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Introduction: Complicated appendicitis is a severe condition, requiring early diagnosis and intervention to prevent complications. We aimed to investigate how resident surgeons distinguish and manage complicated appendicitis and their perspectives on preoperative diagnostic markers., Methods: The electronic survey was face validated. It contained questions about demographics, resident surgeons' considerations on the preoperative diagnosis of complicated appendicitis, and views on the need for and relevance of preoperative diagnostic markers. It was sent to all resident surgeons in the Eastern part of Denmark., Results: Seven hospitals and their 92 resident surgeons received the survey, and 90% responded. Most resident surgeons used symptoms and signs of pain to diagnose suspected complicated appendicitis. Half of the surgeons used computed tomographies, and 95% used routine blood tests. Most surgeons (83%) would change the management of patients with preoperatively diagnosed complicated appendicitis in comparison to uncomplicated appendicitis. However, only 17% felt the need for a preoperative diagnostic marker., Conclusions: Resident surgeons in Eastern Denmark use non-specific diagnostic techniques to distinguish complicated from uncomplicated appendicitis and would change treatment if appendicitis was diagnosed preoperatively. However, despite limited interest, our results suggest a need for new diagnostic markers to differentiate between the severity of appendicitis, thus enhancing education and training in managing such cases., Funding: None., Trial Registration: None., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Artificial intelligence has started to become a part of scientific studies and may help researchers with a wide range of tasks. However, no scientific studies have been published on its ussefulness in writing cover letters for scientific articles. This study aimed to determine whether Generative Pre-Trained Transformer (GPT)-4 is as good as humans in writing cover letters for scientific papers., Methods: In this randomised non-inferiority study, we included two parallel arms consisting of cover letters written by humans and by GPT-4. Each arm had 18 cover letters, which were assessed by three different blinded assessors. The assessors completed a questionnaire in which they had to assess the cover letters with respect to impression, readability, criteria satisfaction, and degree of detail. Subsequently, we performed readability tests with Lix score and Flesch Kincaid grade level., Results: No significant or relevant difference was found on any parameter. A total of 61% of the blinded assessors guessed correctly as to whether the cover letter was written by GPT-4 or a human. GPT-4 had a higher score according to our objective readability tests. Nevertheless, it performed better than human writing on readability in the subjective assessments., Conclusion: We found that GPT-4 was non-inferior at writing cover letters compared to humans. This may be used to streamline cover letters for researchers, providing an equal chance to all researchers for advancement to peer-review., Funding: This study received no financial support from external sources., Trial Registration: This study was not registered before the study commenced., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Groin hernias in adolescents are rare and their management is associated with challenges for surgeons as some adolescents are fully grown, whereas others are not. Current groin hernia guidelines only differentiate between young children and adults; hence, no guidelines exist that may aid surgeons in handling adolescents. The aim of this study was to explore surgeons' considerations on the management of groin hernias in adolescents., Methods: We conducted a qualitative study using pilot-tested individual semi-structured interviews. The participants were surgical specialists with experience in groin hernia repair in adolescents aged 10-17 years. Data were analysed using content analysis where essential quotes were extracted from transcripts and coded, categorised and interpreted into themes., Results: Sixteen surgeons were included. Their considerations were reflected in four themes: 1) mesh-related concerns, 2) watchful waiting, 3) growth and 4) lack of evidence and guidelines. Surgeons performed sutured repairs on adolescents who are still growing due to concerns about mesh-related complications. A watchful waiting strategy was used by some to postpone surgery until adolescents were fully grown, thereby enabling mesh repair. Methods for evaluating growth varied and were not standardised. Finally, surgeons highlighted the need for evidence and guidelines to support their decision-making., Conclusions: This study found a lack of consensus and uniformity on the management of groin hernias in adolescents. Increased research efforts producing clinical guidelines are needed., Funding: This study was funded by the Michaelsen Foundation, the Aage and Johanne Louis-Hansens Foundation, Direktør Emil C. Hertz and Hustru Inger Hertz' Foundation, and the Torben and Alice Frimodts Foundation. The funders had no role in the design, conduct or reporting of the study., Trial Registration: not relevant., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Patients suffering from metastatic upper gastrointestinal cancer are burdened by physical, social, existential and psychological problems, though documentation of these problems may be insufficient. In Denmark, basic palliative care is fragmented and characterised by quality differences. This challenges cohesive palliative care interventions as patients experience transitions in the course of illness. The aim of this study was to identify and present the illness trajectory and to investigate the documentation of palliative needs for patients with metastatic upper gastrointestinal cancer., Methods: Data on the documented palliative needs and on transitions were retrospectively collected from the electronic medical records at a surgical ward at Herlev-Gentofte Hospital during a six-month period in 2019. Descriptive statistics were used to present the palliative care needs., Results: Pain and nausea/vomiting were documented in 62%, constipation in 35% and fatigue in 43% of the 63 patients included. Psychological, existential and social symptoms were sparsely documented. Several patients (41%) had more than one admittance to the surgical ward, 62% were treated in the oncology department and 35% received specialised palliative care., Conclusion: The frequent transitions during the disease trajectory and the need to direct attention towards all four domains of palliative care should compel health professionals to adopt a systematic approach when identifying and treating their patients' palliative needs., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: The most common laparo-endoscopic groin hernia repair techniques are TEP (total extraperitoneal) and TAPP (transabdominal preperitoneal) repair. Despite geographic proximity, Swedish surgeons distinctively favour TEP, whereas Danish surgeons prefer TAPP. The aim of this study is to analyse the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair using data from two nationwide registers. We also aim to discuss advantages of international collaboration between nationwide registers., Methods: All groin hernia operations registered as TEP, TAPP or Lichtenstein repair in the Swedish Hernia Register and the Danish Hernia Database between January 2004 and December 2020 will be included. Cumulative hazard rate of reoperation for recurrence will be estimated using Cox-regression analyses adjusted for age and anatomy., Conclusion: Approximately 400,000 operations are estimated to have been registered prospectively in the inclusion period in the registers. The merging of two nationwide registers was made possible owing to close cooperation between the register steering committees and by obtaining the necessary approvals. This unique collaboration between nationwide registers will make it possible to compare the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair on an international level. In future, similar collaboration may be established to explore other outcomes such as complication rates and chronic pain., Funding: This study protocol is financed by grants generated from Sahlgrenska University Hospital (ALF grant ALFGBG-733561, an agreement concerning research and education of doctors) and the Swedish Society of Medicine (SLS-784551)., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

