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This article compares the success rates and adverse events of two alternative cannulation techniques, transpancreatic sphincterotomy (TPS) and needle knife sphincterotomy (NKS), in endoscopic retrograde cholangiopancreatography (ERCP) when standard guidewire technique with sphincterotomy is unsuccessful. The study analyzed data from the Swedish Registry for Gallstone Surgery and ERCP from 2011 to 2022, with a study population of 45,543 ERCP procedures. The results showed that TPS had a higher success rate of cannulation compared to NKS, but also had a higher occurrence of adverse events, particularly pancreatitis and perforation. The article concludes that TPS should be reserved for difficult situations and performed by skilled endoscopists. [Extracted from the article]

To study nurses' compliance to national guidelines (Sweden) for peripheral venous catheters and to establish the complication frequency connected to time in situ and bore size. Worldwide, there are no standard peripheral venous catheters guidelines, and the need for elective replacement has been challenged. Furthermore, the time interval and need for elective change of peripheral venous catheters has cost implications for hospitals. Prospective register study. The health care professionals in one surgical ward in a university hospital in the south of Sweden prospectively registered peripheral venous catheters parameters. Four hundred and thirteen peripheral venous catheters were registered for time in situ, size and complications. A cost analysis was performed. Non-parametric statistics were used, and p < 0·05 was regarded as significant. Compliance to the guideline of time in situ was 30·2%, and the frequency of thrombophlebitis was 6·5%. Peripheral venous catheters left in situ for more than 72 hours caused more thrombophlebitis ( p = 0·03). There was no difference in thrombophlebitis rate when peripheral venous catheters were changed within 24 hours compared with peripheral venous catheters that were changed within 72 hours. No difference was seen regarding complications between peripheral venous catheters sized 0·9 mm/22 gauge or 1·1 mm/20 gauge. The present Swedish national guidelines, advocating peripheral venous catheter change every 24 hours, should be altered since peripheral venous catheters left in situ for up to 72 hours were not found to be related to a greater risk of developing thrombophlebitis. Nor is it compatible with a greater risk to use a peripheral venous catheter of 1·1 mm/20 gauge instead of 0·9 mm/22 gauge. The change in guidelines would decrease money spent, 250 100 Euro in Sweden, thus allowing time for the nurses to do other tasks and save discomfort for the patients. National guidelines should be based on evidence and current facts, and evaluation of guidelines should be given priority. [ABSTRACT FROM AUTHOR]

Background/Aims: Two differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG), have previously been shown to reduce postoperative intra-abdominal adhesions. This study aims to investigate the possible toxic effects and to establish a lowest effective antiadhesive dose. Methods: 152 mice were investigated with a well-known adhesion model and given different concentrations of the two differently charged polypeptides as well as only the cationic PL. Results: For the first time, a probable toxic level of PL given intraperitoneally (40 mg/kg) and the lowest significant concentration of PL and PG for antiadhesive purposes (1.6 mg/kg) could be established. Conclusion: The gap between the possible toxicity level of PL and the lowest efficient antiadhesive dose is probably too narrow, and the shape and charge of PL warrant continuous research for another polycation in the concept of differently charged polypeptides used as antiadhesive agents. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article reports on a study conducted to evaluate prevention of peritoneal adhesions by combining charged polypeptides. A standardized peritoneal injury model was used in 48 NMRI mice where the length of adhesion formation was estimated and expressed in percentage of the standardized wound length 7 days and 4 weeks after adhesion induction. The test compounds, polylysine and polyglutamate, were administered intraperitoneally immediately following induction of the peritoneal defect. the study shows that polylysine together with polyglutamate caused a reproducible and significant decrease in the extent of peritoneal adhesions, also when administered in a low concentration.

This article focuses on a study related to the prevention of postoperative peritoneal adhesions by bioactive polymers. Intraperitoneal adhesions frequently occur after abdominal and pelvic surgery and may result in intestinal obstruction and potentially infertility. Various bioactive materials and macromolecules have been reported to decrease the extent of postoperative abdominal adhesions. Intraperitoneal administration of lysozyme, polyglutamate and especially a combination of polylysine and polyglutamate significantly decreased experimental abdominal adhesion formation.

