Lars Peter Holst Andersen

Herlev Hospital, Herlev, Capital Region, Denmark

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Publications (17)28.71 Total impact

  • L P H Andersen, M U Werner, J Rosenberg, I Gögenur
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    ABSTRACT: We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements.
    Anaesthesia 05/2014; · 3.49 Impact Factor
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    ABSTRACT: This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The literature search identified nine studies eligible for inclusion. The administration of nonsteroidal anti-inflammatory drugs, local anesthetics (intraperitoneally or subfascially/subcutaneously), transversus abdominis plane block, dexmedetomidine, and ketamine may improve analgesia compared to placebo/controls in LRYGB. None of the studies incorporated multimodal procedure-specific analgesic regimens. The Oxford quality scoring system scores indicated a generally limited methodological quality of the included studies. This review documents a need for high-quality, procedure-specific literature concerning analgesic treatment in LRYGB surgery.
    Obesity Surgery 01/2014; · 3.10 Impact Factor
  • L P H Andersen, J Rosenberg, I Gögenur
    BJA British Journal of Anaesthesia 01/2014; 112(1):7-8. · 4.24 Impact Factor
  • Louise Munk, Lars Peter Holst Andersen, Ismail Gögenur
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    ABSTRACT: Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes that there is a need for guidelines concerning diagnosis and treatment of ED. Risk factors should be investigated further in the clinical setting in the future.
    Journal of perioperative practice 11/2013; 23(11):251-4.
  • Mads Klein, Lars Peter Holst Andersen, Ismail Gögenur, Jacob Rosenberg
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    ABSTRACT: We have with great interest read the recent paper by Joshi and colleagues concerning postoperative pain management following laparoscopic colorectal surgery.(1) We fully support the recommendations by the authors regarding the use of local anaesthetics, systemic steroids, paracetamol and opioids as rescue medication. However, we find it necessary to comment on one specific part of the recommended postoperative analgesic regimen. This article is protected by copyright. All rights reserved.
    Colorectal Disease 05/2013; · 2.08 Impact Factor
  • Lars Peter Holst Andersen, Mads U Werner, Jacob Rosenberg, Ismail Gögenur
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    ABSTRACT: The optimal pain management in relation to laparoscopic colonic surgery remains unclarified. This article presents studies concerning the analgesic effects of paracetamol, NSAIDs, opioids, spinal and epidural blockade, transversus abdominis plane-block, infiltration and intraperitoneal local analgesics, intravenous lidocaine, gabapentinoids and corticosteroids after laparoscopic colonic resection. Moreover, side effects of the analgesics are presented and individually discussed in relation to the specific procedure. We present recommendations for pain management in relation to laparoscopic colonic resection.
    Ugeskrift for laeger 03/2013; 175(11):721-725.
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    ABSTRACT: INTRODUCTION: Due to social norms and the use of clothes the gluteal region of the body is only partially exposed to sun. However, under certain circumstances this skin area may be left unprotected against sunlight. The aim of this study was to evaluate the effect of sunlight on the gluteal region. MATERIAL AND METHODS: Six study participants received sun exposure of the gluteal region. The right and the left gluteal region were randomised to either 20 or 40 minutes exposure. Clinical symptoms, erythema score and pixel colour analysis were used to evaluate the effect. RESULTS: Significantly more erythema was seen after 40 minutes exposure than after 20 minutes. The extent of redness measured by pixel colour analysis was more than 300 times higher for the 40-minute exposure period. CONCLUSION: Twenty minutes sun exposure of the gluteal region appears to be safe with limited erythema compared with 40 minutes exposure, where severe skin reactions were seen. All outdoor activity without clothes should be limited to 20 minutes to avoid skin damage. FUNDING: not relevant TRIAL REGISTRATION: not relevant.
    Ugeskrift for laeger 12/2012; 174(49):3071-3074.
  • L.P.H. Andersen, T.S. Pedersen, J. Rosenberg
