Scandinavian Journal of Surgery最新文献

{"title":"Robotic-assisted versus laparoscopic gastrectomy in a low-incidence Nordic country: A single-center retrospective study.","authors":"Magnus H Fasting, Ulrik Joys, Dag T Førland, Caroline Skagemo, Tobias Hauge, Egil Johnson, Tom Mala","doi":"10.1177/14574969261480875","DOIUrl":"https://doi.org/10.1177/14574969261480875","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted gastrectomy is increasingly used in the treatment of gastric cancer, but the evidence on outcomes in Western low-volume centers remains limited. We aimed to evaluate the surgical and oncological outcomes during implementation of robotic-assisted gastrectomy in a university hospital in Norway and to compare outcomes with laparoscopic-assisted gastrectomy.</p><p><strong>Methods: </strong>All patients undergoing curative-intent resection for gastric adenocarcinoma at Oslo University Hospital with either robotic-assisted gastrectomy or laparoscopic-assisted gastrectomy from November 2018 to December 2025 were included in this retrospective cohort study. Laparoscopic-assisted gastrectomy was introduced at the center in 2015 and robotic-assisted gastrectomy in 2018. During the study period, two surgeons received training in laparoscopic-assisted gastrectomy, while robotic-assisted gastrectomy was implemented with sequential training of five surgeons. The main outcome was textbook outcome, defined as no serious complications, R0 resection, no conversion to open surgery, at least 15 lymph nodes in the specimen, and no 30-day mortality or readmission. Secondary outcomes included R0 resection, number of lymph nodes, serious complications, anastomotic leakage, procedure time and overall survival.</p><p><strong>Results: </strong>During the study period, there were 136 attempted robotic-assisted gastrectomies and 134 attempted laparoscopic-assisted gastrectomies, of which 108 (79%) and 104 (78%) were completed (<i>p</i> = 0.72). The overall distribution of tumor location differed between the robotic-assisted gastrectomy and laparoscopic-assisted gastrectomy groups (<i>p</i> = 0.03). Otherwise, the groups were comparable for the assessed baseline characteristics. Textbook outcome was achieved in 54/108 (50%) robotic-assisted gastrectomy and 55/104 (53%) laparoscopic-assisted gastrectomy procedures (<i>p</i> = 0.67). Procedure time was 60 min (95% confidence interval: 41, 79) longer in robotic-assisted gastrectomy versus laparoscopic-assisted gastrectomy. R0 resection was observed in 94/108 (87%) patients after robotic-assisted gastrectomy and 100/104 (96%) after laparoscopic-assisted gastrectomy (<i>p</i> = 0.03). There was no difference in other short-term outcomes or overall survival.</p><p><strong>Conclusion: </strong>Robotic-assisted gastrectomy was associated with a similar textbook outcome rate compared with that of laparoscopic-assisted gastrectomy. The lower rate of R0 resections after robotic-assisted gastrectomy warrants continued audit and further evaluation.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261480875"},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival following colorectal cancer resection in nonagenarians: A Swedish nationwide population-based study.","authors":"Parisa G Mörlin, Mojgan C Sifolahzadeh, Maziar Nikberg, Peter Matthiessen, Abbas Chabok","doi":"10.1177/14574969261481930","DOIUrl":"https://doi.org/10.1177/14574969261481930","url":null,"abstract":"<p><strong>Background and aims: </strong>To evaluate survival according to treatment strategy among nonagenarians diagnosed with colorectal cancer in Sweden.</p><p><strong>Methods: </strong>This retrospective population-based register study used data from the Swedish Colorectal Cancer Registry. All patients aged ⩾90 years diagnosed with colorectal cancer in Sweden between 2010 and 2019 were included. Patient demographics, tumour characteristics, treatment data, and perioperative outcomes were analysed. Overall survival and relative survival were assessed.</p><p><strong>Results: </strong>A total of 2055 nonagenarians with colorectal cancer were identified. The median age was 91 (range: 90-106), and 1254 (61%) were women. Overall, 1026 patients (50%) underwent bowel resection, of whom 655 (64%) had elective surgery.Among patients undergoing bowel resection, 1- and 3-year overall survival rates were 71% and 37%, respectively. Relative survival was comparable to that of the general population matched for age, sex, and calendar year. Patients who underwent elective resection had significantly longer median survival than those undergoing emergency surgery (37 vs 22 months, <i>p</i> < 0.001). Emergency resection was associated with higher 30- and 90-day mortality than elective resection (15% vs 4%; <i>p</i> < 0.001 and 26% vs 5%; <i>p</i> < 0.001, respectively).In multivariable Cox regression analysis restricted to patients undergoing bowel resection, male sex (hazard ratio = 1.30; standard error = 0.08; <i>p</i> < 0.001), emergency surgery (hazard ratio = 1.70; standard error = 0.09; <i>p</i> < 0.001), advanced tumour stage (hazard ratio = 1.61; standard error = 0.05; <i>p</i> < 0.001), and higher American Society of Anaesthesiologists score (hazard ratio = 1.35; standard error = 0.06; <i>p</i> < 0.001) were independently associated with an increased risk of death.</p><p><strong>Conclusion: </strong>Half of all nonagenarians diagnosed with colorectal cancer underwent bowel resection. Survival following resection was comparable to that expected in the age-matched general population, whereas emergency surgery was associated with substantially higher short-term mortality and poorer long-term survival.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261481930"},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early stoma-related complications in end-colostomy patients: A prospective single-center study.","authors":"Anu Vormisto, Erkki-Ville Wirta, Kirsi Lehto, Marja Hyöty, Heini Huhtala, Jaana Janhunen, Ilona Helavirta","doi":"10.1177/14574969261467357","DOIUrl":"10.1177/14574969261467357","url":null,"abstract":"<p><strong>Background: </strong>End colostomies are performed frequently in both emergency and elective abdominal surgery. The aim of this study was to assess early stoma-related complications and to identify risk factors for severe complications.</p><p><strong>Methods: </strong>All patients undergoing surgery with an end colostomy during 2018-2020 at Tampere University Hospital were identified. This was a single-center study based on a prospective stoma registry complemented with additional retrospective clinical data. A stoma-related complication was classified as severe (Clavien-Dindo grade ⩾3a) or mild (<3a).</p><p><strong>Results: </strong>The study comprises 360 patients (median age = 71, interquartile range = 64-78 years); 197 (55%) patients were male, and out of these 360 patients, 242 (67%) underwent elective operation and 118 (33%) underwent emergency surgery. There were 18/118 (15%) severe stoma-related complications in the emergency and 12/242 (5%) in the elective group. Stoma site was marked preoperatively for 53/118 (45%) in the emergency group and for 235/242 (97%) patients in the elective group. Most of the stomas were performed by a specialist or resident in gastrointestinal surgery (95%, 342/360). In univariate analyses, emergency surgery (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.6-7.4, p = 0.002), smoking (OR = 2.9, 95% CI = 1.3-6.8, p = 0.01), lack of experience in gastrointestinal surgery of the operating surgeon (OR = 4.9, 95% CI = 1.6-14.8, p = 0.05, unmarked stoma site (OR = 2.3, 95% CI = 1.0-5.2, p = 0.04), and American Society of Anesthesiologists (ASA) score IV-V (OR = 2.7, 95% CI = 1.2-6.0, p = 0.01) showed increased risk of severe stoma complications. In multivariate logistic regression analysis, smoking (OR = 3.3, 95% CI = 1.3-7.9, p = 0.009) was associated with severe stoma complications.</p><p><strong>Conclusion: </strong>Morbidity associated with end colostomy is common, especially in emergency surgery. Smoking was the only independent risk factor for severe short-term stoma complications. Stoma site planning and cessation of smoking may reduce stoma-related complications.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"257-263"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary metastasectomy in Iceland: Long-term nationwide trends and outcomes.","authors":"Carlos Magnus Rabelo, Luis Gisli Rabelo, Sigurdis Haraldsdottir, Tomas Gudbjartsson, Halla Vidarsdottir","doi":"10.1177/14574969261468491","DOIUrl":"10.1177/14574969261468491","url":null,"abstract":"<p><strong>Background and aims: </strong>Pulmonary metastases are generally associated with poor prognosis, and only a selected subset of patients undergo surgery. However, population-level data on outcomes remain limited. This study aimed to evaluate temporal trends and outcomes of pulmonary metastasectomy (PM) in a nationwide cohort over more than two decades.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients who underwent PMs in Iceland between 2001 and 2021. The study period was divided into three 7-year intervals for comparison. Survival was evaluated from the first PM using the Kaplan-Meier analysis, and prognostic factors were assessed using multivariable Cox regression.</p><p><strong>Results: </strong>A total of 179 PMs were performed, with procedure volume increasing significantly during the final study period. The median age at the first PM was 62 years, and 54% of patients were male. The most common indication was metastatic colorectal carcinoma (39.3%), followed by renal cell carcinoma (16.4%) and sarcoma (10%). Median follow-up was 52 months. Early major postoperative complications occurred in 2.2% of cases, with a 30-day mortality rate of 1.1%. Five-year overall survival was 49.7%, and 55.5%, 60.9%, and 35.7% for colorectal carcinoma, renal cell carcinoma, and sarcoma tumor subtypes, respectively. Five-year overall survival increased significantly from 31% to 55% across the first and last 7-year periods. In addition to sarcoma histology and an operation in the first period, negative prognostic factors included advanced age, a greater number of metastases, and a prior extrathoracic metastasectomy.</p><p><strong>Conclusions: </strong>The use of PM increased over time and was accompanied by improved long-term survival, likely reflecting advances in systemic therapy, imaging, and patient selection. The procedure had a low rate of major complications, and 5-year survival rates were comparable to those reported in international data.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"354-363"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and outcome of acute kidney injury in open abdomen treatment following open surgery for ruptured abdominal aortic aneurysm.","authors":"Henriette Fagertun, Knut A Rise Langlo, Pål Klepstad, Skule Mo, Tor-Arne Hegvik, Linn Åldstedt Nyrønning, Martin Björck, Arne Seternes","doi":"10.1177/14574969261438658","DOIUrl":"10.1177/14574969261438658","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute kidney injury (AKI) is a key contributor to multiorgan dysfunction and mortality in ruptured abdominal aortic aneurysm (rAAA). Intra-abdominal hypertension and abdominal compartment syndrome (ACS), complications potentially resulting in AKI, can be prevented or managed with open abdomen treatment (OAT). Using consensus-based definitions, this study characterizes AKI in rAAA patients managed with OAT and examines the impact of abdominal wall closure on renal function.</p><p><strong>Methods: </strong>A single-center observational cohort study including all consecutive patients treated with OAT after open surgical repair for rAAA from September 2009 to January 2024. AKI was diagnosed and staged based on urine output (UO) and S-creatinine (SCr) as defined by the KDIGO classification, reassessed at closure of the abdomen and at discharge.</p><p><strong>Results: </strong>Seventy-three patients (mean age 73 years, 85% male) received OAT, prophylactically in 63 (85%) and due to ACS in 11 (15%). AKI occurred in 71 patients (97%) at a median of 2 (IQR, 2-3) days of admittance; 22 patients (30%) had stage 3 AKI, including 13 (18%) needing renal replacement therapy. The multivariable logistic regression showed SCr at admittance (p = .034) and perioperative diuresis (p = .018) as predictors of stage 3 AKI. The UO criterion diagnosed more patients than SCr alone (p = .001). Abdominal closure did not aggravate kidney function. In AKI stage 3, 90-day survival was 46% versus 80% in AKI stage 1 and 2 (p = .008). Forty-seven out of 51 survivors (92%) had resolution of their AKI before discharge.</p><p><strong>Conclusions: </strong>Defined by KDIGO, AKI developed in 71/73 (97%) of rAAA patients with OAT after surgical repair. UO was the most sensitive parameter. AKI was diagnosed at median 2 days of admittance and was transient in majority of survivors. There was no aggravation of kidney function at delayed primary abdominal closure.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"300-311"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term study to assess quality of life and cost outcomes of different delayed breast reconstruction techniques: A randomized controlled trial (GoBreast).","authors":"Fredrik Brorson, Emma Hansson, Anna Paganini, Anna Elander, Mikael Svensson","doi":"10.1177/14574969261462051","DOIUrl":"10.1177/14574969261462051","url":null,"abstract":"<p><strong>Background: </strong>The aim of breast reconstruction after mastectomy is to improve quality of life and patient satisfaction, but cost-effectiveness of different reconstruction techniques remains uncertain due to methodological limitations in existing studies. High-quality trial-based economic evaluations are therefore needed. This study aimed to compare the quality of life and cost outcomes of patients randomized to different delayed breast reconstruction techniques based on previous receipt of radiotherapy.</p><p><strong>Methods: </strong>A single-site randomized controlled trial (GoBreast; NCT03963427) including women aged 18-60 undergoing delayed breast reconstruction was conducted. Patients without previous radiotherapy were randomized to either thoracodorsal flap with implant (TD) or two-stage expander (EXP), while patients with previous receipt of radiotherapy were randomized to either latissimus dorsi with implant (LD) or deep inferior epigastric artery perforator (DIEP) flap. Outcomes included health-related quality of life (HRQoL) (by SF-6D utilities), re-operations, and direct/indirect costs over long-term follow-up.</p><p><strong>Results: </strong>Among patients without previous radiotherapy (<i>n</i> = 75), EXP had slightly lower direct healthcare costs, but higher indirect costs, and generated a statistically significant positive change in HRQoL utility value (0.06 (0.02;0.9)) and fewer re-operations (2.34 vs 4.73) during a mean follow-up of 12.9 years. Among patients who had received radiotherapy (<i>n</i> = 25), there were no statistically significant differences in HRQoL utility scores or total costs, but a higher re-operation rate for LD as compared to DIEP.</p><p><strong>Conclusion: </strong>Among patients without previous radiotherapy, EXP yielded superior HRQoL and fewer re-operations compared to TD. In patients with previous receipt of radiotherapy, DIEP reconstruction was associated with fewer re-operations and comparable costs compared to LD.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"273-281"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to move beyond BMI alone in predicting arthroplasty infections: A large single-center retrospective cohort study.","authors":"Elisa Kosonen, Rasmus Liukkonen, Aleksi Reito, Eerik Skyttä, Antti Eskelinen","doi":"10.1177/14574969261438911","DOIUrl":"10.1177/14574969261438911","url":null,"abstract":"<p><strong>Background and aims: </strong>A high body mass index (BMI) has traditionally been a strict criterion for surgical eligibility for arthroplasty based on the increased risk for periprosthetic joint infection (PJI). Individuals with obesity are two to four times more likely to undergo joint arthroplasty. There are limited data on how well BMI predicts PJI risk and whether strict BMI-based surgical criteria are justified.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included all primary total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) performed at our institution between 1 January 2008 and 28 November 2023. Survival was analyzed using the Kaplan-Meier method, with PJI as the primary outcome. The association between BMI and PJI was assessed using logistic regression and Cox proportional hazards regression.</p><p><strong>Results: </strong>A total of 54,879 arthroplasties (23,544 hip and 31,335 knee arthroplasties) were included. The median age was 68 years (interquartile range (IQR): 60-75), and 60.0% of patients were female. The risk for PJI was highest in patients with a BMI >45. After THA, the lowest risk for PJI was seen with a BMI <25 (1.0%) and between 25 and 30 (1.1%) after TKA. After THA, a J-shaped association between BMI and PJI was observed in logistic regression analysis, as the risk for PJI increased in patients with both low and high BMIs. A J-shaped association between BMI and PJI was also observed in Cox regression analysis after both TKA and THA. Men had a higher risk for PJI after THA than women, whereas no sex variation was observed after TKA.