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Graf, Wilhelm
Alternative names
Publications (10 of 69) Show all publications
Elias, K., Bekhali, Z., Hedberg, J., Graf, W. & Sundbom, M. (2018). Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. Surgery for Obesity and Related Diseases, 14(2), 144-149, Article ID S1550-7289(17)30963-2.
Open this publication in new window or tab >>Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
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2018 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 2, p. 144-149, article id S1550-7289(17)30963-2Article in journal (Refereed) Accepted
Abstract [en]

Background: Bariatric procedures are increasingly being used, but data on bowel habits are scarce.

Objectives: To assess changes in gastrointestinal function and patient-scored symptoms after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS).

Setting: University hospital in Sweden.

Methods: We recruited 268 adult patients (mean age of 42.5 yr, body mass index 44.8, 67.9% female) listed for RYGB and BPD/DS. Patients answered validated questionnaires prospectively concerning bowel function, the Fecal Incontinence Quality of Life Scale, and the 36-Item Short Form Health Survey before and after their operation.

Results: Postoperatively, 208 patients (78.2% of 266 eligible patients) answered the questionnaires. RYGB patients had fewer bowel motions per week (8 versus 10) and more abdominal pain postoperatively (P<.001). Postoperatively, the 35 BPD/DS patients (69% versus 23%) needed to empty their bowel twice or more than twice daily, reported more flatus and urgency, and increased need for keeping a diet (P<.001). Concerning Fecal Incontinence Quality of Life Scale, coping and behavior was slightly reduced while depression and self-perception scores were improved after RYGB. Lifestyle, coping and behavior, and embarrassment were reduced after BPD/DS (P<.05). In the 36-Item Short Form Health Survey, physical scores were markedly improved, while mental scores were largely unaffected.

Conclusion: RYGB resulted in a reduced number of bowel movements but increased problems with abdominal pain. In contrast, BPD/DS-patients reported higher frequency of bowel movements, more troubles with flatus and urgency, and increased need for keeping a diet. These symptoms affected quality of life negatively, however, general quality of life was markedly improved after both procedures. These results will be of great value for preoperative counseling.

Keywords
Bowel habits, Duodenal switch, Fecal incontinence, Gastric bypass, Obesity
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-333263 (URN)10.1016/j.soard.2017.09.529 (DOI)000427662500005 ()29108895 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-05-25Bibliographically approved
Enblad, M., Birgisson, H., Ekbom, A., Sandin, F. & Graf, W. (2017). Increased incidence of bowel cancer after non-surgical treatment of appendicitis. European Journal of Surgical Oncology, 43(11), 2067-2075
Open this publication in new window or tab >>Increased incidence of bowel cancer after non-surgical treatment of appendicitis
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2017 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, no 11, p. 2067-2075Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis.

PATIENTS AND METHODS: Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated.

RESULTS: Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1).

CONCLUSION: Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Appendiceal cancer, Appendicitis, Colorectal cancer, Non-surgical treatment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333277 (URN)10.1016/j.ejso.2017.08.016 (DOI)000418107200012 ()28942236 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-03-09Bibliographically approved
Danielson, J., Karlbom, U., Graf, W. & Wester, T. (2017). Outcome in adults with anorectal malformations in relation to modern classification – Which patients do we need to follow beyond childhood?. Journal of Pediatric Surgery, 52(3), 463-468
Open this publication in new window or tab >>Outcome in adults with anorectal malformations in relation to modern classification – Which patients do we need to follow beyond childhood?
2017 (English)In: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, Vol. 52, no 3, p. 463-468Article in journal (Refereed) Published
Abstract [en]

Background/purpose

Knowledge about the functional outcome in adults with anorectal malformations is essential to organize structured transition to adult care for this patient group. The aim of this study was to investigate the functional outcome and quality of life in adults with anorectal malformations characterized according to the Krickenbeck classification.

Methods

Of 256 patients diagnosed with anorectal malformations at our institution in 1961–1993, 203 patients could be traced and were invited to participate in the study. One hundred and thirty-six patients replied (67%) and were compared with one hundred and thirty-six population based sex and age-matched controls. Patients and controls were evaluated with both a validated questionnaire as well as a study-specific questionnaire to assess bowel function. SF-36 was used for quality of life. Outcome in nine incontinence-related parameters, 10 constipation-related, 6 urogenital function-related, and 13 quality of life parameters were assessed in the patients and compared to the outcome of controls as well as to the type of anorectal malformations according to the Krickenbeck classification.

Results

The ARM-patients had an inferior outcome (P < 0.05) for all incontinence parameters, 8 of 10 parameters for constipation, 2 of 6 for urogenital function and 7 of 13 quality of life parameters. Patients with rectobulbar and vestibular fistulas had the worst statistical outcome but patients with cloaca and rectoprostatic/bladder-neck fistula had worse outcome in absolute numbers. Forty-four patients (32%) reported incontinence of stool at least once a week and 16 (12%) had a permanent colostomy.

Conclusions

The functional outcome and quality of life in adults with anorectal malformations are closely related to the type of malformation. A large proportion of the patients have persistent fecal incontinence, constipation and sexual problems that have a negative influence on their quality of life. Structured multidisciplinary follow-up of adults with anorectal malformations by pediatric and colorectal surgeons, as well as urologists and gynecologists is therefore advocated.

Keywords
Anorectal malformations, Long term outcome, Functional outcome, Sexual outcome, Quality of life, Transition to adult care
National Category
Surgery
Research subject
Pediatric Surgery
Identifiers
urn:nbn:se:uu:diva-241240 (URN)10.1016/j.jpedsurg.2016.10.051 (DOI)000397964100019 ()27894765 (PubMedID)
Available from: 2015-01-09 Created: 2015-01-09 Last updated: 2017-04-26Bibliographically approved
Cashin, P. H., Mahteme, H., Spang, N., Syk, I., Frodin, J. E., Torkzad, M., . . . Graf, W. (2016). Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial. European Journal of Cancer, 53, 155-162
Open this publication in new window or tab >>Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial
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2016 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 53, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Background: First-line treatment of isolated resectable colorectal peritoneal metastases remains unclear. This study (the Swedish peritoneal study) compares cytoreductive surgery and intraperitoneal chemotherapy (surgery arm) with systemic chemotherapy (chemotherapy arm). Methods: Patients deemed resectable preoperatively were randomised to surgery and intraperitoneal 5-fluorouracil 550 mg/m(2) /d for 6 d with repeated courses every month or to systemic oxaliplatin and 5-fluorouracil regimen every second week. Both treatments continued for 6 months. Primary end-point was overall survival (OS) and secondary end-points were progression-free survival (PFS), and morbidity. Results: The study terminated prematurely when 48 eligible patients (24/arm) were included due to recruitment difficulties. Two-year OS was 54% in the surgery arm and 38% in the chemotherapy arm (p = 0.04). After 5 years, 8 versus 1 patient were alive, respectively (p = 0.02). Median OS was 25 months versus 18 months, respectively, hazard ratio 0.51 (95% confidence interval: 0.27-0.96, p = 0.04). PFS in the surgery arm was 12 months versus 11 months in the chemotherapy arm (p = 0.16) with 17% versus 0% 5-year PFS. Grade III-IV morbidity was seen in 42% and 50% of the patients, respectively. No mortalities. Conclusions: Cytoreductive surgery with intraperitoneal chemotherapy may be superior to systemic oxaliplatin-based treatment of colorectal cancer with resectable isolated peritoneal metastases.(ClinicalTrials. gov nr: NCT01524094).

