GIQLI Questionnaire Research Articles

Bile acid diarrhoea and metabolic changes after cholecystectomy: a prospective case-control study

IntroductionBile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation such as following cholecystectomy. However, the mechanism behind this is as yet unknown. The aim of this study was to determine the rate of post-cholecystectomy diarrhoea and to assess whether FGF19 within the gallbladder was associated with the development of BAD.MethodsThis was a prospective case-control study in which patients were assessed pre- and post- cholecystectomy (study group) and compared with patients also having laparoscopic surgery but not cholecystectomy (control group). Their bowel habits and a GIQLI questionnaire was performed to compare the pre- and post-operative condition of the two groups. Gallbladder tissue sample was tested for FGF19 and PPARα in the study group patients. A subset had serum lipid levels, FGF19 and C4 measurements.ResultsGallbladder PPAR α was found to have a significant correlation with stool consistency, with the lower the PPARα concentration the higher the Bristol stool chart number (i.e. looser stool). There were no significant correlation when assessing the effect of gallbladder FGF19 concentration on bowel habit, stool consistency, lipid levels, BMI or smoking. The study group showed a significant increase in triglycerides post-operatively, however there were no changes in cholesterol, HDL and LDL levels. Correlation of the increased triglyceride levels with stool consistency and frequency showed no significant resultsDiscussion and conclusionWe did not find any direct evidence that FGF19 levels within the gallbladder impact the development of post-cholecystectomy diarrhoea. There was however a significant increase in triglycerides postoperatively. There was also no correlation of bowel habits with PPARα suggesting the observed rise is independent of this pathway. Further work is required particularly relating to the gut microbiome to further investigate this condition.

Impact of Probiotics on Gastrointestinal Function and Metabolic Status After Roux-en-Y Gastric Bypass: A Double-Blind, Randomized Trial.

Postoperative changes in gut microbiota may occur in patients undergoing Roux-en-Y gastric bypass surgery. In this study, we evaluate the impact of administering probiotic tablets on the gastrointestinal function and metabolic status of these patients. This double-blinded randomized clinical trial was conducted from 2021 to 2022 on 135 Roux-en-Y surgery candidates. The intervention group underwent the surgical procedure and started receiving probiotic supplements (Familact Co.) 1 week after surgery; the control group received a placebo. The laboratory and anthropometric data were measured and analyzed before and 3 and 6 months after the intervention. GIQLI questionnaire was also used at the beginning and 6 months after the intervention to evaluate GI symptoms. We observed significantly reduced BMI in both groups after surgeries (P < 0.001). The levels of FBS and HbA1C were significantly lower in the probiotic group compared to the placebo in 3 months (P = 0.02 and P = 0.001, respectively) and 6months (P < 0.001 for both) after the intervention. The levels of vitamin B12 increased significantly in the probiotic group (P < 0.001), and the values were substantially higher than the placebo group in 3 and 6 months (P < 0.001), respectively. Analysis of the GIQLI questionnaire before and 6 months after interventions also revealed significant improvement in the GIQLI score in both groups (P < 0.001 for probiotics and P = 0.03 for placebo). Probiotic supplement administration following RYGB improves patients' vitamin and metabolic profile, as well as GI function, although it cannot significantly affect weight loss.

Elective Laparoscopic Sigmoidectomy Reduces IL-6 Serum Levels in Uncomplicated Recurrent Diverticulitis.

Introduction: Although recurrent diverticulitis appears to be a chronic relapsing disease from a clinical standpoint, there are no sufficient data about inflammatory markers that allow monitoring recurrent diverticulitis in the quiescent phase. Our hypothesis is that serum inflammatory markers may be increased during clinical quiescent phases of diverticulitis and will drop after elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. We also believe that a drop in IL-6 levels across surgery could be related to an improved quality of life. Material and Methods: This epidemiological study aims to evaluate IL-6 serum levels and quality of life preoperatively and 6 months after surgery in 30 patients undergoing elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. Results: The mean preoperative IL-6 level was 9.5 Ã+- 9.2 pg/ml (range 0-5), while at six months after surgery the mean IL-6 was 4.5 +- 3.5. (p=0.0085). Preoperative QoL measured with the GIQLI questionnaire was 98 +- 11.3 and raised significantly after surgery to 112 +- 9.8 (p=0.043). Conclusions: We found a serum IL-6 reduction after elective laparoscopic sigmoidectomy that can be attributed to the surgical removal of the source of inflammation in patients suffering from uncomplicated recurrent diverticulitis. Similarly, the GIQLI questionnaire showed a significantly improved QoL after surgery.

Mini-gastric bypass with Nissen fundoplication for the treatment of obesity and gastroesophageal reflx disease

Aim. To develop bariatric and antireflx surgery for the treatment of patients with obesity and GERD, and to assess its effectiveness and safety.Methods. A prospective controlled study included 28 patients who underwent laparoscopic mini-gastric bypass with Nissen fundoplication, and their progress was monitored for three years postoperatively. This study covered the surgical procedure and its technical aspects. Surgical treatment was evaluated using GERD-HRQL, BAROS, and GIQLI questionnaires, as well as instrumental studies (esophagogastroscopy and X-ray of the esophagus and stomach).Results. According to the GERD-HRQL questionnaire, mini-gastric bypass with Nissen fundoplication demonstrated excellent control over GERD symptoms during all stages of postoperative follow-up. The most signifiant reduction in body weight occurred within the fist year after the operation, with sustained effects throughout the observation period. The maximum percentage of excess body weight loss was observed two years post-operation. The GIQLI questionnaire showed an average score increase of 54 % three years after surgical treatment compared to baseline. Evaluation of the bariatric treatment’s effectiveness using the BAROS system criteria consistently indicated «excellent and very good results» throughout the entire postoperative follow-up period. No signifiant postoperative complications were identifid, both in the early and long-term periods.Conclusion.The developed mini-gastric bypass with a Nissen fundoplication proves to be a safe and effective surgical treatment method for patients with obesity and GERD. Following further clinical studies and the analysis of long-term results, the proposed operation could be recommended as an alternative to RYGB and MGB-OAGB for patients with obesity and GERD.

Reliability of self-assessment of quality of life in patients with hiatal hernia associated with gastroesophageal reflux disease after videolaparoscopic anti-reflux surgery

This article aims to investigate the reliability of self-assessment of the quality of life in patients with hiatal hernia after undergoing videolaparoscopic anti-reflux intervention. To achieve this, the responses to a questionnaire were compared with the results of a study on the failure of the cardia anti-reflux mechanism.Materials and methods. A total of 213 patients who underwent videolaparoscopic oesophagus fundoplication were included in this study. The participants completed three questionnaires: GORD-HRQL, GIQLI, and SF-36. The responses obtained from the questionnaires were then compared with the results of a cardia anti-reflux mechanism study, which involved X-ray endoscopy of the oesophagus and stomach, daily oesophageal pH-metry, and oesophagogastric junction manometry. Based on the responses to the three questionnaires, the quality of life index was calculated for all patients. Additionally, a composite index of cardia anti-reflux mechanism failure was computed to assess the severity of pathological gastro-oesophageal reflux and describe the effectiveness of the cardia anti-reflux mechanism in preventing it.Results. The comparison of the components forming the integral quality of life index with the composite index of cardia anti-reflux mechanism failure before and after the operation revealed an inverse relationship: as the values of the integral quality of life index decreased, the values of the composite index of cardia anti-reflux mechanism failure increased.Conclusion. The self-assessment of the quality of life by patients with GORD-associated hiatal hernia after anti-reflux intervention, as assessed through GORD-HRQL, GIQLI, and SF-36 questionnaires, is accurate and can be effectively utilized for screening and diagnosing disease recurrence.

The Impact of the Gastric Pouch and Gastro-Jejunostomy Size after Laparoscopic Roux-En-Y Gastric Bypass - A Prospective, CT-Volumetry Based Study

Abstract Background Some patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) may present with insufficient weight loss or weight regain. Anatomical factors that may lead to failure of LRYGB include the size of the gastric pouch and the diameter of the gastro-jejunostomy. Aims This study explores the gastric pouch size and the size of the gastro-jejunostomy after LRYGB and investigates their impact on weight loss, appetite and quality of life (QoL). Methods Patients undergoing LRYGB in a single centre underwent computed tomography (CT) with oral contrast one day and one year after LRYGB. Volumetry of the gastric pouch and calculation of the size of the gastro-jejunostomy was performed. Appetite was assessed pre-operatively and one year after LRYGB using the Edmonton Appetite Assessment questionnaire. QoL was assessed pre-operatively one year after surgery using the GIQLI and BAROS questionnaires. Results 61 patients were included. Of those, 55 patients (90.2%) underwent CT one year after LRYGB. The mean preoperative Body Mass Index was 40.7±3.97kg/m2. The mean Excess weight loss (%EWL) one year after surgery was 82.1±21.5%. There was no significant change in mean gastric pouch size one day and one year after LYRGB (15.73±11.8cm3 and 14.4±11.5cm3, respectively, p=0.55). The mean size of the gastrojejunostomy increased significantly from 2.63cm2 to 3.60cm2 (p&amp;lt;0.0001). Mean GIQLI and BAROS values improved significantly one year after LRYGB, but no significant changes in the mean Edmonton Appetite Assessment values were found. %EWL and improvement in GIQLI and BAROS values one year after surgery did not correlate with the initial size of the gastric pouch and the increase of the size of the gastro-jejunostomy. Conclusions One year after LRYGB, the size of the gastro-jejunostomy increased significantly, but no difference in the gastric pouch volume was found. Both gastric pouch volume and dilatation of the gastro-jejunostomy did not correlate with weight loss and QoL outcomes.

Health-Related Quality of Life and Stress-Related Disorders in Patients with Complicated Diverticular Disease under Conservative Management.

Diverticular disease is a common gastrointestinal disorder with increasing prevalence in advanced age. This study aimed to investigate the impact of age and complexity of diverticulitis on health-related quality of life (HRQoL) and stress-related disorders. A cross-sectional study was conducted on 180 patients, including adults (18-64 years) with complicated diverticular disease, the elderly (≥65 years) with complicated diverticular disease, and a control group with uncomplicated symptomatic diverticular disease. HRQoL and stress-related disorders were assessed using the SF-36, GIQLI, HADS, and PHQ-9 questionnaires at baseline and six months after the initial episode of diverticulitis. At diagnosis, the adult group had significantly lower mean physical and mental scores compared with the elderly and control groups (p < 0.001). At the 6-month follow-up, the mean physical score increased for all groups, but the difference between adults and the elderly remained significant (p = 0.028). The adult group had a significantly lower mean GIQLI score at diagnosis compared with the elderly and control groups (p < 0.001), although after 6 months it increased and the difference became insignificant. Anxiety scores at diagnosis were significantly higher in the adult group compared with the control group (p = 0.009). The complexity of diverticulitis and age significantly impacted HRQoL at diagnosis, with adults having lower physical and mental scores compared with elderly patients and controls. Although improvements were observed after 6 months, the difference between adults and the elderly remained significant for physical HRQoL scores. This highlights the need for tailored management strategies and psychosocial support to optimize patient outcomes across age groups and diverticulitis complexity.

