Pancreaticoduodenectomy in portal hypertension: use of the Ligasure.
OBJECTIVE
The Ligasure Vessel Sealing System (LVSS) is a new bipolar device, put on the market in 1999, which provides safe and quick hemostasis, sealing blood vessels up to 7 mm in diameter or tissue bundles without dissection or isolation. We tested this instrument in a patient with portal hypertension who had to be submitted to a complex abdominal procedure.


METHODS
A male patient (aged 57 years) with well-compensated cirrhosis of the liver, related to hepatitis C virus (HCV) (Child A) was diagnosed with a neoplasm of the pancreatic head. We performed a Whipple pancreaticoduodenectomy and hemostasis was almost entirely performed with the LVSS. All the blood vessels up to 7 mm in diameter were sealed in this way. Larger vessels were suture ligated primarily.


RESULTS
No post-application bleeding was seen. No postoperative hemorrhagic complications occurred. A significant reduction in blood loss and in surgical time was noted. CONCLUSIONS; We believe that the LVSS could be extremely useful in all the fields of hepatopancreatobiliary surgery, especially in patients with portal hypertension with large intestinal and omental varices. The LVSS guarantees excellent hemostasis, reducing the risk of serious blood loss and shortening the time of surgery, so improving the prognosis.
Belli
Giulio
G
Department of General and Hepato-Pancreato-Biliary Surgery, S. Maria di Loreto Nuovo Hospital, Via Cimarosa 2/a, 80127 Naples, Italy.
Fantini
Corrado
C
Ciciliano
Fabio
F
D'Agostino
Alberto
A
Barberio
Manuel
M
D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000295:instrumentation*