At present, an instrument for measuring the quality of life, specifically for patients with gastrointestinal disease, is not available. A new instrument for gastrointestinal disorders that is system-specific has been developed in three phases. In the first phase, questions were collated and then tested on 70 patients with gastrointestinal diseases and those that worked well were retained. In the second phase, the questions were modified and tested on 204 patients and the results verified by international experts. The instrument was also validated against other generic measures of quality of life. During the third phase, the instrument was validated with 168 normal individuals. Reproducibility was tested on 25 patients with stable gastrointestinal disease and responsiveness was tested on 194 patients undergoing laparoscopic cholecystectomy. The result is a bilingual (German and English) questionnaire containing 36 questions each with five response categories. The responses to questions are summed to give a numerical score. It is concluded that the Gastrointestinal Quality of Life Index (GIQLI) is ready to be used in clinical practice and research.

The probability of adverse and undesirable events during and after operations that have not yet occurred in a finite number of patients (n) can be estimated with Hanley's simple formula, which gives the upper limit of the 95% confidence interval of the probability of such an event: upper limit of 95% confidence interval = maximum risk = 3/n (for n > 30). Doctors and surgeons should keep this simple rule in mind when complication rates of zero are reported in the literature and when they have not (yet) experienced a disastrous complication in a procedure.

Over a 17-year period, 92 patients with esophageal disease underwent colon interposition or bypass, with each operation performed by the same surgeon. The indication was cure of cancer in 20 patients, relief of dysphagia in 55 (cancer in 17 patients and benign in 38), loss of gastrointestinal (G.I.) continuity in ten, and tracheoesophageal fistula in seven patients (malignant in five, benign in 2). The thirty-day operative mortality rate was 5%, and the hospital mortality rate was 9%. Graft necrosis occurred in seven of 92 patients, four of whom later underwent a successful second reconstruction. Thirteen patients required subsequent revisional surgery. In 85 patients, the left colon based on the inferior mesenteric artery was used, and in seven, the right colon was used. Technical insights were gained to help preserve the blood supply to the graft and improve its function in transporting food. Thirty-four patients were available for interview 2-17 years after operation (median of 5 years) 28 of whom had benign disease, and six of whom had malignant disease); 82% of the patients felt they were cured of their preoperative symptoms, 18% improved, and none worsened. Eighty-eight per cent of the patients were able to receive an unrestricted diet. All patients except one were satisfied with the results of surgery, and, asked what they would do if they had to make the choice again, all responded that they would have the operation. Twenty-six of the interviewed patients had their eating ability evaluated with a test meal and the transit time of a liquid and solid barium bolus measured. Compared to controls, patients with colon interpositions consumed a smaller capacity meal over a longer period of time and were not dependent on liquids to flush the food through the colon graft. A colon interposition provides good quality of deglutition, is very durable, and is the organ of choice for patients who require an esophageal substitute and are potential candidates for long survival.