The catheter problems regardless of placement technique are variable as 2 to 31% for flow dysfunction and catheter displacement (1,2) and 1 to 27% for pericatheter leak and hernia (3,4). The most common causes of catheter dysfunction are migration, fibrin clot and omental wrapping (5).Insertion of PDC under direct visualization by laparoscopy affords a number of advantages including decreased operating time, less perioperative pain and fewer complications compared to an open surgical approach (6,7). Various laparoscopic techniques have been described for catheter placement to reduce complications and improve results (7-9). These efforts include rectus sheath tunneling, omentectomy, selective prophylactic omentopexy, catheter fixation by suturing and selective resection of epiploic appendices and adhesiolysis.The aim of this study is to present a novel technique for laparoscopic placement of PDC through a preperitoneal tunnel which can reduce complications and improve catheter survival. PaTIeNTs aND MeThoDsThis project was designed as a prospective interventional study, approved by the Research Committee and financially supported by the Research Deputy of Mashhad University of Medical Sciences. To reduce ambiguous results, we excluded patients who had a possibility of existing abdominal adhesion due to several abdominal operations, intestinal or urinary ostomy, or severe coagulopathies. With their informed consent, the patients were systematically examined. From

Objectives: One of the main concerns in liver transplant is the prolonged ischemia time, which may lead to primary graft nonfunction or delayed function. N-acetylcysteine is known as a hepato-protective agent in different studies, which may improve human hepatocyte viability in steatotic donor livers. This study investigated whether N-acetylcysteine can decrease the rate of ischemia-reperfusion syndrome and improve short-term outcome in liver transplant recipients. Materials and Methods:This was a double-blind, randomized, control clinical trial of 115 patients. Between April 2012 and January 2013, patients with orthotopic liver transplant were randomly divided into 2 groups; in 49 cases N-acetylcysteine was added to University of Wisconsin solution as the preservative liquid (experimental group), and in 66 cases standard University of Wisconsin solution was used (control group). We compared postreperfusion hypotension, inotrope requirement before and after portal reperfusion, intermittent arterial blood gas analysis and potassium measurement, pathological review of transplanted liver, in-hospital complications, morbidity, and mortality. Results: There was no significant difference between the groups regarding time to hepatic artery reperfusion, hospital stay, vascular complications, inotrope requirement before and after portal declamping, and blood gas analysis. Hypotension after portal reperfusion was significantly more common in experimental group compared with control group (P = .005). Retransplant and in-hospital mortality were comparable between the groups. Conclusions: Preservation of the liver inside Univer-sity of Wisconsin solution plus N-acetylcysteine did not change the rate of ischemia reperfusion injury and short-term outcome in liver transplant recipients.

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