Acute cholecystitis is the most common complication of gallstone disease. Although early cholecystectomy is recommended, surgery is frequently delayed in clinical practice. This study aimed to evaluate the association between preoperative length of stay and postoperative complications following cholecystectomy for acute cholecystitis. In addition, reasons for delayed surgery were assessed. This multicenter retrospective cohort study included consecutive patients undergoing laparoscopic cholecystectomy for acute cholecystitis between January 1, 2018, and December 31, 2022. Preoperative length of stay was defined as the time from admission to surgery. Postoperative complications were classified according to the Clavien–Dindo classification, and diagnosis and severity of acute cholecystitis were defined according to the Tokyo Guidelines. A total of 1,544 consecutive patients were included. After adjustment for age, body mass index, ASA classification, performance status, Tokyo Guidelines severity, symptom duration, and treating hospital, each additional preoperative hospital day was associated with higher odds of postoperative complications requiring pharmacological or surgical treatment (Clavien–Dindo ≥2) (OR 1.14, 95

Economic claims after surgery may be regarded as an alternative surrogate outcome for long-term deprived quality of life. This study reports economic claims of chronic pain following inguinal hernia repair. Consecutive data on economic claims following inguinal hernia repair was collected from the nationwide Danish Patient Compensation Association. Patients’ claims were stratified into three groups: 1) isolated chronic pain claims without claims of competing potential reasons for chronic pain (ICP); 2) diverse claims not involving claims of chronic pain (NCP); and 3) claims involving a combination of chronic pain and competing potential claim reasons for chronic pain (CCP). A total of 507 patients were included and 256 (50.5

Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn’s disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data. This nationwide cohort study (2007–2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses. Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5

Purpose The study objective is to document value created by real-world evidence from the Abdominal Core Health Quality Collaborative (ACHQC) for regulatory decisions. The ACHQC is a national effort that generates data on hernia repair techniques and devices.Methods Two retrospective cohort evaluations compared cost and time of ACHQC analyses to traditional postmarket studies. The first analysis was based on 25 reports submitted to the European Medicines Agency of 20 mesh products for post-market surveillance. A second analysis supported label expansion submitted to the Food and Drug Administration, Center for Devices and Radiological Health for a robotic-assisted surgery device to include ventral hernia repair. Estimated costs of counterfactual studies, defined as studies that might have been done if the registry had not been available, were derived from a model described in the literature. Return on investment, percentage of cost savings, and time savings were calculated.Results 45,010 patients contributed to the two analyses. The cost and time differences between individual 25 ACHQC analyses (41,112 patients) and traditional studies ranged from $1.3 to $2.2 million and from 3 to 4.8 years, both favoring use of the ACHQC. In the second label expansion analysis (3,898 patients), the estimated return on investment ranged from 11 to 461% with time savings of 5.1 years favoring use of the ACHQC.Conclusions Compared to traditional postmarket studies, use of ACHQC data can result in cost and time savings when used for appropriate regulatory decisions in light of key assumptions.

Patients with Crohn’s disease (CD) frequently undergo multiple abdominal operations, which increase the risk of incisional hernia repair (IHR) and associated mesh-related complications. Patients with intra-abdominal fistulizing CD (FCD) may be more susceptible to mesh-related complications than patients with non-fistulizing CD (non-FCD). The primary objective was to evaluate the risk of reoperation due to mesh-related complications after IHR in patients with FCD and non-FCD. Secondarily, the study evaluated the impact of isolated perianal fistulizing CD on mesh-related complications and the difference in hernia recurrence reoperation rates between FCD and non-FCD patients. This nationwide study followed patients from 30 days after their first recorded IHR until reoperation due to mesh-related complications or hernia recurrence. Cumulative incidence proportion and Cox regression analysis were used to estimate the risk of these outcomes. A total of 334 patients with CD (FCD, n = 55; non-FCD, n = 279) underwent IHR between 2007 and 2016 with a follow-up rate of 100

Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department for diagnosis and indication for surgery. Patients with giant and parastomal hernias are referred to one of the five Danish regional hernia centres. Patients with parastomal hernias often benefit from being referred to a stoma nurse. The most frequent complications after hernia repair are wound complications and recurrence. In case of severe wound infection, incarceration, or strangulation the patient must always be referred acutely, as argued in this review.