A rapid review is a synthesis of available evidence in which some components of the review process are modified slightly to shorten the process. This will require tight control as well as day-to-day scientific mentoring. The typical rapid review has a focused research question covering a narrow and well-defined clinical problem. With a continuous focus on some elements in the planning and production phases, it is realistic to produce a rapid scoping or systematic review with or without meta-analysis within three months without compromising on scientific quality., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: A laparoscopic repair is recommended for emergency groin hernias. However, due to increasing sub-specialisation, the expertise in performing a laparoscopic hernia repair may not always be present. Therefore, this study aimed to assess the organisation of Danish hospitals' surgical acute teams in regard to emergency groin hernia care., Methods: A nationwide questionnaire study was conducted for all Danish surgical departments performing emergency groin hernia repair and completed by the departments' administrative heads via REDCap., Results: A total of 18 out of 19 departments completed the questionnaire. The overall response was positive towards providing emergency laparoscopic groin hernia repairs at all times. However, this was possible only in a minority of the departments outside daytime on weekdays, and regional differences were found. Surgical proficiency at the hospital and on-call from home varied, and only 24% of the departments could page surgeons (not on-call) to perform emergency laparoscopic groin hernia repair., Conclusions: A discrepancy was found between the wish of the surgical departments to provide laparoscopic emergency groin hernia repairs and the possibilities in today's surgical acute teams. Therefore, a reorganisation should be considered to ensure the availability of laparoscopic groin hernia repair for acute procedures., Funding: This study was funded by The Copenhagen Medical Society and Herlev and Gentofte Hospitals' research council. The funding providers had no role in designing, conducting or analysing the results., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Patients may experience late complications following surgical treatment for colorectal and anal cancer, and we need instruments in Danish to plan treatment and person-centred follow-up treatment approaches. For this purpose, we chose the Measure Yourself Medical Outcome Profile (MYMOP) and Measure Yourself Concerns and Wellbeing (MYCaW). The aim of this study was to translate the two instruments into Danish and conduct a subsequent qualitative validation., Methods: The translation process consists of five stages: forward translation, synthesis, back translation, expert panel review and pretesting. Qualitative validation included interview with target audience representatives, testing of face-validity and evaluation by lay persons., Results: Through the translation process and qualitative validation, we produced Danish versions of the MYMOP and the MYCaW., Conclusions: The Danish versions of the two questionnaires are now ready for use in clinical practice and research after individual licensing consultation with the copyright holders., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