Background: Composite outcome measures aim to provide a more holistic view when determining the effectiveness and safety of surgical interventions. Recently, 'Ideal Outcome' (IO) harmonized the European and American composite outcome of pancreatic surgery. The rate of IO after pancreatoduodenectomy was 54% but is unknown after left pancreatectomy(LP)., Methods: This transatlantic analysis included patients after LP from the audits in North America (NSQIP), Germany (StuDoQ), the Netherlands (DPCA), and Sweden (SNPPCR) (2014 - 2020). IO is obtained in the absence of (1)in-hospital mortality, (2)severe complications (Clavien-Dindo≥3), (3)postoperative pancreatic fistula (ISGPS grade B/C), (4)reoperation, (5)hospital stay exceeding the 75th-percentile, and (6)readmission. Clinical predictors of IO were identified using a multivariable logistic regression., Results: Overall, 20,126 patients after LP were included (37.8% minimally invasive). The rate of IO after LP was 59.1%. The rate of IO varied among the four audits: North America 58.5%, Germany 53.4%, the Netherlands 56.9%, and Sweden 61.7% (P<0.001). Among all variables, the rate of postoperative pancreatic fistula differed the most: North America 9.8%, Germany 23.9%, the Netherlands 20.5%, and Sweden 10.6% (P<0.001). Minimally invasive LP was associated with higher rates of IO (65.4% vs 53.3%, P<0.001) compared to open LP. No difference in the IO was observed between robot-assisted and laparoscopic LP., Conclusion: The new composite outcome measure IO was reached in 59% patients after LP and varied between four transatlantic audits. Minimally invasive LP was associated with higher rates of IO. IO can be used for evaluating, comparing, and improving patient outcomes between the four audits, especially regarding postoperative pancreatic fistula., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Incisional hernia (IH) after open liver surgery is a well-recognized complication. The clinical importance of IH detected on computed tomography in terms of objective abdominal wall discomfort and impairment of quality of life (QoL) is less well known., Methods: Patients who underwent curative surgery for colorectal liver metastases between 2010 and 2015 at a single center and were alive in February 2017 were asked to complete a ventral hernia pain questionnaire and the EORTC QLQ-C30 QoL questionnaire., Results: A total of 105 patients (80%) completed the questionnaires. Forty-three patients (42%) developed IH. The majority (77%) of IHs were < 2.5 cm. Patients who had an IH before liver surgery developed a new IH to a greater extent (P = 0.001). There were no significant differences regarding abdominal wall symptoms and QoL between patients with and without IH. However, about half (48%) of all patients had abdominal wall symptoms after a median follow-up of 34 months., Conclusion: Radiologically detected IH after open liver surgery has low clinical importance. About half of all patients who underwent liver surgery experienced abdominal wall symptoms a long after surgery, but these symptoms were not related to IH., Competing Interests: Declarations. Competing interests: The authors declare that they have no conflict of interest., (© 2025. The Author(s).)

Background: When cannulation is challenging during endoscopic retrograde cholangiopancreatography (ERCP), and the standard guidewire technique with sphincterotomy is unsuccessful, alternative cannulation techniques can be used to access the biliary tree. The purpose of this study was to compare the incidence of adverse events and cannulation success rates between transpancreatic sphincterotomy (TPS) and precut sphincterotomy (PCS)., Methods: Data from the Swedish Registry for Gallstone Surgery and ERCP (GallRiks), collected from 2011 to 2022, were analyzed. A total of 105,303 ERCP procedures were recorded in GallRiks during the study period. After exclusions, the study population consisted of 47,486 ERCP procedures. Of these, 4547 received PCS and 3273 received TPS. The remaining 39,666 ERCP procedures with conventional sphincterotomy served as the control group. The primary endpoints were successful cannulation and adverse events within 30 days., Results: Successful cannulation was more frequent with the TPS technique than with the PCS technique (86.5% vs. 69.7%), but both groups had a lower cannulation rate than the control group (92.4%; OR-PCS 0.20, 95% CI 0.18-0.21; OR-TPS 0.58, 95% CI 0.52-0.64). The TPS group had a higher incidence of adverse events than the PCS group (24.1% vs. 18.8%) and both groups had a higher incidence of adverse events than the control group (15.5%; OR-PCS 1.25, 95% CI 1.15-1.36; OR-TPS 1.71, 95% CI 1.57-1.87). Adverse events for TPS were driven by a higher incidence of pancreatitis (10.5% vs. 6.4% vs. 4.5%; OR 2.53, 95% CI 2.23-2.86) and perforation (1.6% vs. 0.8% vs. 0.5%; OR 2.99, 95% CI 2.20-4.06) compared to both PCS and control., Conclusion: TPS is more successful at cannulation than PCS; however, this success comes at a higher cost in terms of adverse events, particularly pancreatitis and perforation., Competing Interests: Declarations. Disclosures: Dr. Gustafsson, Dr. Olsson, and Prof. Tingstedt have no conflict of interest or financial ties to disclose., (© 2024. The Author(s).)