New technique in hepatic parenchymal transection for living related liver donor and liver neoplasms.
BACKGROUND
Many different surgical techniques have been described for hepatic parenchymal transection. A retrospective analysis of perioperative mortality, length of hospitalization and blood transfused during operation in two patient groups undergoing liver resection was carried out. In group A, we developed a new technique to resect hepatic parenchyma, using an ultrasonic surgical aspirator with monopolar floating ball cautery, while in group B the crushing clamp technique was used.


METHODS
In all, 42 patients with liver resection were enrolled in group A and 107 resections in group B. All patients had hepatic neoplasms except for seven living transplant donors. In group A 43% of resections involved >or=3 segments and 57% involved <or=2 segments; in group B 36.4% involved >or=3 segments and 63.6% consisted of <or=2 segments. Statistical analysis utilised independent T square (Pearson Q square) and Mann-Whitney U test.


RESULTS
In group A 2.4% of patients died perioperatively, while 3.7% died in group B; mean length of stay (LOS) was 10.9 days in group B and 8.0 days in group A. The length of procedure was 7.5 h in group B and 6.7 h in group A. In group A, 79% did not undergo blood transfusion intraoperatively as opposed to 61% in group B. A mean of 0.5 U of blood was utilized in group A and 1.60 U in group B.


CONCLUSIONS
The new method of parenchymal transection seems to reduce the LOS, length of procedure and need for intraoperative blood transfusion.
Gruttadauria
Salvatore
S
Department of Surgery, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Spedalizzazione, IsMeTT-UPMC, Palermo, Italy. sgruttadauria@ismettedu
Doria
Cataldo
C
Vitale
Claudio H
CH
Mandala'
Lucio
L
Magnone
Mario
M
Fung
John J
JJ
Marino
Ignazio R
IR