INTRODUCTION The quality of surgical research was criticised 25 years ago in a Lancet commentary, where an analysis showed that papers published in prestigious surgical journals were rarely randomised clinical trials, but typically simple case series. Therefore, the aim of the present paper was to conduct a new publication analysis to establish if this has changed. METHODS The January issues of the ten surgery and ten general medicine journals with the highest impact factors were analysed. Only original articles were included, and funding and study design were registered. RESULTS Medicine journals had higher impact factors (median 25.0 (range: 9.0-91.2)) than surgical journals (9.1 (7.0-14.8)) (p = 0.004). More randomised trials and fewer retrospective studies were recorded in medicine than in surgery, and more prospective studies were found among surgery than the medicine publications. Furthermore, funding was more frequently involved in medicine than in surgery papers (94% versus 62%, p less-than 0.00001). CONCLUSIONS In the field of surgery, randomised trials remain rare and the field is characterized by more retrospective studies being published than in the field of medicine. The reasons explaining why may be found in knowledge and research traditions, but funding opportunities may also play a role. Furthermore, in clinical trials in surgery, it may be difficult or occasionally impossible to employ a double-blind study design. FUNDING none. TRIAL REGISTRATION not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Reporting of outcomes in groin hernia trials is inconsistent and poorly defined thereby limiting the production of high-quality meta-analyses. Outcome reporting can be standardised and improved through consensus-based development of a core outcome set, which is a minimum set of outcomes recommended to be reported in all effectiveness trials within a specific field of research. We aim to develop a core outcome set for effectiveness trials within clinical groin hernia research., Methods: The study is divided into three phases. Phase 1 is an update of a systematic review on outcome reporting in groin hernia trials, which will identify relevant outcomes of groin hernia repair. In Phase 2, we will conduct multiple Delphi rounds to achieve consensus on which of the identified outcomes are most important. These Delphi rounds will involve important stakeholders in the field, i.e. patients, surgeons and researchers. In Phase 3, we will organise a consensus meeting to determine the final contents of the core outcome set. The meeting will involve the expert members of the study Steering Committee and invited key stakeholders. Data collection permissions and ethical approvals will be sought from the appropriate national and local authorities., Conclusion: Development of a core outcome set for groin hernia trials is necessary and feasible., Funding: none., Trial Registration: COMET Database (registration no.: 1331) https://www.comet-initiative.org/Studies/Details/1331., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Due to disagreement on optimal timing of inguinal hernia repair in children, we explored how Danish surgeons plan repair in children at different ages and with different symptoms., Methods: A validated questionnaire on timing of inguinal hernia repair in children was sent to all surgeons performing paediatric hernia repair in Denmark. The surgeons were asked how they plan repair of asymptomatic reducible, symptomatic reducible, incarcerated, and strangulated hernias in children aged less than 2, 2-12 and 13-18 years., Results: Forty-eight surgeons (81%) completed the questionnaire. Answers concerning the timing of repair of reducible and incarcerated hernias varied greatly for all age groups. For reducible hernias, the answers ranged from repairing within one week to considering watchful waiting. For incarcerated hernias, the answers ranged from repair within 12 hours to three months. There was broad agreement on the need for acute repair of strangulated hernias., Conclusions: Timing of paediatric inguinal hernia repair was inconsistent for children of all age groups and in particular for those with reducible hernias. The results call for a new guideline to ensure consistent and optimal treatment as well as an educational effort about the pros and cons of early and delayed repair., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: No recent guidelines exist for surgical treatment of paediatric inguinal hernias. Internationally, there is disagreement about both the preferred approach and the details of the surgical procedure. The aim of this nationwide survey study was to assess variations in Danish surgeons' technique when repairing inguinal hernias in children., Methods: A questionnaire was sent to all surgeons in Denmark performing paediatric inguinal hernia repair, including questions about demographic details, choice of open or laparoscopic repair, and technical details of the chosen surgical approach. In the questionnaire, each item was repeated for children aged les than 2, 2-12, and 13-18 years of age., Results: In total, 48 of 59 surgeons responded (81%). For children 12 years of age, the majority of surgeons only performed open repair, whereas none performed laparoscopic repair only. For children aged 13-18 years of age, two thirds of the surgeons performed open repair only, 6% performed laparoscopic repair only and the rest used both methods. We found considerable variations in the execution of both open and laparoscopic repair. The variations regarded incision of the external fascia, nerve identification, division of the cremaster muscle, and exploration of the contralateral groin and repair of an asymptomatic hernia., Conclusions: This study found considerable variation in the execution of both open and laparoscopic repair of inguinal hernias in children of different age groups. Research into inguinal hernia repair in children is needed to rationalise and update guidelines in order to improve quality and facilitate research., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: This is a systematic review of existing literature on the diagnostic modalities and treatment of traumatic abdominal wall hernia caused by bicycle handlebar injury in children. 
METHODS: A systematic literature search was conducted covering incidents involving children below 17 years of age. Data were extracted regarding gender, age, diagnostic modality, timing of surgery, location of hernia, associated injuries, management and recurrence of hernia.
 RESULTS: A total of 62 cases of handlebar hernia were included in the systematic review. CT scan was the most frequently used final diagnostic modality (52%) followed by 
ultrasonography (13%), explorative laparotomy (5%) and diagnostic laparoscopy (5%). Coexisting intraabdominal injuries were present in 57% of all hernias located in the upper abdomen. Open surgical repair was the preferred treatment of choice (85%). Laparoscopic suturing was performed in one study. Six cases of handlebar hernia were treated conservatively. No cases of recurrence of hernia were reported in any of the cases. 
CONCLUSIONS: Traumatic abdominal wall hernia can be visualized by ultrasonography, but CT scan is often used as the final diagnostic modality because of the risk of associated intra-abdominal injuries. Open surgical repair in layers or laparoscopic suturing during diagnostic laparoscopy may be appropriate in managing traumatic abdominal wall hernias in children. Non-surgical management has been described, but available data do not support a general recommendation for a non-surgical approach., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB., Methods: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intraabdominal pressure and incidences with tightness of the abdominal wall., Results: No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p < 0.001). The insufflator alarmed in no versus ten procedures (p = 0.001) in the deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively., Conclusion: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy., Funding: This work was funded in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp, USA. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp., Trial Registration: The study was assigned with EudraCT number 2012-003787-51 and registered with clinicaltrials.gov (NCT01722097)., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: The purpose of this study was to present a nationwide cumulative incidence and an age-specific incidence rate of groin hernia repair as well as to evaluate the validity of inguinal and femoral hernia operation codes in the Danish National Patient Registry (DNPR)., Methods: All persons born in Denmark from 1977 to 2010 were investigated for groin hernia operations registered in the DNPR with respect to date of admission, operation, discharge and specific operation codes. To validate the predictive values of registrations, we randomly extracted data on elective and emergency groin hernia operations from the DNPR from 2005 to 2010 and examined the medical records., Results: The study population (n = 2,109,417) from 1977 to 2010 was followed from the primary groin hernia operation (n = 53,262) to 2010, yielding a total of 33.4 million person-years of follow-up. The probability of being operated for a groin hernia prior to the age of 34 years was 5.70% (95% confidence interval (CI): 5.62-5.78) for males and 1.26% (95% CI: 1.20-1.32) for females. The highest incidence rate was seen among males aged 0-1 years (10.19 (95% CI: 10.00-10.38)). The positive predictive value of patients registered with inguinal hernia operations in the DNPR who had been operated for an inguinal hernia was 100% (95% CI: 96-100%) and 91.3% (95% CI: 83-96%) for femoral hernia operations., Conclusions: The incidence rate of groin hernia operations peaked at the 0-1 year age group in males and at the 3-4-year age group in females. Furthermore, the validation of the DNPR showed very high positive predictive values for both inguinal hernia operations and femoral hernia operations., Funding: none., Trial Registration: not relevant.

Introduction: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has a learning curve of about 50-100 cases and decreases chronic pain, but slightly increases the risk of serious complications compared with open mesh repairs. Therefore, a simpler kind of operation is needed. The ONSTEP technique is a possible solution to this problem. The objective of the present randomised clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach., Methods: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic repair. Patients are recruited from surgical departments in Denmark and follow-up is one year. In total, 188 patients will be included., Discussion: This protocol describes one of the first randomised clinical trials investigating the ONSTEP technique. To our knowledge, it is the first clinical trial comparing the ONSTEP technique with the laparoscopic technique. The results from this study are needed before it can be decided whether the ONSTEP technique should replace the laparoscopic technique in general surgical practice., Funding: This study has not received external funding., Trial Registration: NCT01960777 (clinicaltrials.gov).

Introduction: During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep neuromuscular blockade (NMB), defined as a post-tetanic-count (PTC) of 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesised that deep NMB (PTC 0-1) would improve surgical conditions during upper laparotomy as compared to standard NMB with bolus administration., Methods: This is an investigator-initiated, assessor- and patient-blinded, randomised study. A total of 128 patients scheduled for elective upper laparotomy will be included and randomised to either continuous deep NMB or standard NMB defined as bolus administrations. Surgical conditions are evaluated using a five-point rating scale every 30 min. Primary outcome is the average score for a patient's surgical condition. Secondary outcomes are, among others, surgical rating score during fascial closure, wound dehiscence, wound infection requiring surgical drainage and incisional hernia at the six-month follow-up., Conclusions: This randomised, double-blinded study investigates potential effects of deep NMB on surgical conditions and patient outcomes during elective laparotomy., Funding: The study is funded in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp., Trial Registration: NCT02140593.

Introduction: Laparoscopic herniotomy is the preferred technique for some ventral hernias. Several factors may influence the surgical conditions, one being the depth of neuromuscular blockade (NMB) applied. We hypothesised that deep neuromuscular blockade defined as a post-tetanic count below eight would provide a better surgical workspace., Methods: This was an investigator-initiated, assessor- and patient-blinded randomised cross-over study. A total of 34 patients with planned laparoscopic umbilical, incisional and linea alba herniotomy were studied. Patients would be randomised to receive deep NMB followed by no NMB, or no NMB followed by deep NMB. Our primary outcome was improvement of the surgical workspace (rated on a five-point scale) estimated as the difference between the workspace during deep NMB and the workspace without NMB. Secondary outcomes included, among others, surgeon's rating of surgical conditions during suturing, duration of surgery and duration of the suturing of the hernia., Conclusion: This randomised cross-over study investigated a potential effect on the surgical workspace in laparoscopic ventral herniotomy using deep NMB compared with no NMB. The study may provide knowledge relevant to other laparoscopic techniques., Funding: The study is funded by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp., Trial Registration: NCT02247466.

Introduction: Most institutions perform percutaneous liver biopsy with a post-biopsy patient observation period lasting up to eight hours, which is resource-demanding. This study aimed to evaluate the safety of liver biopsy performed in a fast-track set-up with an only one-hour post-biopsy observation time., Methods: Patients referred to our institution underwent fast-track ultrasound-guided 18-gauge Tru-Cut liver biopsy procedures. Each single biopsy procedure was followed by a post-procedure observational period of one hour and an additional focused assessment with sonography for trauma before patient discharge. All patients underwent a clinical follow-up programme at revisit in order to register any delayed onset of major complications., Results: Out of 200 completed biopsy procedures, two major complications were registered post biopsy and they were treated appropriately. All patients were safely discharged from our institution. No fatality or long-term complications were found during this study., Conclusion: The fast-track approach reported herein is a feasible option when adequate patient information is given. Besides the obvious, positive effect on patient logistics and departmental throughput, this approach may also reduce diagnostic work-up time and bring financial benefits. Therefore, we encourage the use of this approach in institutions comparable to our own., Funding: not relevant., Trial Registration: not relevant.

Introduction: There seems to be no dedicated journals available for publication of editorial research in the biomedical sciences; that is research into editorial or publication process issues involving the scientific approach to writing, reviewing, editing and publishing. It is unknown where papers concerning these issues are typically published. We therefore set out to study the distribution of such papers in the biomedical literature., Methods: In this pilot study, we conducted a MEDLINE search for papers on editorial research published in the year 2012., Results: We found 445 articles published in 311 journals with a median of one article per journal (range: 1-17)., Conclusion: The publication of papers on editorial research seems to be dispersed. In order to increase the visibility of this research field, it may be reasonable to establish well-defined platforms such as dedicated journals or journal sections in which such research could preferably be published.

Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

Introduction: Dictation of scientific articles has been recognised as an efficient method for producing high-quality, first article drafts. However, standardised transcription service by a secretary may not be available for all researchers and voice recognition software (VRS) may therefore be an alternative. The purpose of this study was to evaluate the out-of-the-box accuracy of VRS., Methods: Eleven young researchers without dictation experience dictated the first draft of their own scientific article after thorough preparation according to a pre-defined schedule. The dictate transcribed by VRS was compared with the same dictate transcribed by an experienced research secretary, and the effect of adding words to the vocabulary of the VRS was investigated. The number of errors per hundred words was used as outcome. Furthermore, three experienced researchers assessed the subjective readability using a Likert scale (0-10). Dragon Nuance Premium version 12.5 was used as VRS., Results: The median number of errors per hundred words was 18 (range: 8.5-24.3), which improved when 15,000 words were added to the vocabulary. Subjective readability assessment showed that the texts were understandable with a median score of five (range: 3-9), which was improved with the addition of 5,000 words., Conclusion: The out-of-the-box performance of VRS was acceptable and improved after additional words were added. Further studies are needed to investigate the effect of additional software accuracy training.

Introduction: A thorough and accurate admission medical record is an important tool in ensuring patient safety during the hospital stay. Surgeons' performance might be affected during night shifts due to sleep deprivation. The aim of the study was to assess the quality of admission medical records during day, evening and night time., Material and Methods: A total of 1,000 admission medical records were collected from 2009 to 2013 based equally on four diagnoses: mechanical bowel obstruction, appendicitis, gallstone disease and gastrointestinal bleeding. The records were reviewed for errors by a pre-defined checklist based on Danish standards for admission medical records. The time of dictation for the medical record was registered., Results: A total of 1,183 errors were found in 778 admission medical records made during day- and evening time, and 322 errors in 222 admission medical records from night time shifts. No significant overall difference in error was found in the admission medical records when day and evening values were compared to night values. Subgroup analyses made for all four diagnoses showed no difference in day and evening values compared with night time values., Conclusion: Night time deterioration was not seen in the quality of the medical records.

Introduction: Closure of the hernia gap in laparoscopic ventral hernia repair before mesh reinforcement has gained increasing acceptance among surgeons despite creating a tension-based repair. Beneficial effects of this technique have been reported sporadically, but no evidence is available from randomised controlled trials. The primary purpose of this paper is to compare early post-operative activity-related pain in patients undergoing laparoscopic ventral hernia repair with closure of the gap with patients undergoing standard laparoscopic ventral hernia repair (non-closure of the gap). Secondary outcomes are patient-rated cosmesis and hernia-specific quality of life., Methods: A randomised, controlled, double-blinded study is planned. Based on power calculation, we will include 40 patients in each arm. Patients undergoing elective laparoscopic umbilical, epigastric or umbilical trocar-site hernia repair at Hvidovre Hospital and Herlev Hospital, Denmark, are invited to participate., Conclusion: The gap closure technique may induce more post-operative pain than the non-closure repair, but it may also be superior with regard to other important surgical outcomes. No studies have previously investigated closure of the gap in the setting of a randomised controlled trial., Funding: The study is funded by The University of Copenhagen and private foundations., Trial Registration: NCT01962480 (clinicaltrials.gov).

Introduction: The treatment of rectal cancer has improved, and survival rates today exceed those of colon cancer, but functional impairments and other adverse effects of treatment are common among patients. The impact of treatment on patients' quality of life (QoL) remains unclear. Many of the common QoL instruments are brief and not sufficiently detailed to provide a deeper understanding of the factors that determine QoL. The aim of this study was to explore patients' experiences and long-term QoL in an unselected cohort of patients with rectal cancer., Methods: This is a prospective international multicentre study based on a comprehensive, validated questionnaire on functional impairments and QoL administered to an unselected population of 1,500 patients with rectal cancer at diagnosis and after one, two and five years. The clinical characteristics are retrieved from the national quality registers. A total of 14 hospitals in Sweden and Denmark are currently involved in the study. Inclusion is ongoing, and new including hospitals are welcome to join. Full accrual is expected within two years., Conclusion: This study will provide detailed knowledge about the challenges that patients face following diagnosis and treatment of rectal cancer. It will investigate the nature, severity and perceived significance of constraints and symptoms, as well as the impact of a variety of clinical and patient-related factors on QoL. The study will probably identify areas where changes in care routines may improve patients' QoL., Funding: This study was supported by the Swedish Research Council, grant number 2012-1768; the Swedish Cancer Society CAN 2010/593 and CAN 2013/500; the Swedish Society of Medicine; the Gothenburg Medical Society; the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland; ALF grant 138751 and 136151, "Agreement concerning research and education of doctors"; Anna-Lisa and Bror Björnsson Foundation; Assar Gabrielsson Foundation; Mary von Sydow Foundation; Ruth and Richard Julin's Foundation and Lion's Cancer Research Foundation of Western Sweden., Trial Registration: ClinicalTrials.gov (NCT01477229).

Introduction: Researchers are urged to include health-economic assessments when exploring the benefits and drawbacks of a new treatment. The aim of the study was to assess the costs associated with the establishment of a new patient education programme for patients with a stoma., Material and Methods: Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment Scale six months after surgery. The secondary outcome was generic health-related quality of life measured with Short Form (SF)-36. In this secondary analysis, we calculated direct health-care costs for the first six months post-operatively from the perspective of the health-care system, including costs related to the hospital as well as primary health care., Results: The overall cost related to establishing a patient education programme showed no significant increase in the overall average costs. However, we found a significant reduction in costs related to unplanned readmissions (p = 0.01) as well as a reduction in visits to the general practitioner (p = 0.05)., Conclusion: Establishing a patient education programme - which increased quality of life - will probably not increase the overall costs associated with the patient course., Funding: The study received financial support from Søster Inge Marie Dahlgaards Fond, Diakonissestiftelsen, Denmark, and from Aase and Ejnar Danielsens Foundation, Denmark., Trial Registration: NCT01154725.

Introduction: Ischaemia-reperfusion injury following acute myocardial infarctions (AMI) is an unavoidable consequence of the primary percutaneous coronary intervention (pPCI) procedure. A pivotal mechanism in ischaemia-reperfusion injury is the production of reactive oxygen species following reperfusion. The endogenous hormone, melatonin, works as an antioxidant and could potentially minimise the ischaemia-reperfusion injury. Given intracoronarily, it enables melatonin to work directly at the site of reperfusion. We wish to test if melatonin, as an antioxidant, can minimise the reperfusion injury following pPCI in patients with AMI., Material and Methods: The IMPACT trial is a multicentre, randomised, double-blinded, placebo-controlled study. We wish to include 2 × 20 patients with ST-elevation myocardial infarctions undergoing pPCI within six hours from symptom onset. The primary end-point is the Myocardial Salvage Index assessed by cardiovascular magnetic resonance imaging on day 4 (± 1) after pPCI. The secondary end-points are high-sensitivity troponin, creatinekinase myocardial band and clinical events., Conclusion: The aim of the IMPACT trial is to evaluate the effect of melatonin on reperfusion injuries following pPCI. Owing to its relatively non-toxic profile, melatonin is an easily implementable drug in the clinical setting, and melatonin has the potential to reduce morbidity in patients with AMI., Funding: This study received no financial support from the industry., Trial Registration: www.clinicaltrials.gov, clinical trials identifier: NCT01172171.

Introduction: Inguinal hernia is a common condition that affects millions of people world-wide every year. In Denmark (population of 5.5 million), more than 10,000 repairs of inguinal hernias are performed annually. The optimal surgical procedure for mesh placement and fixation is still being debated because of long-term complications such as persisting pain and impairment of sexual function. The Onstep approach is a newer type of groin hernia repair with promising preliminary results in terms of very few cases of chronic pain and recurrences. This protocol describes a randomised clinical trial the objective of which is to evaluate chronic pain and sexual dysfunction after inguinal hernia repair using the Lichtenstein repair compared with the Onstep approach., Material and Methods: The study is designed as a two-arm blinded multicentre, randomised clinical trial, currently involving five centres in Denmark and with ongoing recruitment. The plan is to recruit a total of 282 patients (Lichtenstein, n = 141 and Onstep, n = 141) and to perform one-year follow-ups. Follow-up will be done by clinical examination, phone interviews and questionnaires., Conclusion: This study will be the first randomised clinical trial to compare the Lichtenstein repair with the Onstep technique. The results are important in order to guide further research and clinical guidelines for inguinal hernia repair., Funding: The study was funded in part by Bard Europe., Trial Registration: NCT01753219 (clinicaltrials.gov).

Introduction: Ventral hernia repairs are common surgical procedures and quality monitoring with a high validity is mandatory. The aim of the present study was to validate the data quality of the Danish Ventral Hernia Database (DVHD)., Material and Methods: All ventral hernia repairs performed in the Region of Zealand and registered in the DVHD between 1 October 2010 and 1 October 2011 were included. Eleven clinically relevant surgical variables in the DVHD were compared for agreement with data in hospital files., Results: The Region of Zealand cohort included 410 ventral hernia repairs corresponding to 13.8% of the repairs registered in the DVHD in Denmark during the inclusion period. There was 89-99% agreement between data in the DVHD and hospital files (κ = 0.75-0.99)., Conclusion: The present study based on a regional cohort suggests that the DVHD can be used as a reliable tool to monitor clinical quality following ventral hernia repair.

Introduction: The problem of initiating the writing process is a well-known phenomenon, especially for young and inexperienced scientists. The purpose of this paper is to present an effective method to overcome this problem and increase writing efficiency among inexperienced scientists., Material and Methods: Twelve young scientists within the medical/surgical fields were introduced to the mind-to-paper concept. The first and last article drafts produced by each of the scientists were scored for language complexity (LIX number, Flesch Reading Ease Scale and Gunning Fog), flow, structure, length and use of references; and the results were compared., Results: All participants produced one full article draft during each of the three dictation days. When comparing the first and last article draft regarding time used, no significant difference was detected. In general, the manuscripts were of high quality on all evaluated parameters, but language complexity had increased in the final manuscript., Conclusion: Mind-to-paper dictation for scientific writing is an effective method for production of scientific papers of good initial quality, even when used for the first time by inexperienced scientists. We conclude that practicing this concept produces papers of an adequate language complexity, and that dictation as a writing tool allows for fast transfer of ideas and thoughts to written text., Funding: not relevant., Trial Registration: not relevant.

Introduction: Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (< 12 mmHg), but surgical conditions may not be optimal. The present study aimed at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mmHg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions., Material and Methods: This was an investigator-initiated, patient- and assessor-blinded study. Up to 72 patients scheduled for elective LC were randomised to either deep neuromuscular blockade (post-tetanic count 0-1) or moderate neuromuscular blockade, where at least one response to train-of-four nerve stimulation was present. The primary outcome was surgical space conditions at the time during surgery when conditions were worst. The secondary outcomes included the proportion of procedures completed at pneumoperitoneum 8 mmHg, post-operative pain, and incidence of nausea and vomiting., Results: This study was the first randomised study to assess the association between depth of neuromuscular blockade and surgical space conditions during low-pressure LC. The study findings may be applicable to a general surgical population undergoing LC., Funding: The University of Copenhagen, Denmark and Sophus Johansens Foundation of 1981, Denmark funded this study, which was also financed by a research grant from the Investigator Initiated Studies Program of Merck Sharp and Dohme Corp., Trial Registration: NCT 01523886.

Introduction: Errors in surgery often stem from failure related to non-technical skills such as communication and teamwork. Tools for training and assessment of non-technical skills are needed to ensure safe surgery. The aim of this study was to customize the Non-Technical Skills for Surgeons (NOTSS) rating system for Danish general surgeons., Material and Methods: Eight group interviews were conducted at two hospitals with consultant general surgeons, trainee surgeons, scrub nurses and anaesthesia staff (n = 72). Interviews were transcribed and analysed by two coders identifying surgeons´ non-technical skills. Skills were sorted according to NOTSS and behavioural examples were written. The prototype of NOTSSdk was discussed with a panel of surgeons (n = 12) to ensure face validity., Results: The skills identified in a Danish context fitted NOTSS's four categories: situation awareness, decision making, leadership, communication and teamwork and the 12 underlying elements. Only one element was added to the NOTSSdk; "monitoring own performance." A total of 3-8 good and 3-6 poor behavioural examples were written for each element. Respecting team members, creating a good working atmosphere and discussing options in the surgical team were distinct themes., Discussion: The tool, which was customized for Danish surgeons, comprises four categories, 13 elements and numerous behavioural examples. The distinct themes regarding respect, discussing options and creating a good working atmosphere are more prominent than in the Scottish NOTSS, which may be explained by cultural differences or the fact that the present study included the perspectives of the entire surgical team., Conclusion: NOTSSdk holds potential as a tool for the guiding of assessment and feedback on surgeons´ non-technical performance., Funding: not relevant., Trial Registration: The study was registered with clinicaltrials.gov (NCT01334411).

Introduction: Research into the peer review process has previously been conducted in English-language journals. This study deals with a Danish general medical journal with a relatively small pool of both reviewers and readers. The aim of the study was to compare the quality of reviews produced by identifiable and anonymous reviewers, and further to characterize authors' and reviewers' attitudes towards different peer review systems., Material and Methods: The study was conducted as a blinded, randomised controlled trial. Each manuscript was reviewed by an identifiable and an anonymous reviewer. Review quality was subsequently assessed by two blinded editors, using the validated Review Quality Instrument. Reviewers' and authors' attitudes towards different peer review systems were characterized using questionnaires., Results: The study included 364 reviews. There was no statistically significant difference in quality between anonymous and identifiable reviewers' evaluations. 55% of the authors preferred the evaluation produced by the identifiable reviewer (p < 0.05). 26% of the identifiable reviewers found it unpleasant that authors knew their identities; 43% of the anonymous reviewers found it reassuring that authors did not know their identities. Regarding reviewers' preferences for different peer review systems, 38% preferred a double-blinded, 34% preferred a single-blinded and 28% preferred an open system. For authors, the corresponding proportions were 43%, 19% and 37%., Conclusion: Implementing open peer review will not affect review quality, but lack of anonymity may cause reviewers, already limited in number, to decline when asked to review. Even though this would be a serious implication for a national journal like the Ugeskrift for Læger, the implementation of an open system should be discussed., Funding: not relevant., Trial Registration: not relevant.