    European geriatric medicine 04/2012; 3(2):112–113. · 0.63 Impact Factor
  • Lars Peter Holst Andersen, Mads Klein, Ismail Gögenur, Jacob Rosenberg
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    ABSTRACT: Surgical procedures are mentally and physically demanding, and stress during surgery may compromise patient safety. We investigated the impact of surgical experience on surgeons' stress levels and how perioperative sleep quality may influence surgical performance. Eight experienced and 8 inexperienced surgeons each performed 1 laparoscopic cholecystectomy. Questionnaires measuring perioperative mental and physical strain using validated visual analog scale and Borg scales were completed. Preoperative and postoperative sleep quality of the surgeon was registered and correlated to perioperative strain parameters. Preoperative to postoperative frustration among experienced surgeons was significantly reduced and this was not found in the inexperienced surgeons (visual analog scale: preoperative 13 (2-65) mm, postoperative 4 (0-51) mm vs. preoperative 5(0-10) mm, postoperative 5(1-46) mm; P=0.04). Physical strain was significantly induced in both groups in the upper extremities. Preoperative and postoperative sleep quality was significantly correlated to postoperative mental strain parameters. Perioperative frustration levels were different among inexperienced and experienced surgeons. Perioperative sleep quality may influence postoperative mental strain and should be considered in studies examining surgeons' stress.
    Surgical laparoscopy, endoscopy & percutaneous techniques 02/2012; 22(1):73-8. · 0.88 Impact Factor
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    ABSTRACT: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect psychological and physiological stress in experienced laparoscopic surgeons. This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery. Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two of these parameters reached statistical significance. We did not find any significant differences in the subjective parameters of surgeon satisfaction or the measured heart rate variability parameters. Physical strain on the surgeon was reduced when performing laparoscopic cholecystectomy in a modern OR compared with a standard room.
    Surgical laparoscopy, endoscopy & percutaneous techniques 08/2010; 20(4):237-42. · 0.88 Impact Factor
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    ABSTRACT: Colorectal cancer will present itself as a bowel obstruction in 16-23% of all cases. However, not all obstructing tumors are malignant and the differentiation between a benign and a malignant tumor can be difficult. The purpose of our study was to determine whether fast dynamic gadolinium-enhanced MR imaging combined with MR colonography could be used to differentiate a benign from a malignant obstructing colon tumor. Patients with benign colon tumor stenosis, based on diverticulitis, were asked to participate in the study. The same number of patients with verified colorectal cancer was included. Both groups had to be scheduled for surgery to be included. Two blinded observers analyzed the tumors on MR by placing a region of interest in the tumor and a series of parameters were evaluated, e.g. wash-in, wash-out and time-to-peak. 14 patients were included. The wash-in and wash-out rates were significantly different between the benign and malignant tumors, and a clear distinction between benign and malignant disease was therefore possible by looking only at the MR data. Furthermore, MR colography evaluating the rest of the colon past the stenosis was possible with all patients. The results showed the feasibility of using fast dynamic gadolinium-enhanced MR imaging to differentiate between benign and malignant colonic tumors. With a high intra-class correlation and significant differences found on independent segments of the tumor, the method appears to be reproducible. Furthermore, the potential is big in performing a full preoperative colon evaluation even in patients with obstructing cancer. Trial number: NCT00114829.
    European journal of radiology 06/2009; 74(3):e45-50. · 2.65 Impact Factor
