Anders Mellgren

University of Illinois at Chicago, Chicago, Illinois, United States

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Publications (127)482.09 Total impact

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    ABSTRACT: Background: The TOPAS™ system is a posterior anal sling that is a minimally invasive, self-fixating polypropylene mesh intended to treat fecal incontinence (FI) in women who have failed conservative therapy. Objectives: We are reporting one year outcome in a prospective, multi-center study under Investigational Device Exemption, evaluating this new treatment modality. Study design: A total of 152 women were implanted with the TOPAS™ system at 14 centers in the United States. FI was assessed preoperatively and at the 12 month follow up with a 14 day bowel diary, Cleveland Clinic Incontinence Scores (CCIS) and Fecal Incontinence Quality of Life (FIQOL) questionnaires. Treatment success was defined as reduction in number of FI episodes of 50% or more compared to baseline. Missing bowel diary data were considered treatment failures. The Wilcoxon signed-rank test was used to compare changes observed at 12 month versus baseline. Results: Mean age was 59.6 years old (sd 9.7). The mean duration of FI was 110 mos (range 8-712). Mean length of the implant procedure was 33.4 minutes (sd 11.6). Mean EBL 12.9cc (sd 10.5). Average FU was 24.9 month. At 12 month, 69.1% of patients met the criteria for treatment success, and 19% of subjects reported complete continence. FI episodes/week decreased from a median of 9.0 (range 2 40.5) at baseline to 2.5 (range 0-40) (p < 0.001). Fecal incontinent days decreased from a median of 5.0 (range 1.5-7) at baseline to 2.0 (range 0-7) (p <0.001) over a 7 DAY PERIOD: FI associated with urgency decreased from a median at baseline of 2.0 (range 0-26) to 0 (range 0-14.5) (p<0.001). The mean CCIS decreased from 13.9 at baseline to 9.6 at 12 months (p<0.001). FIQOL scores for all four domains improved significantly from baseline to 12 month (p<0.001). A total of 66 subjects experienced 104 procedure and/or device-related adverse events. Most AEs were short in duration and 97% were managed without therapy or with non-surgical interventions. No treatment-related deaths, erosions, extrusions, or device revisions were reported. The most common AE categories were pelvic pain (n=47) and infection (n=26). Those subjects experiencing pelvic pain had a mean pain score (0-10 scale, 0=no pain) during the 12 month follow-up of 1.2 (sd 2.4). Conclusion: The TOPAS™ system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women.
    No preview · Article · Oct 2015 · American journal of obstetrics and gynecology
  • D. Fenner · M. Zutshi · V Lucente · P. Culligan · M. Nihira · A. Mellgren

    No preview · Conference Paper · Aug 2015
  • M. Zutshi · P. Culligan · D. Fenner · V Lucente · M. Nihira · A. Mellgren

    No preview · Conference Paper · Aug 2015
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    ABSTRACT: We aimed to review and compare outcomes of patients with and without Clostridium difficile infection (CDI) after elective colorectal operations. Retrospective cohort study of patients with CDI after elective colon and rectal operations from 2007 to 2012 (Group A) was conducted. Outcomes were compared with patients with a negative C. difficile toxin assay performed for postoperative diarrhea or high stoma output (Group B) and matched controls (Group C). Forty-four patients (median age 53 years) developed CDI postoperatively (Group A). Fourteen patients (32%) had surgical site infections. Both Group A and Group B patients received ertapenem as preoperative antibiotic prophylaxis significantly more often than matched controls (P < .0001), and also had significantly more surgical site infections (P = .004), longer hospital stays (P = .003), and more readmissions (P = .02) compared with Group C patients. In this study, postoperative CDI was uncommon, of low morbidity, and no mortality. Postoperative diarrhea and high stoma output, whether in patients who are C. difficile positive or not, appear to impact postoperative outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · The American Journal of Surgery
  • M. Zutshi · P. Culligan · D. Fenner · V. Lucente · M. Nihira · A. Mellgren

    No preview · Conference Paper · May 2015
  • D. Fenner · V. Lucente · M. Zutshi · P. Culligan · A. Mellgren

    No preview · Article · Apr 2015 · Journal of Minimally Invasive Gynecology
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    ABSTRACT: BACKGROUND: Overall, the incidence of colorectal cancer appears to be stable or diminishing. However, based on our practice pattern, we observed that the incidence of rectal cancer in patients under 40 is increasing and may be associated with a prominence of signet-ring cell histology. OBJECTIVE: The aim of this study was to verify the rising trend in rectal cancer in patients under 40 and describe the histology prominent in that cohort. DESIGN: This is a retrospective cohort study. SETTING AND PATIENTS: We performed a retrospective cohort study of all patients diagnosed with rectal adenocarcinoma from 1980 to 2010 using the Surveillance, Epidemiology, and End Results cancer registry. MAIN OUTCOME MEASURES: Rectal cancer incidence, histology, and associated staging characteristics were the primary outcomes measured. RESULTS: Although the incidence of rectal cancer for all ages remained stable from 1980 to 2010, we observed an annual percent change of +3.6% in the incidence of rectal cancer in patients under 40. The prevalence of signet cell histology in patients under 40 was significantly greater than in patients over 40 (3% vs 0.87%, p < 0.01). A multivariate regression analysis revealed an adjusted odds ratio of 3.6 (95% CI, 2.6-5.1) for signet cell histology in rectal adenocarcinoma under age 40. Signet cell histology was also significantly associated with a more advanced stage at presentation, poorly differentiated tumor grade, and worse prognosis compared with mucinous and nonmucinous rectal adenocarcinoma. LIMITATIONS: The study was limited by its retrospective nature and the information available in the Surveillance, Epidemiology, and End Results database. CONCLUSIONS: Despite a stable incidence of rectal cancer for all ages, the incidence in patients under 40 has quadrupled since 1980, and cancers in this group are 3.6 times more likely to have signet cell histology. Given the worse outcomes associated with signet cell histology, these data highlight a need for thorough evaluation of young patients with rectal symptoms.
    Full-text · Article · Apr 2015 · Diseases of the Colon & Rectum
  • J. Nordenstam · A.-M. Boller · A. Mellgren
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    ABSTRACT: Defecation problems occur in patients of all ages, but are more prevalent in the elderly, postpartum women, and patients with chronic and debilitating medical conditions. Most of the time, these problems respond to medical therapy and nonsurgical options, but it is not uncommon for patients to require surgical intervention. Sacral nerve stimulation (SNS) presents an alternative for patients with bowel dysfunction combining proven therapeutic benefits and limited surgical risks. Here we describe the common indications for SNS, patient selection, technical details of the procedure, published outcomes, and complications that can arise. Based on our review, SNS is an effective treatment option for fecal incontinence and may reduce the patients' clinical symptoms and help restore their quality of life. Future research studies may expand the role of this modality for other bowel disorders.
    No preview · Article · Jan 2015 · Progress in neurological surgery
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    ABSTRACT: Rectal prolapse occurs primarily in older patients who often have significant comorbidities. With the aging population, increasing numbers of elderly patients are presenting with rectal prolapse. The perineal approach is preferred for these patients because it involves less perioperative risk than an abdominal procedure, but the outcomes of this procedure in elderly patients are unknown.
    No preview · Article · Nov 2014 · Diseases of the Colon & Rectum
  • W B Gaertner · J Witt · R D Madoff · A Mellgren · C O Finne · M P Spencer
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    ABSTRACT: Background: Fistula between an ileal pouch and the vagina, anus, or perineum is an uncommon complication of ileal pouch-anal anastomosis and is a cause of considerable morbidity. Its optimal management has not been determined because of its low incidence. The aim of this study was to review the outcomes of patients who presented with symptomatic ileal pouch-associated fistulas after restorative proctocolectomy (RPC) and to present a diagnostic and treatment algorithm. Methods: Retrospective review of patients treated for symptomatic ileal pouch-associated fistulas after RPC from 1989 to 2011. Results: Twenty-five patients (14 men, mean age 40 years) were presented with symptomatic ileal pouch-associated fistulas. Median time to pouch fistula following RPC was 6.9 years (range 1 month-20 years). Fistulas were classified as pouch-anal (n = 12, 48 %), pouch-vaginal (n = 7, 28 %), complex (n = 4, 16 %), and pouch-perineal (n = 2, 8 %). Etiology included Crohn's disease (n = 15, 60 %), cryptoglandular (n = 6, 24 %), and anastomotic failure (n = 4, 16 %). Each patient underwent an average of 2.8 local procedures or repairs. Overall healing rate was 64 % at a median follow-up of 29 (range 2-108) months. None of the complex fistulas were healed. Postoperative pelvic sepsis, fecal diversion, anti-tumor necrosis factor therapy, and fistula etiology did not significantly impact fistula healing. Three patients required pouch excision with end ileostomy. Conclusions: Operative treatment of pouch fistulas after RPC resulted in complete healing in 64 % of patients following a stepwise diagnostic and therapeutic approach.
    No preview · Article · Jul 2014 · Techniques in Coloproctology
  • M. Bernstein · T. Hull · A. Barrett · K. Matzel · A. Mellgren · W. Graf

    No preview · Article · May 2014 · Diseases of the Colon & Rectum
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    A. Mellgren · K. E. Matzel · J. Pollack · T. Hull · M. Bernstein · W. Graf
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    ABSTRACT: Background Injectable bulking treatment for fecal incontinence (FI) is intended to expand tissue in the anal canal and prevent fecal leakage. Use of injectable bulking agents is increasing because it can be performed in an outpatient setting and with low risk for morbidity. This study evaluated the long-term (36-month) clinical effectiveness and safety of injection of non-animal stabilized hyaluronic acid/dextranomer (NASHA Dx) on FI symptoms.Methods In a prospective multicenter trial, 136 patients with FI received the NASHA Dx bulking agent. Treatment success defined as a reduction in number of FI episodes by 50% or more compared with baseline (Responder50). Change from baseline in Cleveland Clinic Florida Fecal Incontinence Score (CCFIS) and Fecal Incontinence Quality of Life Scale (FIQL), and adverse events were also evaluated.Key ResultsSuccessful decrease in symptoms was achieved in 52% of patients at 6 months and this was sustained at 12 months (57%) and 36 months (52%). Mean CCFIS decreased from 14 at baseline to 11 at 36 months (p < 0.001). Quality-of-life scores for all four domains improved significantly between baseline and 36 months of follow-up. Severe adverse events were rare and most adverse events were transient and pertained to minor bleeding and pain or discomfort.Conclusions & InferencesSubmucosal injection of NASHA Dx provided a significant improvement of FI symptoms in a majority of patients and this effect was stable during the course of the follow-up and maintained for 3 years.
    Preview · Article · May 2014 · Neurogastroenterology and Motility
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    ABSTRACT: The TOPAS AMS pelvic floor repair system is a self-fixating polypropylene mesh intended for use to reinforce soft tissues where weakness exists in the gynecological and gastroenterological anatomy. It is not available commercially in any country. This was a preliminary study conducted to obtain initial clinical experience with the TOPAS system for the treatment of fecal incontinence (FI) in women. This was a prospective study conducted at 5 centers in the United States. Women with FI who failed 1 or more conservative therapies were candidates for the study. Fecal incontinence was assessed with a bowel diary, Cleveland Clinic incontinence scores (CCISs), and Fecal Incontinence Quality of Life (FIQOL) questionnaires, and patients were followed prospectively up to 24 months. Treatment success was defined as a reduction in number of FI episodes of 50% or more compared with baseline. A total of 29 women (mean age, 60.6 years) were implanted with the TOPAS system. Mean number of FI episodes per 14 days decreased from 6.9 at baseline to 3.5 at 24 months of follow-up, and the reduction was significant for the entire follow-up period compared with baseline (P < 0.001). A total of 55.6% of the subjects reported treatment success. The CCIS and FIQOL scores for all domains were significantly improved during the overall follow-up period compared with baseline (P < 0.001). The most common procedure and/or device-related adverse events were de novo urinary incontinence, including bladder spasms (n = 6), worsening FI (n = 2), and constipation (n = 2). No device-related erosions or extrusions were reported. Initial experience of the TOPAS system demonstrated a significant improvement in FI episodes, CCIS and FIQOL scores, and a benign safety profile. These results indicate that the TOPAS system has potential as a new therapeutic option for FI, but it needs to be confirmed in a larger study.
    No preview · Article · Apr 2014
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    ABSTRACT: Transanal endoscopic microsurgery has gained increasing popularity as a treatment alternative for early stage rectal neoplasms. With continued advances in technique and experience, more proximal rectal tumors are being surgically managed by using transanal endoscopic microsurgery with an intraperitoneal anastomosis. The purpose of this study was to review the outcomes of patients who have undergone intraperitoneal anastomosis with the use of the transanal endoscopic microsurgery technique. A prospective, single-surgeon database documented 445 consecutive patients undergoing transanal endoscopic microsurgery from October 1, 1996 through January 1, 2012. We retrospectively reviewed information from all patients who underwent transanal endoscopic microsurgery with an intraperitoneal anastomosis in this prospective database. All procedures took place in an inpatient hospital setting. All patients satisfied workup criteria to undergo surgery for rectal neoplasm. All patients underwent transanal endoscopic microsurgery for rectal neoplasm. Size and pathology of lesion, length of procedure, hospital stay, estimated blood loss, margin status, and complications were the outcomes measured. Twenty-eight patients who underwent transanal endoscopic microsurgery had definitively documented intraperitoneal entry and anastomosis. Median follow-up was 12 months (range, 0.5-111 months). There were no operative mortalities. Procedure-related complications included urinary retention (11%), fever (11%), and fecal seepage (4%). Four patients (14%) had positive margins on final pathology. One patient (3%) required abdominal exploration for an anastomotic leak but did not require diversion. Although this study analyzes prospectively collected data, it is nonetheless a retrospective analysis that can introduce bias. Because this is a single-center study with a relatively homogenous population, the results may not be generalizable. Our sample size may also be underpowered to detect clinically significant outcomes. Transanal endoscopic microsurgery with intraperitoneal anastomosis can be safely performed without fecal diversion by experienced surgeons.
    No preview · Article · Apr 2014 · Diseases of the Colon & Rectum
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    ABSTRACT: Sacrocolpopexy with rectopexy is advocated for combined rectal and vaginal prolapse, but limited outcome data have been reported. The purpose of this study was to evaluate the indications and outcomes of sacrocolpopexy and rectopexy by comparing pre- and postoperative function and quality of life. A retrospective review of prospectively collected data was performed of all patients undergoing sacrocolpopexy and rectopexy at our institution from 2004 to 2011. Preoperatively, all patients underwent physiology testing and completed 4 validated questionnaires assessing bowel symptom severity and associated quality of life. Patients completed the same questionnaires in 2012. A total of 110 women (median age, 55 years; range, 28-88) underwent a sacrocolpopexy and rectopexy, 33 with concomitant hysterectomy. All patients had rectal prolapse (n = 96) or rectal intussusception (n = 14), and each also had either enterocele (n = 86) or vaginal prolapse (n = 48). Rectal prolapse with enterocele was the most common presentation (n = 75). Previous surgery included rectal prolapse repair (21%) and hysterectomy (57%). Complications included presacral bleeding (n = 2), ureteral injury (n = 2), wound infection (n = 8), and pulmonary embolism (n = 2). There were no mortalities. Fifty-two patients completed the follow-up questionnaires, with a median follow-up of 29 (range, 4-90) months, and preoperative surveys were available in 30 of these patients. Preoperatively, 93% reported constipation; 82% reported resolution or improvement postoperatively. Constipation severity, measured with the Patient Assessment of Constipation Symptom Questionnaire, demonstrated improvement (1.86-1.17; p < 0.001). Fecal incontinence severity scores (Fecal Incontinence Severity Index) improved (39-24; p < 0.01), and 82% of incontinent patients reported cure or improvement. Quality-of-life scores also improved significantly. No patient developed recurrent rectal prolapse. This was a retrospective review, and the response rate to questionnaires was limited. Sacrocolpopexy and rectopexy for combined middle and posterior compartment prolapse is a safe procedure, with low risk for recurrence, and improves bowel function and quality of life in most patients.
