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Comparative analysis of different transection techniques in minor and major hepatic resections: A prospective cohort study

Authors
Journal
International Journal of Surgery
1743-9191
Publisher
Elsevier
Volume
11
Issue
9
Identifiers
DOI: 10.1016/j.ijsu.2013.08.010
Keywords
  • Liver Transection Techniques
  • Stapler
  • Water-Jet
  • Electrocautery
  • Hepatectomy
Disciplines
  • Medicine

Abstract

Abstract Background In liver surgery different transection techniques are available without clear evidence regarding indication and advantage for each technique. The aim of this study was to identify the most superior liver transection technique between the different techniques (stapler, water-jet and electrocautery). Comparative analyses were performed for minor and major hepatectomies. Methods In a single-center study, all liver resections performed between July 2007 and July 2012 were prospectively recorded and analysed. Results 366 liver resections were included according to predefined eligibility criteria. No clear benefit for one particular technique in minor or major hepatectomy could be shown. Cost-effectiveness analysis revealed disadvantages for stapler-hepatectomies. However, minor hepatectomies were performed with significantly lower morbidity (p < 0.001), lower operating time (p = 0.001), fewer need of transfusion (p < 0.0001) and shorter ICU stay (p = 0.001) than major hepatectomies. Conclusions If possible, minor hepatectomies should be chosen. Competing techniques, selected according to surgeon's preference, revealed no significant differences in primary outcome measures.

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