False-positive symptoms of recurrence of gastroesophageal reflux disease (gerd) in patients with hiatal hernia (hh) after anti-reflux videolaparoscopy

We compared the results of remote survey of 213 patients with HH associated with GERD in the long term after anti-reflux videolaparoscopy, according to the GERD-HRQL, GIQLI, and SF-36 questionnaires (patients’ complaints) and special methods for studying the anti-reflux function of the cardia (X-ray endoscopy of the esophagus and stomach, daily esophageal pH monitoring, esophageal manometry). Based on the results of special studies, a generalized indicator of failure of the anti-reflux function of the cardia (GIFAFC) was developed. It was found that 57.3% of the examined patients had false-positive symptoms of GERD recurrence, which was manifested by pain in the epigastric region (31.2%), belching with air (4.1%), and heartburn (21.3%). There were no symptoms when bent over or lying down. The existing symptoms were mild, easily stopped by conservative treatment. The patients with false-positive GERD symptoms after surgery showed an improvement in GIFAFC by 7.9 times (p &lt;0.001), but it was 5.4 times worse than in patients without recurrent GERD (p &lt;0.001), and 6.3 times better in relation to patients with recurrent GERD (p&lt;0.05). False-positive symptoms of GERD recurrence contributed to a decrease in the generalized indicator of quality of life, which, according to the SF-36 questionnaire, was 76% of the maximum desired result. Due to the absence of reliable clinical manifestations, all patients with HH who have certain symptoms of GERD after fundoplication should undergo an instrumental study of the anti-reflux function of the cardia. Patients with established false-positive symptoms of GERD are subject to dispensary follow-up.

CHANGES IN QUALITY OF LIFE AND EXPRESSION OF ANXIETY AND DEPRESSION IN PATIENTS WITH DIVERTICULAR COLON DISEASE

The constant increase in the incidence of diverticular disease (DD), especially in middle-aged and elderly people, the establishment of new additional etiological factors of development and pathogenetic mechanisms of progression make the problem of this nosology extremely relevant. The presence of persistent symptoms such as abdominal pain, stool disorders, which constantly bother 20% of patients and frequent recurrences of diverticulitis and their complications, which occur in 25% of such patients, lead to high levels of stress. Diverticular disease has a negative impact on the quality of life of patients, which worsens with increasing duration of the disease. Most studies on quality of life and the development of anxiety and depression concern patients with complicated diverticular disease and patients after surgery for their complications. At the same time, there is limited information and statistics on the relationship between uncomplicated diverticular disease and anxiety, depression and reduced quality of life.&#x0D; The aim of the study: to assess the severity of anxiety and depression and reduced quality of life in patients with diverticular disease of the colon.&#x0D; Materials and methods. The study included 48 patients with diverticular disease, 32 - with irritable bowel syndrome and 15 healthy individuals. Depending on the severity of clinical manifestations, the nature of the course, the results of laboratory, radiological, sonographic results and computed tomography used classification of DD according to B. Lembske, and among patients such types as 0, 3a, 3b prevailed, which was 87.5 %. Taylor scales, the Hospital Anxiety and Depression Scale (HADS), and the Spielberg-Hanin situational anxiety level were used to assess the severity of anxiety and depression. The quality of life of patients and patients in the control group was assessed using the GIQLI questionnaire and the WSAS questionnaire (appendices A and D).&#x0D; Research results. According to the Taylor scale, a high level of anxiety (35.8 ± 0.8 points) occurred in 58.3%, and average (23.9 ± 0.7 points) in 22.9% of respondents, while in healthy people the indicator was low (12.0 ± 1.1 points). In 20.8% of patients with diverticular disease, symptoms of depression prevailed with an index of 12.2 ± 1.1 points. According to the results of the Spielberg-Hanin questionnaire, 72.9% of patients with DD had moderate anxiety (39.7 ± 1.2 points), and 20.1% had depression (6.7 ± 1.0 points). There is a direct correlation between anxiety indicators according to the Taylor, Spielberg - Khanin scale (r = 0.71 p &lt;0.05).&#x0D; The quality of life of patients with DH decreased by 30.2% due to intestinal symptoms and slightly less due to the emotional component. Diverticular disease decreased physical status (by 18.7 points) and social activity (by 9.3 points). Appendix D of the WSAS also confirmed a decline in employment and social activity and a quality of life (Appendix A).&#x0D; Conclusions. Thus, uncomplicated diverticular disease causes anxiety in 81.2%, and depression - in 20.8%, and according to Spielberg - Khanin - in 72.9% and 20.1%, respectively. Diverticular disease also reduces the quality of life according to the GIQLI questionnaire by 37.64%. Assessment of manifestations of anxiety and depression and reduced quality of life will allow to choose further tactics of treatment of patients with diverticular disease.