Introduction: Transnasal endoscopy is well tolerated, but physiological benefits compared with conventional gastroscopy have not been studied in detail. The aims of this randomised study were to evaluate cardiopulmonary features, patient tolerance, and the endoscopist's evaluation of transnasal versus conventional endoscopy., Material and Methods: Patients were randomized to either a conventionally sized transoral (50 patients) or to a transnasal endoscopy (48 patients). Pulse rate and oxygen saturation were registered as well as the patient's tolerance and the endoscopist's evaluation of the procedure., Results: The success rate for transnasal gastroscopy was 77%, mainly because of nasal stenosis. The per- and post-endoscopy pulse rates of the conventional group were elevated compared with those of the transnasal group (p = 0.04 and p = 0.02). Procedural discomfort in the two groups was similar, but significantly fewer transnasal patients reported gagging (p < 0.01). The endoscopists evaluated the technical features as good even if they did not reach those of conventional gastroscopy (p < 0.05)., Conclusion: In this study, transnasal gastroscopy was technically inferior to conventional gastroscopy. There was no benefit in terms of patient comfort, except for less gagging. A lower stress response was indicated by significantly lower pulse rates during transnasal than during conventional gastroscopy, but the clinical relevance of this finding needs to be further investigated.

Introduction: Authorship should establish accountability and transparency, but previous research into authorship has demonstrated that authors do not always meet the International Committee of Medical Journal Editors' (ICMJE) authorship criteria. Yet, these studies have mainly focused on international, high-impact journals. The aim of the present study was to assess Danish authors' general authorship experiences and views on authorship and authorship criteria., Material and Methods: Corresponding authors of articles published in Ugeskrift for Læger and Danish Medical Journal in 2010 received a web-based questionnaire about the sampled article, co-authors and contributors, general authorship experiences and views on authorship and authorship criteria., Results: A total of 470 authors received the questionnaire and 292 responded (response rate 62%). 29% had experienced that "somebody" (the respondent himself/herself or an acquaintance/colleague) had been excluded from the author byline. 17% had been offered illegitimate authorship. 16% of the respondents had offered illegitimate authorship to somebody else. 25% of the respondents did not agree that legitimate authorship requires fulfilment of all three current ICMJE authorship criteria. Some contributions/functions not part of the current ICMJE criteria were also considered relevant for authorship, e.g. co-author supervision, statistical assistance and research group leadership., Conclusion: Illegitimate authorship is prevalent also in low-impact, national journals. In order to promote legitimate authorship, mandatory contribution statements should be considered, but education and information about existing criteria for authorship may be even more important., Funding: not relevant., Trial Registration: not relevant.

Introduction: The ultrasound-guided transversus abdominis plane (TAP) block is used to treat postoperative pain after abdominal surgery. Abdominal wall sensory nerves are anaesthetised by injecting local anaesthetics into the neurofascial plane between the internal oblique and the transversus abdominis muscles. Sensory assessment of a TAP block may guide the decision on the extent of the block. The purpose of this study was to investigate if the dermatomal extent of sensory blockade after injection of 20 ml 0.5% ropivacaine bilaterally into the TAP can be assessed using cold and pinprick sensation., Material and Methods: Subcostal TAP block was performed bilaterally in 20 awake patients scheduled for elective abdominal surgery. Sensory change in dermatomes T4-L4 was tested with pinprick using a blunt needle and cold disinfectant swabs after 10, 20 and 30 minutes., Results: Data from 20 patients (40 blocks) were analysed. Eighteen patients registered sensory change after subcostal TAP block, and dermatomes T10-T12 were blocked after 30 minutes in all of these patients. Spread of sensory change to dermatomes T5-L3 was variable., Conclusion: This study confirmed that the dermatomal extent of a sensory blockade after a single-shot subcostal TAP block can be assessed using cold and pinprick sensation., Funding: not relevant., Trial Registration: The study was registered at clinicaltrials.gov with the registration number NCT01024868.

Introduction: Internationally, the number of authors per scientific article is increasing. The objective of this study was to determine authorship trends over the past fifty years in Ugeskrift for Læger (UfL)., Material and Methods: From 1960 to 2010, ten volumes of the UfL, 5,962 articles in total, were studied. For each article, category and number of authors were recorded., Results: The median number of authors per article (all categories) was one in 1960 (range 1-3), two in 1985 (range 1-9) and three in 2010 (range 1-14). The proportion of articles published by three or more authors constituted 1% in 1960 and 68% in 2010. For original articles, the median number of authors per article was two in 1960 (range 1-3), three in 1985 (range 1-9) and three in 2010 (range 1-9). For reviews, the median number of authors per article was one in 1960 (range 1-2), two in 1985 (range 1-5) and three in 2010 (range 1-14). For case reports, the median number of authors per article was one in 1960 (range 1-2), two in 1985 (range 1-5) and three in 2010 (range 1-6)., Conclusion: The number of authors per article increased for all types of articles published in the UfL. This could reflect increases in "gift authorship", but "multiple authorship" could also be fully legitimate. Replacing or supplementing authorship criteria with contribution statements would provide some transparency and accountability. Yet, questions about credit assessment and overall responsibility need to be clarified., Funding: not relevant., Trial Registration: not relevant.

Introduction: Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death < 30 days after elective ventral hernia repair., Material and Methods: The present study was a nationwide case-control study based on prospective results from elective ventral hernia repairs (incisional, umbilical/epigastric, parastomal and other rare ventral hernia repairs) performed in Denmark during 2008. The exclusion criteria were emergency operation and ventral hernia repair in addition to another surgical procedure. The study group were patients with poor outcome (a LOS ≥ 5 days and/or readmission and/or death ≤ 30 days) and the control group were patients without a poor outcome. Major complications were defined as severe and potentially fatal complications., Results: The cohort included 2,258 patients (a study group counting 258 patients (259 repairs) and a control group comprising 2,000 patients (2,016 repairs)). Patients in the study group underwent repair significantly more often for incisional (76% versus 28%, p < 0.001), parastomal (3% versus 1%, p = 0.001) and recurrent hernia (21% versus 12%, p < 0.001). Furthermore, hernia defects were significantly larger (median 8 cm versus 2 cm, p < 0.001) in the study group than in the control group. Prolonged LOS was mainly due to pain (27%), major complications (19%), and seroma formation (9%). Readmissions were primarily caused by wound infections and pain., Conclusion: Readmissions and prolonged hospital stay after ventral hernia repair were mainly due to pain, major complications, wound infections and seroma formation., Funding: The foundation of Engineer Johs. E. Ormstrup and wife Grete Ormstrup and Region Zealand"s foundation for health-care research provided funding for this study., Trial Registration: The study was registered with the Danish Data Protection Agency (ref. no. 2008-58-0020) and www.clinicaltrials.gov (ref. no. NCT01388634).

Introduction: This study describes unsedated transnasal oesophagogastroduodenoscopy (UT-OGD) in the office setting. Evaluation of national guidelines regarding primary endoscopy for the investigation of upper gastrointestinal (GI) symptoms was also a focus of this study., Material and Methods: Retrospective registration of 2,000 cases regarding demographics, symptoms, pre-endoscopic treatment, feasibility and findings., Results: The proportion of males was 42%. 19% of the patients were referred due to alarm symptoms. The transnasal feasibility was 97%. Endoscopic findings: No abnormal findings (NAF) 53%, hiatal hernia 25%, oesophagitis 11%, gastric inflammation 11%, ulcer 10%, cancer 1% and others 1%. Alarm symptoms (AS) versus non-alarm symptoms (NAS): 35% of patients with AS had NAF versus 58% in the NAS group (p < 0.001). Cancer was present in 4% of the cases in the AS group versus 0.1% in the NAS group (p < 0.001). < 45 years versus ≥ 45 years: 69% of patients < 45 years had NAF versus 45% of patients ≥ 45 years (p < 0.001). Cancer was present in 0% of the cases in those < 45 years versus 1.4% in those ≥ 45 years (p = 0.002)., Conclusion: UT-OGD in private practice had a higher proportion of females than similar procedures performed in hospital settings. Feasibility was high. Endoscopic findings were comparable to those reported by other studies, except for a lower prevalence of oesophagitis. Age < 45 years and absence of alarm symptoms were strong negative predictors for the presence upper GI cancer. Our data thus seem to confirm the Danish guideline regarding primary endoscopy for the investigation of upper GI symptoms.

The nationwide Danish Hernia Database, recording more than 10,000 inguinal and 400 femoral hernia repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish patients with groin hernia. The cumulated data have been discussed at biannual meetings and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In patients with indicative symptoms of hernia, but no detectable hernia, diagnostic laparoscopy may be an option. Once diagnosed, hernia repair is recommended in the presence of symptoms affecting daily life. In male patients with minimal or absent symptoms watchful waiting is recommended. In females, however, repair is recommended also in asymptomatic patients. In male patients with primary unilateral or bilateral groin hernia the preferred method is mesh repair, either at open surgery (Lichtenstein) or laparoscopically, irrespective of age. Conventional tension-producing methods like Bassini, McVay or Shouldice are no longer recommended in a routine elective setting. Whether repair should be done by open or laparoscopic technique, depends on local expertise, economical considerations and patient preference. Compared to the Lichtenstein operation laparoscopic repair is associated with less acute pain and faster recovery. Furthermore, available data suggest less chronic long-term pain after laparoscopic repair. In female patients laparoscopic repair is the recommended method. In patients with recurrent hernia laparoscopic repair is preferred in patients with a previous open repair, while patients with recurrence after laparoscopic repair should undergo open mesh repair. In open repair it is recommended to use a mesh secured with a nonabsorbable monofilament suture. In laparoscopic repair a mesh without a slit and with a minimum size of 15 by 10 cm is used. For mesh fixation absorbable or nonabsorbable tacks or glue can be used. Elective surgery for groin hernia should be performed in an outpatient setting, using cost-effective local anaesthesia in open mesh repair and general anaesthesia for laparoscopic repair. Spinal anaesthesia is not recommended. Routine prophylactic antibiotics are not indicated. In the early convalescence period there are no physical restrictions. These guidelines will also be available at the website for the Danish Hernia Database (www.herniedatabasen.dk). The guidelines will be updated when new substantial evidence becomes available.

Introduction: The Danish Medical Association (DMA) performed a survey together with TNS Gallup Denmark among the readers of Ugeskrift for Laeger (Journal of the Danish Medical Association). The main motivation for the questionnaire was to evaluate the acceptability of changing the publication language in original articles from Danish into English., Material and Methods: The study was conducted as an on-line questionnaire among the members of the DMA. A systematic sample was drawn from the DMA's member database. The sample comprised a total of 1,970 e-mail addresses. Among these, 1,952 were valid, and 1,952 physicians were invited to participate by e-mail., Results: The response rate (1,046/1,952) was 54%. Among the participants 43% were specialists, 36% were junior doctors and 20% general practitioners. Overall, 45% of the respondents published scientific articles, and particularly specialists and junior doctors did not object to the shift from Danish to English language., Conclusion: Our survey showed that the readers and authors were willing to accept a shift from Danish into English publication language for original research papers.

In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration in patients with acute perforated appendicitis.

Temporary ileostomy is frequently constructed to relieve a rectal anastomosis and avoid peritonitis if the anastomosis is leaking. Ostomy is a burden for both the patient and society and early closure is therefore desirable to counteract increased morbidity. Several prospective studies and a single randomized controlled trial have shown that closure in less than two weeks was associated with lower or equal morbidity compared with later closure. Thus, current data support early closure of temporary ileostomy performed to cover rectal anastomosis in routine clinical practice.