Keywords
Cytoreductive surgery, Intraperitoneal chemotherapy, Colorectal cancer, Systemic chemotherapy, Peritoneal metastases, Peritoneal carcinomatosis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-280096 (URN)10.1016/j.ejca.2015.09.017 (DOI)000368789100017 ()26751236 (PubMedID)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-11-30Bibliographically approved
Enblad, M., Birgisson, H., Wanders, A., Sköldberg, F., Ghanipour, L. & Graf, W. (2016). Importance of Absent Neoplastic Epithelium in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Annals of Surgical Oncology, 23(4), 1149-1156
Open this publication in new window or tab >>Importance of Absent Neoplastic Epithelium in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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2016 (English)In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 23, no 4, p. 1149-1156Article in journal (Refereed) Published
Abstract [en]

The importance of absent neoplastic epithelium in specimens from cytoreductive surgery (CRS) is unknown. This study aimed to investigate the prevalence and prognostic value of histopathology without neoplastic epithelium in patients treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). Data were extracted from medical records and histopathology reports for patients treated with initial CRS and HIPEC at Uppsala University Hospital, Sweden, between 2004 and 2012. Patients with inoperable disease and patients undergoing palliative non-CRS surgery were excluded from the study. Patients lacking neoplastic epithelium in surgical specimens from CRS, with or without mucin, were classified as "neoplastic epithelium absent" (NEA), and patients with neoplastic epithelium were classified as "neoplastic epithelium present" (NEP). The study observed NEA in 78 of 353 patients (22 %). Mucin was found in 28 of the patients with NEA. For low-grade appendiceal mucinous neoplasms and adenomas, the 5-year overall survival rate was 100 % for NEA and 84 % for NEP, and the 5-year recurrence-free survival rate was 100 % for NEA and 59 % for NEP. For appendiceal/colorectal adenocarcinomas (including tumors of the small intestine), the 5-year overall survival rate was 61 % for NEA and 38 % for NEP, and the 5-year recurrence-free survival rate was 60 % for NEA and 14 % for NEP. Carcinoembryonic antigen level, peritoneal cancer index, and completeness of the cytoreduction score were lower in patients with NEA. A substantial proportion of patients undergoing CRS and HIPEC have NEA. These patients have a favorable prognosis and a decreased risk of recurrence. Differences in patient selection can affect the proportion of NEA and hence explain differences in survival rates between reported series.

National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-282455 (URN)10.1245/s10434-015-4989-y (DOI)000371333200015 ()26577120 (PubMedID)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-03-09Bibliographically approved
Linder, F., Graf, W. & Edholm, D. (2016). Letter to the editor: stercoral perforation of the sigmoid colon possibly associated with anticholinergic drugs or opiates [Letter to the editor]. International Journal of Colorectal Disease, 1(7), 1383-1384
Open this publication in new window or tab >>Letter to the editor: stercoral perforation of the sigmoid colon possibly associated with anticholinergic drugs or opiates
2016 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 1, no 7, p. 1383-1384Article in journal, Letter (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-285847 (URN)10.1007/s00384-015-2488-z (DOI)000379024300022 ()26715435 (PubMedID)
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-11-30Bibliographically approved
Siproudhis, L., Graf, W., Emmanuel, A., Walker, D., Shing, R. N., Pediconi, C., . . . Scholefield, J. (2016). Libertas: a phase II placebo-controlled study of NRL001 in patients with faecal incontinence showed an unexpected and sustained placebo response. International Journal of Colorectal Disease, 31(6), 1205-1216
Open this publication in new window or tab >>Libertas: a phase II placebo-controlled study of NRL001 in patients with faecal incontinence showed an unexpected and sustained placebo response
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2016 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 6, p. 1205-1216Article in journal (Refereed) Published
Abstract [en]

Faecal incontinence (FI) is distressing, significantly reduces quality of life (QoL) and has few pharmacological treatments. The alpha(1)-adrenoceptor agonist NRL001 (1R,2S-methoxamine hydrochloride) improves anal sphincter tone. NRL001 efficacy was evaluated by changes in Wexner scores at week 4 vs. baseline in NRL001-treated patients compared with placebo. Impact of NRL001 on QoL and safety were also assessed. Four hundred sixty-six patients received NRL001 (5, 7.5 or 10 mg) or placebo as suppository, once daily over 8 weeks. Wexner score, Vaizey score and QoL were analysed at baseline, week 4 and week 8. FI episodes and adverse events were recorded in diaries. At week 4, mean reductions in Wexner scores were -3.0, -2.6, -2.6 and -2.4 for NRL001 5, 7.5, 10 mg and placebo, respectively. All reduced further by week 8. As placebo responses also improved, there was no significant treatment effect at week 4 (p = 0.6867) or week 8 (p = 0.5005). FI episode frequency improved for all patients, but not significantly compared with placebo (week 4: p = 0.2619, week 8: p = 0.5278). All patients' QoL improved, but not significantly for all parameters (p > 0.05) except depression/self-perception at week 4 (p = 0.0102) and week 8 (p = 0.0069), compared with placebo. Most adverse events were mild and judged probably or possibly related to NRL001. All groups demonstrated improvement in efficacy and QoL compared with baseline. NRL001 was well-tolerated without serious safety concerns. Despite the improvement in all groups, there was no statistically significant treatment effect, underlining the importance of relating results to a placebo arm.

Keywords
Faecal incontinence, Quality of life, Episode frequency, Alpha-1 receptor agonist, NRL001
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-302234 (URN)10.1007/s00384-016-2585-7 (DOI)000376293400013 ()27075314 (PubMedID)
External cooperation:
Available from: 2016-09-01 Created: 2016-08-31 Last updated: 2017-11-21Bibliographically approved
Graf, W., Andersson, M., Åkerlund, J.-E. & Börjesson, L. (2016). Long-term outcome after surgery for Crohn's anal fistula. Colorectal Disease, 18, 80-85
Open this publication in new window or tab >>Long-term outcome after surgery for Crohn's anal fistula
2016 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 18, p. 80-85Article in journal (Refereed) Published
Abstract [en]

AIM: Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing.

METHOD: 119 patients (63 female, mean age 36 (±13.7) years with histopathologically verified Crohn's disease underwent a surgical procedure for anal fistula at four main referral centres in Sweden, January 1998 - December 2009. Baseline and treatment-related variables were recorded and analysed for correlation with fistula healing at a final follow-up at a mean 7.2 (median 7.1, 1.0-17.5) years.

RESULTS: Of the 119 patients 62 (52%) were healed at final follow-up. Fourteen healed after one procedure and the remaining 48 healed after a further median of 4.0 (2-20) procedures. Ten (8%) patients were subjected to a proctectomy. Final healing was more common in patients operated with a procedure aiming at eradicating the fistula (P=0.0001), without proctitis (P=0.02), and a shorter duration of Crohn' disease (P=.0019).

CONCLUSION: Long-term healing of a Crohn's anal fistula can be expected in about half of the patients, usually after repeated surgical treatment. The probability for cure was higher when a curative operation was performed in a patient without proctitis and a shorter duration of Crohn's disease. An attempt to close a Crohn's anal fistula is thus often worthwhile. This article is protected by copyright. All rights reserved.

Keywords
Crohn disease; anal fistula; surgery
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-265753 (URN)10.1111/codi.13106 (DOI)000368355200019 ()26338142 (PubMedID)
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
Lomnytska, M., Stalberg, K., Birgisson, H., Silins, I. & Graf, W. (2015). Complications Related To Surgery For Ovarian Cancer With Intestinal Involvement. International Journal of Gynecological Cancer, 25(9), 492-492
Open this publication in new window or tab >>Complications Related To Surgery For Ovarian Cancer With Intestinal Involvement
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2015 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 25, no 9, p. 492-492Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-299992 (URN)000377145701104 ()
Available from: 2016-08-01 Created: 2016-08-01 Last updated: 2017-11-28Bibliographically approved
Cashin, P., Graf, W., Nygren, P. & Mahteme, H. (2015). Considerations on the Selection Process for Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy for Colorectal Carcinomatosis Reply [Letter to the editor]. Annals of Surgery, 262(2), e48-e49
Open this publication in new window or tab >>Considerations on the Selection Process for Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy for Colorectal Carcinomatosis Reply
2015 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 262, no 2, p. e48-e49Article in journal, Letter (Refereed) Published
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-261054 (URN)000357949100010 ()25719806 (PubMedID)
Available from: 2015-09-01 Created: 2015-08-28 Last updated: 2017-12-04Bibliographically approved
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