http://repub.eur.nl/res/aut/26284/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34362/ 2011-08-30T00:00:00Z Background: The median laparotomy is frequently used by abdominal surgeons to gain rapid and wide access to the abdominal cavity with minimal damage to nerves, vascular structures and muscles of the abdominal wall. However, incisional hernia remains the most common complication after median laparotomy, with reported incidences varying between 2-20%. Recent clinical and experimental data showed a continuous suture technique with many small tissue bites in the aponeurosis only, is possibly more effective in the prevention of incisional hernia when compared to the common used large bite technique or mass closure. Methods/Design. The STITCH trial is a double-blinded multicenter randomized controlled trial designed to compare a standardized large bite technique with a standardized small bites technique. The main objective is to compare both suture techniques for incidence of incisional hernia after one year. Secondary outcomes will include postoperative complications, direct costs, indirect costs and quality of life. A total of 576 patients will be randomized between a standardized small bites or large bites technique. At least 10 departments of general surgery and two departments of oncological gynaecology will participate in this trial. Both techniques have a standardized amount of stitches per cm wound length and suture length wound length ratio's are calculated in each patient. Follow up will be at 1 month for wound infection and 1 year for incisional hernia. Ultrasound examinations will be performed at both time points to measure the distance between the rectus muscles (at 3 points) and to objectify presence or absence of incisional hernia. Patients, investigators and radiologists will be blinded during follow up, although the surgeon can not be blinded during the surgical procedure. Conclusion: The STITCH trial will provide level 1b evidence to support the preference for either a continuous suture technique with many small tissue bites in the aponeurosis only or for the commonly used large bites technique. Trial registration. Clinicaltrials.gov NCT01132209. http://repub.eur.nl/res/pub/33443/ 2011-05-01T00:00:00Z Objective: Endoscopic transpapillary stenting (ETS) of the pancreatic duct facilitates ductal outflow and may reduce time to pancreatic fistula closure. However, data on the feasibility of ETS in patients with necrotizing pancreatitis are scarce. Background: Pancreatic fistulas often occur after intervention in necrotizing pancreatitis and frequently close only after months of conservative treatment. Methods: From a prospective cohort of patients with acute pancreatitis admitted in 15 hospitals (2004-2007), all patients who underwent ETS or conservative treatment for a pancreatic fistula were identified. Safety, feasibility, and outcome of ETS were evaluated. Furthermore, a literature review was performed for similar studies in necrotizing pancreatitis. Results: Of 731 patients with acute pancreatitis, 19 patients were treated with ETS and 16 patients were treated conservatively for a pancreatic fistula. Fistula closure was achieved in 16 of 19 patients (84%) in the ETS group and in 8 of 12 patients (75%) in the conservative group (P = 0.175). The median time to fistula closure after ETS was 71 days (interquartile range [IQR] 34-142) compared with 120 days (IQR 51-175 days) in the conservative group (P = 0.130). Complications were observed in 6 patients. A total of 10 studies reporting the results of 281 patients with stent placement for pancreatic fistulas were included in the literature review. Fistula closure was achieved in 200 patients (71%). Stent-related complications were reported in 9% of patients. Conclusions: ETS seems a feasible and safe alternative to conservative treatment in patients with pancreatic fistulas after intervention for necrotizing pancreatitis. http://repub.eur.nl/res/pub/30449/ 2008-12-29T00:00:00Z A novel J-shaped incision for liver transplantation was introduced in attempt to reduce the wound-related complication rate while maintaining comparable access. Some 58 consecutive patients with the classic Mercedes incision were compared with the following 60 consecutive patients with a J-shaped incision. Nine of 60 patients (15%) with a J-shaped incision were converted to an extensive incision. The duration of surgery did not differ between both groups, and relaparotomy rates were comparable in both groups (45% versus 31%, P = 0.487) whereas the early wound-related morbidity was significantly reduced in the J-shaped incision group (3% versus 19%, P = 0.009), as well as incisional hernia rate (7% versus 24%, P = 0.002, corrected for different length of follow-up). Other factors such as previous surgery, ascites, abdominal drainage, retransplantation, and indications for transplantation did not differ between both groups and were not predictive of wound-related morbidity or incisional hernia. We therefore conclude that a J-shaped incision should be the incision of choice in liver transplantation. This new, seemingly minor modification reduces wound infections, fascial dehiscence, and incisional hernia. http://repub.eur.nl/res/pub/29065/ 2008-12-01T00:00:00Z http://repub.eur.nl/res/pub/29006/ 2008-05-01T00:00:00Z http://repub.eur.nl/res/pub/35221/ 2007-09-01T00:00:00Z Background: Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still under debate. The objective of this study was to compare the outcome in our series of operative versus conservative treatment of these patients. Methods: In the period between 1990 and 2004, 34 patients with an umbilical hernia combined with liver cirrhosis and ascites were identified from our hospital database. In 17 patients, treatment consisted of elective hernia repair, and 13 were managed conservatively. Four patients underwent hernia repair during liver transplantation. Results: Elective hernia repair was successful without complications and recurrence in 12 out of 17 patients. Complications occurred in 3 of these 17 patients, consisting of wound-related problems and recurrence in 4 out 17. Success rate of the initial conservative management was only 23%; hospital admittance for incarcerations occurred in 10 of 13 patients, of which 6 required hernia repair in an emergency setting. Two patients of the initially conservative managed group died from complications of the umbilical hernia. In the 4 patients that underwent hernia correction during liver transplantation, no complications occurred and 1 patient had a recurrence. Conclusions: Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting, whereas elective repair can be performed with less morbidity and is therefore advocated. http://repub.eur.nl/res/pub/21284/ 2000-02-02T00:00:00Z