria for endoscopic retrograde cholangiopancreaticography (ERCP) in patients with gallstone disease.

Endoscopic retrograde cholangiopancreatography (ERCP) has been used in patients referred to cholecystectomy when clinical information, biochemical values, or ultrasonography (clinical characterization) have indicated possible presence of common bile duct stones. A retrospective study of 599 patients treated for gallstone disease was used to develop a characterization procedure for predicting common bile duct stones by a discriminant analysis procedure. The variables selected by the analysis as the best combination for CBDS prediction were age (years), the values of bilirubin (micromol/l), ALAT (U/l) and gamma GT (U/l).

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.

Prospective nonrandomized study of conventional versus laparoscopic appendectomy.

With the introduction of laparoscopic appendectomy a prospective study was started. Patients with suspected appendicitis were selected for conventional appendectomy or laparoscopy according to the preference of the surgeon on call. During a 1-year period 233 patients were included, of whom 97 underwent conventional appendectomy and 136 laparoscopy.

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.

Laparoscopic and open cholecystectomy. A prospective, randomized study.

Objective: To compare laparoscopic with open cholecystectomy.

Design: Prospective random control trial.

Setting: Central Hospital of Akershus, Nordbyhagen, Norway.