Could bipolar vessel sealers prevent bile leaks after hepatectomy?
OBJECTIVE
The aim of this work was to test the feasibility of using a bipolar low thermal acting system inducing collagenic sealing but not protein coagulation to secure hepatic parenchyma cutting.


METHODS
Thirty consecutive hepatectomies were carried out using kellyclasy plus ligatures and clips (controls), while the following 50 hepatectomies used kellyclasy plus bipolar vessels sealer (BVS). Blood loss, duration of hepatic pedicle clamping, length of hospital stay, and complications were recorded.


RESULTS
There was no statistically significant difference in blood loss and duration of clamping between controls and BVS. Specific complications (9/21 in the control group vs 1/49 for the BVS group, p<0.00045) and length of hospital stay (14 days in the control group vs 11 days in the BVS group, p<0.014) were statistically lower in BVS group than in the controls, mainly due to prevention of bile duct leakages.


CONCLUSIONS
Our data suggest that BVS may be particularly efficient to achieve bilistasis leading to the highest level of safety in performing hepatectomies. Further studies are now needed to confirm its superiority on the classical biliary ducts occlusion techniques.
Evrard
Serge
S
Digestive Oncology Unit, Institut Bergonié, Comprehensive Cancer Center, Victor Ségalen Bordeaux 2 University, Bordeaux, France. evrard@bergonie.org
Bécouarn
Yves
Y
Brunet
René
R
Fonck
Marianne
M
Larrue
Caroline
C
Mathoulin-Pélissier
Simone
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017115:Catheter Ablation; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged