Rubber transcystic drainage reduces the post-removal biliary complications in liver transplantation: a matched case-control study.

PURPOSE: Bile duct (BD) complications continue to be the "Achilles' heel" of liver transplantation, and the utilization of bile duct drainage is still on debate. We describe the results of a less invasive rubber trancystic biliary drainage (TBD) compared to a standard silicone T-tube (TT). METHODS: The transplanted patients (n = 248), over a period of 5 years with a TBD (n = 20), were matched 1:2 with control patients with a TT (n = 40). Primary end points were the overall incidence of BD complications and graft and patient survival. Secondary end points included the complications after the drainage removal. RESULTS: Although the bile duct leakage rates were not significantly different between both groups, the TT group had a significantly higher rate of overall 1-year BD stenosis (40 versus 10 %) (p = 0.036). Three-year patient/graft survival rates were 83.2/80.1 and 84.4/84.4 % for the TT and TBD groups, respectively. The postoperative BD complications, after drainage removal (peritonitis and stenosis), were significantly reduced (p = 0.011) with the use of a TBD. CONCLUSION: The use of rubber TBD in liver transplant recipients does not increase the number of BD complications compared to the T-tube. Furthermore, less BD anastomotic stenosis and post-removal complications were observed in the TBD group compared to the TT group.

Long-term quality-of-life assessment of gastrointestinal symptoms before and after laparoscopic Nissen fundoplication.

PURPOSE: This was a prospective quality-of-life (QoL) assessment of gastrointestinal symptoms before laparoscopic Nissen fundoplication and during the 6-year postoperative follow-up. METHODS: Over a 15-month period, 35 consecutive patients with gastroesophageal reflux disease (GERD) underwent surgery after failure of medical treatment with proton pump inhibitors. QoL was assessed using the Gastrointestinal Quality of Life Index (GIQLI) preoperatively, and at 3, 6, 12, 24, 48 and 72 months postoperatively. RESULTS: The preoperative GIQLI score was lower than the 'normal' score (126 points), as were the scores overall and for each dimension (social integration, physical function, emotions and gastrointestinal symptoms; all P<0.001). Also, although the GIQLI increased significantly (P<0.0001) at 3, 6, 12, 24, 48 and 72 months, it remained below normal (P<0.01). The symptom score also remained below that of the normal population (57 vs 67; P<0.0001), while the percentages of patients with abdominal pain, dysphagia, modified eating habits and belching decreased non-significantly. However, GERD symptoms were significantly reduced (51% vs 4%; P=0.01), although 20% of patients started taking proton pump inhibitors again during the follow-up period. Surgery eliminated 50% of the dysphagia symptoms reported preoperatively and, after 6 years, only 8% of patients still complained of dysphagia. CONCLUSION: Patients who undergo surgery after failure of medical treatment for GERD can expect an improved QoL, although they may not be able to achieve normal levels. Preoperative symptoms should be carefully recorded in order to better inform patients of the expected outcome following surgery.