title: A clinical comparative analysis of crush/clamp, stapler, and dissecting sealer hepatic transection methods.
abstract: BACKGROUND
  Several methods for hepatic parenchymal division exist. The primary aim was to assess differences in postoperative bile leaks, operative blood loss, and margin status between three transection methods: crush/clamp (CC), stapler (SP), or dissecting sealer (DS).
  
  
  METHODS
  A single institution, retrospective cohort study was performed on data collected over a three-year period in patients undergoing elective liver resection using the CC, SP, or DS. Patients were excluded if multiple methods of transection were used or for intraoperative death. The association of bile leak with transection type was assessed. A logistic regression model was tested to assess if blood loss was associated with the covariates of transection method, use of portal inflow occlusion, extent of liver resection, and other concurrent major operations.
  
  
  RESULTS
  Analyses included 141 patients. The stapler method was quicker than the other methods (p=0.01). The risk of postoperative bile leak was no different between CC, SP, and DS transection methods (p=0.23). There was no difference in mean blood loss or transfusions; however, hepatectomies performed with DS were associated with an increased risk of blood loss > or = 1000 mL compared to CC (p=0.04). There were no differences in mean surgical margin between the three methods.
  
  
  CONCLUSIONS
  The risk of bile leaks was not different between the three methods. While mean blood loss was similar, hepatectomy performed with the DS was associated with an increased risk of having operative blood loss > or = 1000 mL compared to CC. Margins were equal by all methods. The stapler method was quicker.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-4753, USA. wright.pinson@vanderbilt.edu
authors.forename: Eric T
authors.initials: ET
authors.lastname: Castaldo
authors.forename: T Mark
authors.initials: TM
authors.lastname: Earl
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Chari
authors.forename: D Lee
authors.initials: DL
authors.lastname: Gorden
authors.forename: Nipun B
authors.initials: NB
authors.lastname: Merchant
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Wright
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson