Nykoping

Researchers are evaluating the effectiveness of adding gastropexy to the conventional surgical repair of primary paraesophageal hernias. This randomized, double-blind, multicenter clinical trial compares the outcomes of patients undergoing standard crural repair and Nissen fundoplication with those receiving the same repair plus an additional gastropexy procedure. The study aims to determine if gastropexy improves the success of hernia repair by reducing recurrence rates. Participants are randomly assigned to either the control group, which receives crural repair combined with a short and floppy Nissen fundoplication, or the interventional group, which receives these repairs along with a three-point gastropexy. The gastropexy involves fixing parts of the stomach wrap to the diaphragm and abdominal wall using running non-absorbable sutures. Surgical procedures include careful dissection, mobilization of the esophagus, preservation of vagal nerves, and creation of the fundoplication without routine use of calibration bougies. Participants undergo imaging with computed tomography scans before surgery and at 1 and 3 years after surgery to assess anatomical results. Patient-reported outcomes are collected through various questionnaires measuring quality of life, gastrointestinal symptoms, reflux frequency, and swallowing difficulties before surgery and at 3 months, 1 year, and 3 years post-surgery. The primary outcome is the recurrence of hernia one year after surgery. Safety and follow-up extend for up to three years to monitor long-term effects and treatment success.

Researchers are evaluating treatments for elderly patients aged 75 and older who have an undisplaced femoral neck fracture (uFNF), classified as Garden I-II. The study compares whether replacing the hip (arthroplasty) reduces the need for further surgeries compared to preserving the hip with internal fixation. The goal is to lower the combined risk of needing reoperation or death within 1 to 2 years after surgery. Participants are randomly assigned to one of two treatment groups using the Swedish Fracture Register. One group receives arthroplasty, which may be either a hemi or total hip replacement depending on hospital routine based on patient age and mobility. The other group undergoes internal fixation, where the fracture is repaired using 2-3 screws, pins, or a sliding hip screw device, again according to hospital routine. Both treatments are devices applied to stabilize or replace the hip after fracture. During the study, participants are monitored for outcomes including the rate of additional surgeries and mortality up to 2 years after their initial operation. The main measure combines these two outcomes into a single variable to evaluate overall treatment success. The entire process is registered and randomized within the Swedish Fracture Register system, ensuring consistent follow-up and data collection.