</p><p><strong>Conclusion: </strong>The risk for PJI does not increase linearly with BMI and the risk differs between women and men. When BMI exceeds 45, risk levels become notably high. Otherwise, the absolute risk differences between different BMI categories are relatively low. Emphasis should be placed on individualized risk assessment and shared decision-making rather than focusing solely on BMI.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"291-299"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of localized rectal cancer in the Nordic countries-comparison of Nordic to Dutch, ESMO, and NCCN guidelines.","authors":"Erkki-Ville Wirta, Usman Saeed, Gijs Stuart, Laurids Østergaard Poulsen, Camilla Qvortrup, Pia Österlund, Jørgen Smeby, Jens Ravn Eriksen, Bengt Glimelius, Esther Consten, Pamela Buchwald, Toni T Seppälä, Johannes Kurt Schultz","doi":"10.1177/14574969261462056","DOIUrl":"10.1177/14574969261462056","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer treatment in Nordic countries has traditionally differed, especially regarding neoadjuvant treatment. The aim of this review is to give an overview of the current rectal cancer guidelines in the Nordics and compare these to international guidelines.</p><p><strong>Methods: </strong>Oncologists and colorectal surgeons from the Nordic countries (Denmark, Finland, Norway, and Sweden) and the Netherlands were invited to participate in this narrative review. Two consensus meetings were held to agree on the content. All authors provided recommendations from their national guidelines. In addition, recommendations from the European Society of Medical Oncology (ESMO) and from the US National Comprehensive Cancer Network (NCCN) guidelines were extracted.</p><p><strong>Results: </strong>Several differences between the included guidelines were identified. The radiological \"sigmoid take-off\" definition for the upper margin of the rectum has been adapted in Denmark and the Netherlands, whereas the other guidelines rely on distance from the anal verge on rigid sigmoidoscopy. Indications for direct surgery vary considerably, where the NCCN guidelines recommend more aggressive neoadjuvant treatment, primarily total neoadjuvant therapy (TNT), the Nordic and European guidelines open for direct surgery more often, and reserve especially TNT for high-risk cases. European countries more often recommend short-course radiotherapy, whereas NCCN maintains chemoradiotherapy as the mainstay. Whereas intentional and opportunistic organ preservation is an established part of the Dutch, NCCN, and ESMO guidelines, its use is mostly restricted to clinical trials in the Nordics. The Nordics and the Netherlands are restrictive in terms of adjuvant treatment, which is frequently recommended in ESMO and NCCN. Whereas neoadjuvant immunotherapy is recommended for mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) rectal cancer in NCCN, this use is off-label in Europe and not routinely recommended.</p><p><strong>Conclusion: </strong>Although all guidelines rely on the same evidence, there are considerable differences, especially in the indications and type of oncologic treatment, both in the neoadjuvant and in the adjuvant setting.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"364-382"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional variations in surgeries for carpal tunnel syndrome and ulnar nerve disorders: A registry-based study in Finland.","authors":"Vieda Lusa, Ville Ponkilainen, Anniina Laurema, Ville M Mattila, Teemu Karjalainen","doi":"10.1177/14574969261458557","DOIUrl":"10.1177/14574969261458557","url":null,"abstract":"<p><strong>Background and aims: </strong>A large variation in surgery rates can be indicative of its overuse. In Finland, surgeries for carpal tunnel syndrome (CTS) and ulnar nerve disorder (UN) are common, but regional differences in their incidence rates remain unexplored. This study examined how the incidence rates of these surgeries vary across hospital districts in Finland to evaluate regional consistency.