Purpose Risk assessment of disease recurrence in pT1 colorectal cancer is crucial in order to select the appropriate treatment strategy. The study aimed to develop a prediction model, based on histopathological data, for the probability of disease recurrence and residual disease in patients with pT1 colorectal cancer. Methods The model dataset consisted of 558 patients with pT1 CRC who had undergone endoscopic resection only ( n = 339) or endoscopic resection followed by subsequent bowel resection ( n = 219). Tissue blocks and slides were retrieved from Pathology Departments from all regions in Denmark. All original slides were evaluated by one experienced gastrointestinal pathologist (TPK). New sections were cut and stained for haematoxylin and eosin (HE) and immunohistochemical markers. Missing values were multiple imputed. A logistic regression model with backward elimination was used to construct the prediction model. Results The final prediction model for disease recurrence demonstrated good performance with AUC of 0.75 [95% CI 0.72–0.78], HL chi-squared test of 0.59 and scaled Brier score of 10%. The final prediction model for residual disease demonstrated medium performance with an AUC of 0.68 [0.63–0.72]. Conclusion We developed a prediction model for the probability of disease recurrence in pT1 CRC with good performance and calibration based on histopathological data. Together with lymphatic and venous invasion, an involved resection margin (0 mm) as opposed to a margin of ≤ 1 mm was an independent risk factor for both disease recurrence and residual disease.

Aim Patients with inflammatory bowel disease (IBD) may undergo several abdominal surgeries with a risk of incisional hernia repair (IHR). The objectives of this study were to establish the risk of IHR and to analyse predictors of IHR after a first-time abdominal surgery for IBD.Method This Danish nationwide register-based cohort study (1996-2018) followed IBD patients from index operation until the date of IHR. The absolute risk was calculated as the cumulative incidence proportion treating death as a competing risk. Cox proportional hazard regression was used to compare the risk of IHR among different subtypes of IBD and to explore predictors of IHR. IBD subtypes were classified as ulcerative colitis (UC), Crohn's disease (CD) or unclassified IBD (IBD-U).Results In total, 10 130 patients with IBD (UC 3911 [39%]; CD 4210 [41%]; IBD-U 2009 [20%]) underwent either an open or a laparoscopic index operation. The 10-year cumulative incidence of IHR varied between 5.0% and 6.3%, with a significantly higher risk in patients with UC and IBD-U. Patients with UC (75.9%) and IBD-U (91.9%) had more (two or more) abdominal surgeries in the follow-up period compared with CD (51.9%). The risk of IHR increased dramatically with the number of surgeries, although not as markedly if a laparoscopic approach was used. Male sex, age, comorbidity, fascial dehiscence, wound infection and presence of stoma were predictors of IHR for patients with IBD.Conclusion The long-term risk of IHR was roughly 5%-6%, with a higher risk in patients with UC and IBD-U. Open surgical approach and number of previous surgeries were, among other things, important predictors of IHR.

Evidence for mesh-related surgical complications and chronic pain after umbilical hernia repair is only sparsely reported. The present study used economic claims and compensation as a proxy for mesh-related complications and chronic pain. Mesh-related complications and chronic pain may be important adverse long-term outcomes following umbilical hernia repair. Mesh-related complications were an important reason for granting economic compensation.