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    ABSTRACT: It is well known that synchronous cancers (incidence, 2%-11%) and polyps (incidence, 12%-58%) occur in patients with colorectal cancer. Magnetic resonance colonography (MRC) seems like the obvious choice as a diagnostic tool in preoperative evaluation, because it is noninvasive, and most of the colon can be evaluated. Furthermore, it has higher patient acceptance, and no sedation or radiation is used. The purpose of this study was to determine the feasibility of performing MRC preoperatively in an everyday clinical situation in a group of patients who were not offered a full conventional colonoscopy or in whom full conventional colonoscopy was not possible. In a 13-month period, 47 patients diagnosed with rectal or sigmoid colon cancer scheduled for operation were included in the study. MRC was performed with bowel purgation either the night before surgery or as ambulatory MRC the week before surgery. Full MRC was performed in 98% of the patients. In four patients, 12 synchronous lesions (one cancer, two plaques of carcinosis, and nine adenomas) were found. One flat adenoma and five small polyps were missed by MRC and perioperative palpation but found on postoperative colonoscopy. The findings resulted in altered operative strategies in three patients. This study shows the feasibility and potential gain of preoperative MRC in patients with sigmoid colon cancer or rectal cancer.
    Academic radiology 05/2009; 16(7):790-7. · 2.09 Impact Factor
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    Lars Peter Holst Andersen, Mads Klein, Ismail Gögenur, Jacob Rosenberg
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    ABSTRACT: Incisional hernia after abdominal surgery is a well-known complication. Controversy still exists with respect to the choice of hernia repair technique. The objective of this study was to evaluate the long-term recurrence rate as well as surgical complications in a consecutive group of patients undergoing open repair using an onlay mesh technique. Consecutive patients undergoing open incisional hernia repair with onlay-technique between 01/05/1995 and 01/09/2007 at a single institution were included in the study. For follow-up patients were contacted by telephone, and answered a questionnaire containing questions related to the primary operation, the hernia and general risk factors. Patients were examined by a consultant surgeon in the outpatient clinic or in the patient's home if there was suspicion of an incisional hernia recurrence. The study included 56 patients with 100% follow-up. The median follow-up was 35 months (range 4-151). Recurrent incisional hernia was found in 8 of 56 patients (15%, 95% CI: 6-24). The overall complication rate was 13% (95% CI, 4-22). All complications were minor and needed no hospital admission. This study with a long follow-up showed low recurrence and complication rates in patients undergoing incisional hernia repair with the open onlay technique.
    BMC Surgery 05/2009; 9:6. · 1.97 Impact Factor
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    ABSTRACT: Over a period our department experienced an unexpected high frequency of anastomotic leakages. After diclofenac was removed from the postoperative analgesic regimen, the frequency dropped. This study aimed to evaluate the influence of diclofenac on the risk of developing anastomotic leakage after laparoscopic colorectal surgery. This was a retrospective case-control study based on 75 consecutive patients undergoing laparoscopic colorectal resection with primary anastomosis. In period 1, patients received diclofenac 150 mg/day. In period 2, diclofenac was withdrawn and the patients received an opioid analgesic instead. The primary outcome parameter was clinically significant anastomotical leakage verified at reoperation. 1/42 patients in the no-diclofenac group compared with 7/33 in the diclofenac group had an anastomotic leakage after operation (p = 0.018). In a multivariate regressional analysis, none of the recorded factors were significantly associated with the frequency of anastomotical leakages when diclofenac treatment was omitted from the model. We found an increased number of clinically significant anastomotic leakages in patients receiving oral diclofenac for postoperative analgesia. There is an urgent need to test our hypothesis in prospective randomized clinical trials and to examine whether our findings can be extended to open surgery and to other NSAIDs.
    Digestive surgery 02/2009; 26(1):27-30. · 1.37 Impact Factor
  • Lars Peter Holst Andersen, Ismail Gögenur, Jacob Rosenberg
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    ABSTRACT: The introduction of laparoscopic surgery has put focus on the assessment of the technical abilities of the surgeon. Studies on learning curves have often focused on operative time, conversion rate, complication rate and length of hospital stay as effect parameters. Learning is a complex process, and the interpretation of learning curves is not straight-forward. This paper addresses the problems concerning the analysis of learning curves in surgery.
