NSAP is still the main differential diagnostic problem in the ED. Except acute appendicitis, distribution of specific diagnoses causing AAP remained rather stable through 26-year audit.

In carefully selected patients suffering from chronic abdominal pain, the positive effect of laparoscopic adhesiolysis stands beyond 15 years after the surgery. Although the patients reported relief of pain they still had various abdominal symptoms.

Background and Aims: Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use.

No abstract

This study compared four geographically adjacent populations with identical demographics, similar patient characteristics, and similar indications for the treatment of intact abdominal aortic aneurysms. Endovascular repair was adopted with significantly variable rates between these populations ranging from 38% to 74%. However, despite these disparities between the regions, there were no significant differences in early or late outcomes such as mortality, complications, and re-interventions. Thus, the remarkably different enthusiasm for the use of endovascular repair between these health care districts did not seem to affect the overall outcomes of these otherwise comparable patient populations. Objectives: The aim was to study outcomes of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in four geographically adjacent populations with identical demographics and variable EVAR rates. Methods: This was a multicentre cohort study based on local and national registry data from an area of 815 000 inhabitants. The study involved 527 consecutive patients with an intact AAA treated with EVAR (n ¼ 327) or OSR (n ¼ 200) between 2010 and 2016. The catchment area was divided into four health care districts (populations A, B, C, and D) with one central hospital in each district. Each hospital decided independently between OSR and EVAR for patients within their population; OSR was performed in all hospitals while EVAR was centralised in one of them. Patient demographics and treatment outcomes were extracted from local registries. Population demographics, overall AAA incidence, and mortality data were retrieved from a national database. Results: The rate of new intact AAA diagnosis varied between 20 and 29 per 100 000 inhabitants/year with the highest incidence in population D (p < .001). The intact AAA repair rates were 9.8, 8.9, 9.9, and 8.7 per 100 000 inhabitants/year for populations A, B, C, and D, respectively (p ¼ .64). There were no significant differences in mean age (73.6 AE 8.0 years) or mean aortic diameter (62 AE 13 mm) between the treated patient populations. Groups A and B had high EVAR rates (74% and 72%, respectively) whereas the EVAR rates were lower in groups C and D (50% and 38%, respectively) (p < .001). The 30 day mortality rates were 2%, 2%, 4%, and 1% (p ¼ .55), and complication rates were 17%, 12%, 15%, and 11% (p ¼ .39) for A, B, C and D, respectively. There were no significant differences in mortality, complication or re-intervention rates between the groups during the mean follow up of 3.3 AE 2.0 years. Conclusions: At population level, high EVAR rates had no measurable effect compared with lower EVAR rates on the outcomes in patients with intact AAA.

No abstract

Introduction: About half of the adult patients suffering from chronic abdominal pain may have no organ-related cause. Our purpose was to evaluate the additional information of magnetic resonance imaging (MRI) in diagnosing the underlying organic causes of such pain. Methods: We performed retrospective audit of 636 consecutive abdominal MRI in patients suffering from nonspecific abdominal pain (NSAP) during years 2014-2017. Medical history, clinical examination, endoscopy reports, and the results of MRI were compared in all patients. The hypothesis was that MRI increases markedly the diagnostic specificity of patients' symptoms. Results: The mean age of patients was 66 ± 14 years and 60 percent were females. Duration of abdominal pain ranged from 1 month to 30 years (median 1.1 ± 4.0 years). Concurrently with abdominal MRI (n = 636), also ultrasound (n = 106, 17%), colonoscopy (n = 222, 35%), and gastroscopy (n = 217, 34%) were performed. Abdominal MRI revealed additional information in 161/636 (25%) of NSAP patients. Spinal and pelvic bone abnormalities (n = 107) and malignant tumors (n = 31) were the most significant organ-specific findings changing the treatment algorithm. Conclusions: When computerized tomography is not available in outpatient clinics, abdominal MRI increases markedly diagnostic specificity and alters the treatment in 1 of 4 patients suffering from NSAP. Abdominal MRI is therefore suggested for patients suffering from severe symptoms of NSAP.

Background: The incidence of occult inguinal or Spigelian hernias found in other laparoscopies is seldom studied and their development to symptomatic hernias is unknown. Materials and Methods:The orifices of all inguinal and Spigelian hernias at linea semilunaris were carefully recorded prospectively in the laparoscopic surgery during the years 2003-2004 (104 cholecystectomies, 55 fundoplications, 36 diagnostic, and 6 miscellaneous). The patients were followed up over 15 years to find out how often the detected occult hernias at index laparoscopy become later symptomatic and were repaired.Results: The index laparoscopic operation was performed to 201 patients with a mean age of 53 ± 14 years. The overall frequency of unexpected hernias was 21% including 36 (18%) inguinal hernias, 5 (2.5%) Spigelian hernias, and 2 (1.0%) ventral hernias. At the index laparoscopy, only 5/201 inguinal and 2 Spigelian hernioplasties were concomitantly undertaken. After 15 years, data of 169 patients were available and new hernia repairs were performed only in 8 (4.7%) patients (2 inguinal, 4 umbilical, and 2 ventral hernias).Conclusions: Asymptomatic occult hernias detected during laparoscopic surgery of other reason evolve very seldom (< 5%) to symptomatic and need to be repaired.