Mesh is recommended for umbilical hernias with defects > 1 cm to reduce recurrence. For umbilical hernias with defect width ≤ 1 cm, the literature is sparse. The aim of this nationwide cohort study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width ≤ 1 cm and to evaluate outcomes after onlay mesh repair specifically. By merging data from the Danish Hernia Database and the National Patients Registry from 2007 to 2018, patients undergoing elective open repair of an umbilical hernia with defect width ≤ 1 cm were identified. Available data included details about comorbidity, surgical technique, 90-day readmission, 90-day reoperation and operation for recurrence. A total of 7849 patients were included, of whom 25.7% (2013/7849) underwent mesh repair. Reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1–4.1) compared with suture repair 6.7% (95% C.I. 6.0–7.4), P < 0.001. Readmission and reoperation rates were significantly higher for mesh repair 7.9% (159/2013) and 2.6% (52/2013) than for suture repair 6.5% (381/5836) and 1.5% (89/5836), P = 0.036 and P = 0.002, respectively. Onlay mesh repairs had the lowest risk of recurrence 2.0% (95% C.I. 0.6–3.5), and readmission [7.9% (65/826)] and reoperation [3.9% (32/826)] rates within 90 days were comparable to suture repairs [6.5% (381/5836)] and [3.3% (192/5836)], P = 0.149 and P = 0.382, respectively. Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with lowest risk of recurrence without increasing early complications.

The National Danish Inguinal Hernia Database (1997) and Ventral Hernia Database (2007), together the Danish Hernia Database, was launched to monitor and optimize surgical quality and outcomes after hernia repairs. The purpose of the present qualitative review was to present five “highlight” publications from the 123 published/in press (October 2020) original publications from the Danish Hernia Database. Two international hernia experts independently nominated 10 publications from the Database publication list published between 2010 and 2020. Each of the 10 members of the database steering group ranked the 10 publications according to the following three categories: (I) originality, (II) methodology, and (III) clinical impact. The publications were ranked as 1= good, 2= very good, 3= outstanding. The five publications with the highest score were depicted as highlights. The publications dealt with: (I) long-term mesh-related complications after incisional hernia repair, (II) outcomes after parastomal hernia repairs, (III) mesh or suture repair of ventral hernias in women having subsequent pregnancy, (IV) reoperation for recurrence versus clinical recurrence rates, and (V) recurrence rates after resorbable versus non-resorbable tackers for laparoscopic ventral hernia repair. Data from the Danish Hernia Database is internationally acknowledged. The nationwide Danish data supplements the higher-ranking evidence by randomized controlled trials (RCTs) by adding evidence-based answers to scientifically clinically relevant questions. The Danish Hernia Database is still active after more than 20 years.

Obesity is associated with adverse labor market outcomes. We examine whether undergoing bariatric surgery is associated with better labor market outcomes such as lower risks of unemployment and sickness absence. This is a register-based cohort study of 9126 patients undergoing bariatric surgery from 2005 to 2013 and a reference group of 10,328 individuals with obesity. Age: 18–60 years, body mass index (BMI): 32–60 kg/m2. Participants were either working, unemployed, or on sickness absence at baseline. Inverse probability of treatment weighting was used to account for baseline differences between the two groups. Relative risk ratios of labor market participation were estimated at 1 year, 3 years, and 5 years of follow-up. Women who had undergone bariatric surgery had a higher risk of unemployment 1 year (RRR = 1.20 (95% CI: 1.02–1.41)) and 5 years (RRR = 1.23 (95% CI: 1.05–1.44)) after surgery; however, men with bariatric surgery had a lower risk of unemployment after 5 years (RRR = 0.71 (95% CI: 0.55–0.92)). The risk of sickness absence was higher at all follow-up time points for both men and women who had undergone bariatric surgery compared with non-operated references with obesity. Men undergoing bariatric surgery had a lower risk of unemployment 5 years after surgery compared with non-operated men with obesity; however, women presented a higher risk of unemployment after 5 years. The risk of sickness absence was higher for both men and women up to 5 years after undergoing bariatric surgery.

INTRODUCTION:Following endoscopic removal of malignant colorectal polyps, patients may undergo completion radical resection or surveillance. The optimal surveillance strategy remains unknown. This study included colorectal departments in Scandinavian countries with a focus on follow-up periods and examination modalities for patients with endoscopically removed malignant polyps with a resection margin > 1 mm.METHODS:This study was conducted as an internet-based survey. A questionnaire was sent to all Scandinavian surgical departments performing > 20 colorectal procedures annually. Questions differed between follow-up on rectal and colonic malignant polyps with presence or absence of histological risk factors. The follow-up period was defined as short (one year), intermediate (three years) or long (five years).RESULTS:The majority of the departments used a long (five years) (38-59%) or intermediate (three years) (26-38%) follow-up programme. In patients with rectal malignant polyps and presence of histological risk factors, a significant difference was observed in the use of endoscopy according to length of follow-up. No difference in the use of the different modalities was seen according to length of follow-up in patients with colonic malignant polyps.CONCLUSIONS:The follow-up on patients with endoscopically removed malignant polyps and a surveillance strategy varies both in terms of length and performed modalities. Future studies should compare long-term patient outcomes in departments employing different follow-up strategies.FUNDING:none.TRIAL REGISTRATION:not relevant.