    Ugeskrift for laeger 06/2008; 170(21):1823-5.
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    ABSTRACT: Both magnetic resonance (MR) and computed tomographic (CT) colonography are useful for colon examination. With sensitivities close to those for conventional colonoscopy (CC) for polyps, colonography has been proposed as an alternative to diagnostic CC. MR colonography (MRC) with fecal tagging may be a method of gaining further patient acceptance and widespread use, but the method has to be optimized. The aim of our study was to evaluate the quality of a new contrast agent mixture and to validate a new method for evaluating the tagging efficiency of contrast agents. Twenty patients referred to CC underwent dark lumen MRC prior to the colonoscopy. Two groups of patients received two different oral contrast agents (barium sulfate and barium sulfate/ferumoxsil) as a laxative-free fecal tagging prior to the MRC. After MRC, the contrast agent was rated qualitatively (with the standard method using contrast-to-wall ratio) and subjectively (using a visual analog scale [VAS]) by three different blinded observers. Evaluated both qualitatively and subjectively, the tagging efficiency of barium sulfate/ferumoxsil was significantly better (P < .05) than barium sulfate alone. The VAS method for evaluating the tagging efficiency of contrast agents showed a high correlation (observer II, r = 0.91) to the standard method using contrast-to-wall ratio and also a high interclass correlation (observer II and III = 0.89/0.85). MRC found 1 of 22 (5%) polyps <6 mm, 2 of 3 (67%) polyps 6-10 mm, and 2 of 2 (100%) polyps >10 mm. MRC with fecal tagging using barium sulfate/ferumoxsil as contrast agent will give better overall assessment of the colon wall compared to barium sulfate alone. Furthermore, the VAS method of evaluating fecal tagging efficiency correlated with the standard method of calculating the contrast-to-wall ratio.
    Academic Radiology 05/2008; 15(5):576-83. · 1.91 Impact Factor
  • Lars Peter Holst Andersen, Mads Klein, Ismail Gögenur, Jacob Rosenberg
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    ABSTRACT: Incisional hernia after open surgery is a well-known complication with an incidence of up to 20% after a 10-year period. Data regarding the long-term hernia risk after laparoscopic colonic surgery are lacking in the literature. In the present study we compared the long-term hernia incidence after laparoscopic versus open sigmoid resection. The study included patients undergoing laparoscopic sigmoid resection in the period January 1995 to December 2004 in the eastern part of Denmark. This group was matched with a consecutive group of patients undergoing open surgery in our department in the same period. Patients were contacted by telephone, and a questionnaire was completed for each patient. If the patient was believed to have a hernia or if there was any suspicion of a hernia, a consultant surgeon examined the patient and completed the questionnaire. Factors related to the primary operation, the hernia and general risk factors were registered for all patients. A total of 201 patients answered the questionnaire (95.3%). The laparoscopy group was comprised of 58 patients and 143 patients were included in the laparotomy group. The patients had a median follow-up of 4.6 years (range 2.4-11.7 years) and 4.9 years (range 2.4-8.5 years) after laparoscopic and open surgery, respectively (P = 0.326). Incisional hernia was found in two of 58 patients (3.4%, 95% CI -1.4-7.4) in the laparoscopic surgery group compared with 21 of 143 patients (14.7%, 95% CI 8.9-20.5) in the open surgery group (P = 0.026). There were no significant differences in demographic data or the occurrence of risk factors between the two groups. Laparoscopic sigmoid resection leads to a significantly lower incidence of incisional hernia compared with the open surgical technique.
    Surgical Endoscopy 05/2008; 22(9):2026-9. · 3.43 Impact Factor

Publication Stats

60 Citations
28.71 Total Impact Points

Institutions

  • 2009–2014
    • Herlev Hospital
      Herlev, Capital Region, Denmark
  • 2008–2014
    • University of Copenhagen
      København, Capital Region, Denmark
  • 2008–2013
    • University of Copenhagen Herlev Hospital
      Herlev, Capital Region, Denmark