Assessment of the quality of life of patients with achalasia of the cardia after videoendoscopic Heller cardiomyotomy with Dor fundoplication

Background. The leading symptom of achalasia of cardia (AC) is dysphagia, along with other symptoms significantly affecting the quality of life of patients.The aim. Based on the results of questioning patients using special and general questionnaires and using special methods for studying the closing function of the cardia, to evaluate the quality of life of patients with stages 2–4 of AC after video-laparoscopic esophagocardiomyotomy according to Heller with anterior hemiasophagofundoplication according to Dor.Materials and methods. The basis of the work was the analysis of the results of esophagocardiomyotomy according to Heller with anterior hemiesophagofundoplication according to Dor in 106 patients with stages 2–4 of AC. The postoperative follow-up period averaged 2 ± 0.4 years. In the pre- and postoperative periods, the results of fluoroscopy of the esophagus and stomach, manometry of the esophagus and the esophageal-gastric junction were studied, and three questionnaires were used (Eckhardt scale, GIQLI questionnaire and SF-36).Results. Analysis of the data obtained showed that the clinical manifestations of the disease in the postoperative period decreased in all patients with stages 2–4 of AC, the results in patients with stage 2 were better than in patients with stages 3 and 4 (p &lt; 0.05). The results of fluoroscopy of the esophagus and stomach, manometry of the esophagus and the esophagogastric junction showed improvement in the postoperative period in patients at all stages of the disease, the results of patients with stage 4 were worse compared with stages 2 and 3 (p &lt; 0.05).Conclusion. Videoendoscopic esophagomyotomy according to Heller with anterior fundoplication according to Dor significantly reduces the severity of clinical manifestations of AC and improves the quality of life in patients with stages 2–4 of AC, as a result of which surgery should be recommended to patients already at stage 2 and organ-preserving surgery at stage 4 of the disease.

Long-Term Quality of Life in Achalasia Patients After Esophagectomy: A Single Center Experience

Introduction: Achalasia is a chronic motility disorder of the esophagus with difficult to manage symptoms. Despite multi-modal therapies, some patients progress to end-stage disease requiring esophagectomy. Quality of life (QOL) has not been fully described in this population. Methods: A cross-sectional QOL study was performed on a cohort of end-stage achalasia patients who underwent an esophagectomy (2010-2020). Patients who met inclusion criteria were contacted by phone in 2021 to complete GIQLI and OES-18 questionnaires. Descriptive statistics were performed. Results: Of 14 patients who met inclusion criteria, 9 (64.3%) completed the QOL questionnaires. Mean age was 53-years, and the majority were white (88.9%) women (63.7%). Prior to esophagectomy, management of achalasia included Botox (33.3%), dilation (66.7%), and Heller myotomy (100%). All patients reported dysphagia and 88.9% reported regurgitation prior to esophagectomy. All patients underwent a minimally invasive surgical approach. At the time of QOL surveillance, the mean time from operation was 66 months. The mean GIQLI score in this population was 97 (Max 144), compared to previously reported scores of 126 in a healthy population and 119 after Heller myotomy. Only ICU and hospital LOS had a statistically significant association with poorer GIQLI scores. The results of the OES-18 showed higher median severity scores for reflux, dry mouth and trouble with coughing. Conclusions: Even after esophagectomy for end stage achalasia, symptoms can be persistent and impact QOL. While some patients may benefit from esophagectomy, future research should aim to identify which patients will benefit the most from this operation.