Background and objective Bariatric surgery is a major event associated with psychological changes such as improvements in self-esteem, increased autonomy, and better self-value. Such changes could affect the patient’s interpersonal relationships; however, little is known about the impact of bariatric surgery on changes in relationship status. In this paper, we aim to test the hypothesis that bariatric surgery is associated with changes in interpersonal relationships such as becoming single for those who were in a relationship or entering a relationship among those who were single before surgery. Methods This register-based cohort study consisted of 12,493 patients undergoing bariatric surgery (95% gastric bypass) from 2005 to 2013 and a reference group of 15,101 individuals with obesity between the age of 18–63 with a body mass index between 32 and 60 kg/m 2 . Transitions between married, divorced, widowed, never-married single, and living with a partner without being married were analyzed by Poisson regression. Additionally, the outcome was dichotomized, and transitions between being single and being in a relationship were also analyzed. All analyses were weighted using inverse probability of treatment weighting based on propensity scores. Results The overall incidence rate ratio (IRR) of changing status from being single to in a relationship was 2.03 (95% CI: 1.18–2.28), and the overall IRR of changing status from being in a relationship to single was 1.66 (95% CI: 1.50–1.83). Conclusion Bariatric surgery is associated with a higher chance of finding a partner among single individuals, and a higher risk of separating from a partner among individuals in a relationship.

Traditionally, the quality of ventral hernia repair has been measured by hard outcomes such as morbidity and recurrence, but patient-reported outcome measures (PROMs) have become increasingly popular. In this review we suggest, that only a minor subset of PROMs has improved in patients undergoing elective large-sized incisional hernia repair. For umbilical and smaller incisional hernia repairs, no significant evidence for improved PROMs was found. The vast majority of data were of questionable scientific methodology.

Approximately 5% of patients undergoing open hernia repair, and probably less after laparoscopic repair, will suffer from severe disabling chronic pain. The optimal strategy for surgical treatment of chronic pain following inguinal hernia repair is debatable and not evidence-based. Laparoscopic removal of mesh and/or retroperitoneal neurectomies have been performed in attempts to treat patients with chronic pain after inguinal hernia repair. The aim of this qualitative review is to analyze the evidence surrounding a laparoscopic approach to the surgical management of chronic pain following inguinal hernia repair. Only prospective studies including at least 10 patients operated with a laparoscopic technique were included. Non-English published studies were excluded. The MEDLINE database was searched and supplemented by screening the reference lists of included studies. Each study is presented separately. In total, six studies including 14–42 patients (n=189) reported outcomes with a postoperative follow-up of 3–57 months. Five studies analyzed clinical outcomes after laparoscopic triple or selective neurectomy and one study reported outcome following only laparoscopic mesh removal. The outcome variables were often poorly defined and inconsistent between studies. However, results were generally promising in respect of reduction in pain and increase in activity level. The definition of a successful postoperative outcome was lacking in most studies making it difficult to assert definitive conclusions. What is clear, is that a laparoscopic approach to managing postoperative pain after inguinal hernia repair is feasible but with some risks. More specifically, an extraperitoneal laparoscopic neurectomy may benefit patients suffering from severe chronic pain after inguinal hernia repair. The literature does not provide evidence supporting a universal laparoscopic approach to chronic pain following inguinal hernia repair. More large-scale high-quality studies are warranted before final conclusions can be made on the indication to offer a laparoscopic pain-operation and the long-term outcome.

