Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Biochemical analyses of blood on POD1 enables stratification of patients into low- and high-risk groups for negative outcomes, with serum bilirubin associated with overall and hepatic morbidity and AST associated with mortality.

Although up to 50% of patients with alcoholic liver disease (ALD) resume alcohol consumption after liver transplantation (LT), numerous studies indicate that long-term results are not compromised. This study focused on evaluating the impact of ALD on outcomes up to and beyond the fifth year after LT. Among the 432 primary LT recipients included in this study, 97 underwent transplantation for ALD. Alcohol relapse rate at 10 yr was 33.5%, with younger recipient age being the only independent predictor (p = 0.019). Survival of patients with ALD (77.0%) was similar to those without (79.0%) up to the fifth post-transplant year (p = 0.655) but worse during the five subsequent years among the five-yr survivors (70.6% vs. 92.9%; p = 0.002). ALD was an independent risk factor for poorer survival beyond the fifth post-transplant year (p = 0.049), but not earlier (p = 0.717). Conversely, alcohol relapse increased the risk of death only during the first five post-transplant years (p = 0.039). There were no significant differences regarding graft failure incidence between ALD and non-ALD recipients up to the fifth post-transplant year (7.3% vs. 11.6%; p = 0.255) and beyond (12.9% vs. 5.0%; p = 0.126). In conclusion, pre-transplant diagnosis of ALD yields negative effects on post-transplant outcomes beyond the fifth post-transplant year, not attributable to recidivism.

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Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an inappropriate choice of staple size in relation to gastric wall thickness. Due to the variable nature of gastric wall thickness, the choice of proper staple height is not obvious. In the few studies in which gastric wall thickness was measured, it was observed to decrease gradually from the antrum to the fundus. However, the authors are divided on the issue of whether gender and body mass index influence gastric wall thickness. The question whether there are other perioperative factors that would allow gastric wall thickness to be predicted remains unanswered.

Background: The main principle of abdominal incisional hernia repair is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. Ideally, midline structural support is restored by midline approximation of local musculo-aponeurotic tissues. Approximation of these tissues without tension on the suture line will restore the elasticity and flexibility of the abdominal wall. However, 30% to 50% of defects larger than 6 cm recur after primary closure, because of the tension on the suture line. Insertion of an alloplastic material to decrease or eliminate tension on the suture line can reduce the incidence of recurrence to 10% or less. But inorganic prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization. With the availability of biological materials, surgeons are increasingly using these materials for effective surgical management of abdominal incisional hernia The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay. Methods: Between January 2002 and December 2009, 104 patients underwent repair oflarge incisional hernias at 2 community hospitals. After replacement of hernia sac contents into the peritoneal cavity, a relaxing incision was made in the ARS bilaterally. Then the midline was closed primarily. The biological material was onlaid and sutured to the lateral edges of the relaxed ARS. Main outcome measures were postoperative complications and hernia recurrence. Results: Median age 61 years (range, 39-86) years. Body mass index was 34 (range, 23-44). Of the 104 patients, 37 had undergone I or more previous repairs. In 19 patients (18%), mesh had been used. In 14 patients the mesh had been placed as a sub lay, and in 5 patients the mesh had been placed laparoscopically. We removed the mesh in all 19 cases. Size of the defect was 195 (range, 150-420) cm 2 • Median operation time was 125 (range, 75-255) minutes. Four patients (3.8%) had a large wound hematoma that required operative drainage. Four (3.8%) patients developed skin necrosis at the edge of the wound, exposing the biological material; they were treated conservatively with dressings and oral antibiotics and discharged 9 days after surgery. Three (2.8%) developed urinary tract infection, which was treated successfully with appropriate oral antibiotics. One (0.9%) developed pneumonia postoperatively; this was successfully treated with appropriate antibiotics and the patient was discharged 10 days after surgery. Wound seroma occurred in 57 (55%) patients. In all cases, the seroma was suspected by physical examination and both confirmed and managed by fine needle aspiration, with or without sonography. The median time between surgery and diagnosis of seroma was 19 days (range, 12-42). The mean time to complete resolution was 52 days...

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Purpose The variables possibly enabling the prediction of gastric wall thickness during laparoscopic sleeve gastrectomy remain undetermined. The aim of the study was to identify preoperative factors affecting gastric wall thickness in patients undergoing laparoscopic sleeve gastrectomy. Methods The measurements of the double-wall thickness of gastric specimen excised during sleeve gastrectomy were taken at three locations after 15 s of compression with an applied pressure of 8 g/mm2. Statistical calculations were used to determine the influence of preoperative weight loss and other perioperative parameters on gastric wall thickness. Results The study involved one hundred patients (78 female; 22 male). The thickest tissue was observed at the antrum with the mean value 2.55 mm (range 1.77–4.0 mm), followed by the midbody, mean 2.13 mm (range 1.34–3.20 mm), and the fundus, mean 1.69 mm (range 0.99–2.69 mm). Positive relationships were found between gastric wall thickness and both preoperative weight loss and age in all three measured locations; p < 0.05. In a linear regression model, age and preoperative weight loss were found to be statistically significant and positive predictors of higher gastric wall thickness only at the antrum. Male patients were observed to have thicker gastric wall at all three locations as compared to female patients. Conclusion Preoperative weight loss should be considered an important factor influencing gastric wall thickness. Age and gender can also be helpful in predicting the varying tissue thickness. Anatomical region is a key factor determining thickness of the stomach walls.