</p><p><strong>Methods: </strong>We compared regional age- and sex-adjusted incidence rates per 100,000 person-years based on data from Finland's Care Register for Health Care for CTS and UN surgeries from 2010 to 2021, calculated relative to population size as reported by Statistics Finland. The study included 21 hospital districts in Finland.</p><p><strong>Results: </strong>During the 4-year period from 2018 to 2021, the difference between the lowest (99.6 cases per 100,000 person-years (95% confidence interval (CI) 80.7-122)) and the highest (351 cases per 100,000 person-years (95% CI 336-367)) adjusted incidence rates for CTS surgery was 3.5-fold, with a median adjusted incidence rate of 213 cases per 100,000 person-years. Over the same period, the difference between the lowest (1.04 cases per 100,000 person-year (95% CI 0.03-5.78)) and the highest (81.9 cases per 100,000 person-years (95% CI 73.2-91.5)) adjusted incidence rates for UN surgery was up to 79-fold, with a median adjusted incidence rate of 17.8 cases per 100,000 person-years.</p><p><strong>Conclusions: </strong>Surgery for CTS shows up to a 3.5-fold variation across Finland's hospital districts. Although less common in absolute numbers, surgical treatment rates for UN vary up to 79-fold among these regions. Such significant variations are unlikely to be attributed solely to differences in population morbidity. Instead, the findings indicate that the criteria for performing these surgeries vary considerably across the Finland's hospital districts, suggesting a potential overuse in certain areas.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"344-353"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A two-center randomized clinical superiority trial of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy for severe obesity: SASSY study protocol.","authors":"Helene M Haug, Rolf E Hagen, Jon A Kristinsson, Marius Svanevik, Rune Sandbu, Asle W Medhus, Morten W Fagerland, Carl F Schou, Tom Mala, Torgeir T Søvik","doi":"10.1177/14574969261470903","DOIUrl":"10.1177/14574969261470903","url":null,"abstract":"<p><strong>Background: </strong>Single-anastomosis sleeve ileal bypass is a novel metabolic bariatric surgery intended to enhance metabolic outcomes and reduce the risk of postoperative complications. Although preliminary outcome data for single-anastomosis sleeve ileal bypass are promising, evidence from adequately powered, randomized head-to-head comparisons is scarce. This trial compares the efficacy and safety of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy in patients with class II obesity (body mass index = 35.0-39.9 kg/m²) with at least one obesity‑related comorbidity or class III obesity (body mass index ⩾40.0 kg/m²).</p><p><strong>Methods: </strong>This two-center randomized clinical superiority trial enrolls patients eligible for metabolic bariatric surgery at two specialized Norwegian centers. Included patients are randomly assigned (1:1) to either single-anastomosis sleeve ileal bypass or sleeve gastrectomy with standardized perioperative treatment and care. The primary endpoint is the between-group difference in change in body mass index from baseline to 2 years after single-anastomosis sleeve ileal bypass versus sleeve gastrectomy. Secondary endpoints include additional weight loss outcomes, the prevalence of gastroesophageal reflux disease, surgical and postoperative complications, obesity-related comorbidities, nutritional status, bone mineral density, gastrointestinal symptoms, quality of life, and rates of revisional and conversion surgery. All endpoints will be evaluated at 2 and 5 years after surgery. Statistical analyses utilize linear mixed models and analysis of covariance within an intention-to-treat framework.</p><p><strong>Discussion: </strong>This trial will provide high-level evidence with robust and comparative outcome data on single-anastomosis sleeve ileal bypass and sleeve gastrectomy, aiming to clarify the clinical utility of single-anastomosis sleeve ileal bypass and inform surgical practice. Findings will address gaps in medium- and long-term evidence regarding weight loss, safety, comorbidity resolution, and quality of life following single-anastomosis sleeve ileal bypass.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"391-399"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}