MECHANISMS OF THE FORMATION OF MOTOR-SECRETORY DISORDERS IN PATIENTS WITH GERD WITH CONCOMITANT AIT

The aim: The aim of this work was to study the effect of thyroid hormones on motor-secretory dysfunction in patients with GERD with concomitant AIT. Materials and methods: The study involved three groups of patients: with isolated GERD, GERD with AIT at the stage of hypothyroidism and GERD with AIT at the stage of hyperthyroidism. The control group consisted of 15 practically healthy individuals. GERD and AIT were diagnosed on the basis of ICD-10. All patients underwent a comprehensive examination, including ultrasound examination of the motor-evacuation function of the esophagus and stomach. Quality of life of patients was assessed by using the GIQLI questionnaire. Results: The most expressed complaints and low quality of life are observed among patients with combined pathology. The results of pH-metry indicate more severe course of GERD among patients with concomitant AIT. The most pronounced decrease in the tone of the lower esophageal sphincter and increased regurgitation were observed in the second group. Conclusions: 1. It was found that more reliable motor-secretory disorders were observed among patients with GERD with concomitant AIT. 2. A close correlation was established between the severity of the clinical picture, the level of increased thyroid hormones and the degree of impairment of motor-secretory disorders among patients with GERD with concomitant AIT; 3. The results obtained indicate that changes in the metabolism of thyroid hormones are one of the factors involved in the mechanisms of GERD formation.

The effect of eradication therapy on the quality of life of patients with chronic erosive gastritis induced with Helicobacter pylori

The aim of the study was to evaluate the effect of eradication therapy on the quality of life of patients with chronic erosive gastritis induced with Helicobacter pylori. The quality of life was assessed according to the GIQLI questionnaire before treatment during incomplete remission, remission, and during the year. It was found that the exacerbation of the disease significantly changes the level of quality of life of patients, and the complex treatment, eradication of Helicobacter pylori, which stopped the exacerbation of the disease, gradually increases and brings this indicator closer to the control group. The gastrointestinal quality of life index can be used as an additional criterion for diagnosing the stages of chronic erosive gastritis, for evaluating the effectiveness of therapy, determining the timing of treatment, rehabilitation and prevention in the dispensary management of patients at the therapeutic site.

Endoscopic intragastric injection of botulinum toxin A in obese patients on bariatric surgery waiting lists: A randomised double-blind study (IntraTox study)

Several studies have evaluated the effect of intragastric injection of botulinum toxin A to treat obesity, achieving mixed results. Our objective is to determine the effect of intragastric botulinum toxin A on weight loss, satiety, biomarkers, and quality of life of obese patients prior bariatric surgery. Design: single-centre, randomised, double-blind, placebo-controlled clinical trial in 52 obese patients on bariatric surgery waiting lists. Two-arm parallel: the treatment group was administered intragastric botulinum toxin A by endoscopy, whereas the control group was administered physiological saline solution. Weight loss was evaluated at weeks 2, 4, 8, 16, and 24, as well as changes in body composition, satiety (Visual analogue scale (VAS) and GCSI questionnaire), quality of life (GIQLI questionnaire), and biomarkers of satiety and appetite. Weight loss at weeks 2, 4, 8, 16, and 24 after the endoscopy, with respect to the basal visit, was 0.6±2kg, 0.4±2.7kg, 0.4±3.1kg, 0.2±4.5kg, and 0.6±4.3kg for the control group vs 1.9±2.1kg, 2±2.6kg, 2.8±4.1kg, 3.5±5.3kg, and 4.5±7kg for the treatment group, respectively, being differences between groups significant at all times (p=0.016, 0.031, 0.014, 0.021, and 0.023, respectively). Treatment group patients obtained a significantly higher score for GIQLI questionnaire compared with baseline (104.4±13.9 points vs 97.7±15.6 points; p=0.024), showing a significant improvement in the section of subjective physical capacity. No significant differences were found regarding perception of satiety, or biomarkers of satiety and appetite. Intragastric injection of botulinum toxin A is an effective and safe procedure to achieve a moderate weight loss and improve quality of life. Registered under clinicaltrialsregister.eu Identifier EudraCT number 2015-004391-29 https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004391-29/ES.

Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study

Patients undergoing colon resection are often concerned about their functional outcomes after surgery. The primary aim of this prospective, multicentric study was to assess the intestinal activity and health-related quality-of-life (HRQL) after ileocecal valve removal. The secondary aim was to evaluate any vitamin B12 deficiency. The study included patients undergoing right colectomy, extended right colectomy and ileocecal resection for either neoplastic or benign disease. Selected items of GIQLI and EORTC QLQ-CR29 questionnaires were used to investigate intestinal activity and HRQL before and after surgery. Blood samples for vitamin B12 level were collected before and during the follow-up period. The empirical rule effect size (ERES) method was used to explain the clinical effect of statistical results. Linear mixed effect (LME) model for longitudinal data was applied to detect the most important parameters affecting the total score. A total of 158 patients were considered. Applying the ERES method, the analysis of both questionnaires showed clinically and statistically significant improvement of HRQL at the end of the follow-up period. Applying the LME model, worsening of HRQL was correlated with female gender and ileum length when using GIQLI questionnaire, and with female gender, open approach, and advanced cancer stage when using the EORTC QLQ-CR29 questionnaire. No significant deficiency in vitamin B12 levels was observed regardless of the length of surgical specimen. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory.

Posterior rectal pouch after large full-thickness disc excision of deep endometriosis infiltrating the low/mid rectum and relationship with digestive functional outcome

IntroductionThe aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms. Material and MethodsSingle center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence. ResultsEighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = −0.24, 95%CI -0.51−0.69, p = 0.44). ConclusionLarge disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.

Redo surgery after laparoscopic fundoplication

To analyze the results of redo surgeries after previous laparoscopic fundoplication. A retrospective analysis included 37 repeated anti-reflux surgeries. Control group consisted of 38 patients after the first anti-reflux surgery performed on the same clinical base. The causes of unsatisfactory results of the first operations were studied. Intraoperative data, immediate and long-term results of surgical treatment were compared in both groups. Quality of life in both groups was studied before surgery and in long-term period using GIQLI questionnaire. The most common cause of recurrent reflux was a hernia recurrence combined with slipping or destruction of the fundoplication cuff. Dysphagia was usually a result of compression of the esophagus by tightly sutured diaphragmatic crura and recurrent paraesophageal hernia. The main group was characterized by significantly greater surgery time, hospital-stay, incidence of intraoperative and postoperative complications. However, a more significant improvement of quality of life (∆GIQLI) was observed in the main group due to the low QOL index before redo surgery. Redo surgeries are effective and safe procedures. These operations significantly improve QOL in long-term period despite certain technical difficulties. Repeated surgeries for dysphagia accounted for 2%, for recurrent reflux - 6%. Persistent postoperative dysphagia is usually associated with diaphragm repair rather fundoplication cuff. Reflux recurrence is often caused by cuff slippage and recurrent hernia.

Propensity-score matching analysis of postoperative outcome including quality of life after single incision versus multiport laparoscopic cholecystectomy: A nationwide prospective multicenter study in Korea

Introduction: There is still controversy for usefulness of single incision laparoscopic cholecystectomy (SILC) compared to multiport laparoscopic cholecystectomy (MPLC) due to no clear indication and technical difficulties. SILC could reduce the number of ports, but cause more postoperative pain and worsen quality of life (QoL) because of large umbilical incision. The purpose of this study was to compare postoperative outcomes of SILS with those of MPLC. Method: In a prospective Korea Cholecystectomy Quality Improvement Program cohort including 18 institutions from October 2016 to March 2017, 2510 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were enrolled. Various postoperative outcomes were compared between two groups including operative details, postoperative complications, pain assessed by NRS score, and QoL assessed by GIQLI questionnaire after propensity score matching (PSM) with 1: 2 balances using multiple covariates, such as, age, sex, ASA classification, comorbidities, biliary drainage, and pathology of acute cholecystitis. Result: Among study cohort, SILS were performed 331 patients, whereas MPLC were 2179 patients. After uni- and multivariate analysis, there were no significant differences in terms of operative finding including operative time (46±20 min. vs 45±24 min., p= NS) and difficulty, postoperative complications including biliary injury. Also, there were no significant differences in terms of postoperative pain (2.1±1.9 vs. 2.3±2.3, p= NS) and QoL (1.8±2.1 vs. 1.7±1.6, p= NS). Conclusion: SILC showed comparable postoperative outcomes including operative findings, postoperative complications, and patients- reported outcomes after PSM analysis with a nationwide prospective data. In conclusion, SILC is as safe as MPLC for benign gallbladder disease compared with MPLC.

Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI).

Right hemicolectomy is a very common surgery. Many studies compare different options for laparoscopic ileocolic anastomoses: intra- or extracorporeal; handsewn or stapled; side-to-side or end-to-side. However, there are no studies about the influence that peristalsis could have on this anastomosis. The aim of this study is to compare safety and feasibility of isoperistaltic and antiperistaltic anastomosis in terms of postoperative morbidity and mortality between both groups. The secondary endpoint is to compare long-term functional outcomes (chronic diarrhoea) and quality of life (GIQLI questionnaire) after a 1-year follow-up period. A double-blind, randomised, prospective trial in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and isoperistaltic (ISO) or antiperistaltic (ANTI) ileocolic anastomoses. Hundred and eight patients were included in the study. Patients were randomised either to isoperistaltic or antiperistaltic configuration (54 ISO/ANTI). No significant differences in baseline variables were found. No differences in surgical time (130 [120-150]min ISO vs. 140 [127-160] ANTI, p = 0.481), nor in anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207) and nor in postoperative complications: 37.0% ISO versus 40.7% ANTI, (p = 0.693) were found. There were no differences in postoperative ileus (p = 0.112) nor in anastomotic leakage (3.7% vs. 5.56%, p = 1.00). Differences in "time to first flatus" and "time to first deposition" were found in favour of the antiperistaltic group (p = 0.004 and p = 0.017). Anastomotic configuration did not influence hospital stay (3days [2-6] isoperistaltic vs. 3 [2-4] antiperistaltic, p = 0.236). During follow-up, there were no differences between the two groups at 1, 6 and 12months (p = 0.154, p = 0.498 and p = 0.683), nor in chronic diarrhoea rates in GIQLI scores (24% ISO vs. 31.4% ANTI, p = 0.541). The isoperistaltic and antiperistaltic ileocolic anastomosis present similar results in terms of performance, safety and functionality. However, further studies must be carried out in order to assess relationship between postoperative ileus and anastomosis configuration. Randomised Clinical trial (Identifier: NCT02309931).

PS01.029: QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL ACHALASIA AFTER VIDEO-LAPAROSCOPIC SURGERY

Abstract Background Achalasia is the most frequent motor disorder of the esophagus associated with dysphagia, regurgitation, weight loss and a decline in the quality of live. Videolaparoscopic surgery remains the gold standard, however health related quality of live measurements still necessary to asses treatment results and the impact on their lives. Asses health related quality of live in patients with esophageal achalasia after videolaparoscopic surgery. Methods Observational descriptive longitudinal and prospective study, by using GIQLI questionnaire before, three months and a year after videolaparoscopic surgery in patients with achalasia from January to December 2015 in the National Center of Minimally Invasive Surgery. Percentages for qualitative variables, means ± SD of the mean for quantitative variables. To asses health related quality of live a variance analysis of repetitive measures was made (ANOVA) with level of statistical significance α = 0.05. Results 34 patients included; 14 men (41,2%); 20 women (58,8%), with a median age of 44,8 years, preoperative median GIQLI score 85,6 (± 20,9), median GIQLI at follow-up of three months was 125,2 (± 12,4) and twelve months was 134,0 (± 9,6) P = 0000. Conclusion Videolaparoscopic surgery improve health related quality of live in patients with esophageal achalasia. Disclosure All authors have declared no conflicts of interest.