    No preview · Article · Dec 2013 · Diseases of the Colon & Rectum
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    ABSTRACT: : Preoperative chemoradiation therapy in patients with rectal cancer results in pathologic complete response in approximately 10% to 30% of patients. Accurate predictive factors for obtaining pathologic complete response would likely influence the selection of patients best treated by chemoradiation therapy as the primary treatment without radical surgery. : The aim of this study was to evaluate the impact of tumor size, stage, location, circumferential extent, patient characteristics, and pretreatment CEA levels on the development of pathologic complete response after chemoradiation therapy. : This study is a retrospective review. : Five hundred thirty patients treated with preoperative chemoradiation therapy and radical surgery for rectal adenocarcinoma between 1998 and 2011 were identified. A total of 469 patients remained after excluding patients with a history of pelvic radiation (n = 2), previous transanal endoscopic microsurgery or polypectomy of the primary lesion (n = 15), concurrent malignant tumor (n = 14), and no information about pre- or posttreatment T stage in the chart (n = 30). Preoperative CEA levels were available for 267 patients (57%). : Preoperative chemoradiation therapy and total mesorectal excision were performed in patients with rectal cancer. : The primary outcome measured was pathologic complete response. : Ninety-six patients (20%) were found to have a pathologic complete response in the operative specimen. Low pretreatment CEA (3.4 vs 9.6 ng/mL; p = 0.008) and smaller mean tumor size (4.2 vs 4.7 cm; p = 0.02) were significantly associated with pathologic complete response. Low CEA levels and interruption in chemoradiation therapy were significant predictors of pathologic complete response in the multivariate analysis. When stratifying for smoking status, low CEA level was significantly associated with pathologic complete response only in the group of nonsmokers (p = 0.02). : This study was limited by its retrospective design, missing CEA values, and lack of tumor regression grade assessment. : We demonstrated an association between low pretreatment CEA levels, interruption in chemoradiation therapy, and pathologic complete response in patients treated with neoadjuvant chemoradiation therapy for locally advanced rectal cancer. The predictive value of CEA in smokers can be limited, and further studies are needed to evaluate the impact of smoking on the predictive value of CEA levels for pathologic complete response in rectal cancer.
    No preview · Article · Jul 2013 · Diseases of the Colon & Rectum

  • No preview · Conference Paper · Apr 2013

  • No preview · Conference Paper · Apr 2013
  • R. Cannom · A. Lee · A. Mellgren · R. Madoff · A. Lowry

    No preview · Conference Paper · Apr 2013

  • No preview · Conference Paper · Apr 2013

Publication Stats

5k Citations
482.09 Total Impact Points

Institutions

  • 2014-2015
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 1998-2015
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2010
    • Saint Mary's University of Minnesota
      Minneapolis, Minnesota, United States
  • 2008
    • Massachusetts General Hospital
      • Department of Surgery
      Boston, Massachusetts, United States
  • 2006
    • University of Minnesota Medical Center, Fairview
      Minneapolis, Minnesota, United States
    • Saint Catherine University
      Minneapolis, Minnesota, United States
  • 1992-2006
    • Karolinska Institutet
      • Department of Surgery
      Solna, Stockholm, Sweden
  • 2001-2002
    • Karolinska University Hospital
      Tukholma, Stockholm, Sweden