The authors of this article have requested the following corrections to the manuscript (bold text added to indicate key changes):1In the Methods section, where it reads "The secondary outcomes were changes in the horizontal and vertical defect sizes and the hernia sac volume (V), given as V = π x length x width x depth x 4/310," it should read "The secondary outcomes were changes in the horizontal and vertical defect sizes and the hernia sac volume (V), given as V = π x (length/2) x (width/2) x (depth/2) x 4/3 10."2In the Results section, where it reads "The median hernia sac volume increased from 5.11 L (2.28 – 8.09) to 6.25 L (3.03 – 10.39), P < 0.001," it should read "The median hernia sac volume increased from 0.64 L (0.29 – 1.01) to 0.78 L (0.38 – 1.30), P < 0.001." Similarly, in Table 2, the corresponding hernia sac volumes should be corrected.Table 2Changes from baseline visit to follow-up, median 5.5 months (IQR 4.2-6.3), n = 35.VariableBaselineFollow-upPFascial defect area [cm2], median (IQR)117.3 (46.5- – 181.2)150.4 (62.5- – 199.0)<0.001Horizontal fascial defect [cm], median (IQR)10.3 (7.3- – 15.4)11.3 (9.1- – 15.9)0.001Vertical fascial defect [cm], median (IQR)13.8 (8.6- – 16.5)14.9 (10.1- – 17.1)0.004Hernia sac volume [L], median (IQR)0.64 (0.29- – 1.01)0.78 (0.38- – 1.30)<0.001HerQLes score, median (IQR)53.0 (31.8- – 77.3)51.5 (37.9- – 71.2)0.770IPAQ score [MET-minutes/week], median (IQR)2142 (709- – 4111)1386 (514-– 4158)0.246HerQLes: Hernia-related Quality of Life Score. Range 0 (worst) to 100 (best).IPAQ: International Physical Activity Questionnaire.MET-minutes/week: The energy expended during an activity, relative to the energy expended at rest.IQR: Interquartile range. Open table in a new tab HerQLes: Hernia-related Quality of Life Score. Range 0 (worst) to 100 (best). IPAQ: International Physical Activity Questionnaire. MET-minutes/week: The energy expended during an activity, relative to the energy expended at rest. IQR: Interquartile range. The authors apologize for these errors and any inconvenience they have caused. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. Large Incisional Hernias Increase in SizeJournal of Surgical ResearchVol. 244PreviewPatients with an incisional hernia often wait a significant period of time from the first referral to hernia surgery because of waiting lists, watchful waiting, or the need for preoperative optimization. It is unknown if hernia dimensions or patient-reported symptoms increase during this period. The aim of the study was to examine if incisional hernias increase in size during the time from initial assessment to surgical repair. Full-Text PDF

Abstract Aim The risk of mesh-related surgical complications after umbilical hernia repair is not known and chronic pain has only sparsely been analysed. Economic claims may represent a surrogate for poor postoperative surgical outcomes. Thus, the present study used mesh-related complications and chronic pain as primary and secondary outcomes, respectively. Material and Methods Blinded assessment of Swedish and Danish nationwide consecutive economic claim data from 2007 –2019. The study variables and outcomes were pre-study defined. Major complications were defined as acutely life-threatening complications requiring emergency surgery, clinically important complications were defined as all complications requiring surgical intervention but not emergency surgery. Results During the 13-years study period 181 patients were eligible for analysis. There were 96 patients with a surgical complication. In 52 (54%) and 44 (46%) patients the complication was mesh- or non-mesh-related, respectively. In the group of mesh- and non-mesh-related complications, major complications were found in 14 (14,6%) vs 21 (21,9%) patients and clinically important complications were found in 38 (39,5%) vs 23 (23,9%) patients respectively (P < 0.05). Chronic pain was reported in 18%, followed by wound complications (14%) and cosmetic claim reasons (11%). After open repair, claim because of chronic pain was significantly more common after mesh repair (48%) compared with non-mesh repairs (32%), P = 0.05. The economic compensation after a mesh- and non-mesh complication was 3,488€ (291 – 188,186€) and 2,342€ (507€ - 58,437€) (P = 0.55), respectively. Conclusions Mesh-repair was related to postoperative complications and chronic pain after umbilical hernia repair