Hepatic parenchyma resection using stapling devices: peri-operative and long-term outcome.
BACKGROUND
Stapler-assisted hepatectomy has not been well established, as a routine procedure, although few reports exist in the literature. This analysis assesses the safety and outcome of the method based on peri-operative data.


METHODS
From February 2005 to December 2006, endo GIA vascular staplers were used for parenchymal liver transection in 62 consecutive cases in our department. There were 18 (29%) patients with hepatocellular carcinoma (HCC), 31 (50%) with metastatic lesions and 13 (21%) with benign lesions [adenoma, focal nodular hyperplasia (FNH), simple cysts]. Twenty-one patients underwent major resections (33.9%) (i.e. removal of three segments or more) and 41 (66.1%) minor hepatic resections.


RESULTS
Median blood loss was 260 ml. The median total operative time was 150 min and median transection time was 35 min. No patient required more than 2 days of intensive care unit (ICU) treatment. The median hospital stay was 8 days. Surgical complications included two (3%) cases of bile leak, two (3%) cases of pneumonia, two (3%) cases with wound infection and two (3%) cases with pleural effusion. The peri-operative mortality was zero. In a 30-month median follow-up, all patients with benign lesions were alive and free of disease. The 3-year disease-free survival for patients with HCC was 61% (57% for patients with colorectal metastases) and the 3-year survival 72% (68% for patients with colorectal metastases).


CONCLUSIONS
Stapler-assisted liver resection is feasible with a low incidence of surgical complications. It can be used as an alternative for parenchyma transection especially in demanding hepatectomies for elimination of the operating time and control of bleeding.
Delis
Spiros G
SG
Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-Agia Olga Hospital, Athens, Greece. sgdelis55@yahoo.gr
Bakoyiannis
Andreas
A
Karakaxas
Dimitrios
D
Athanassiou
Kostantinos
K
Tassopoulos
Nikolaos
N
Manesis
Emanouel
E
Ketikoglou
Ioannis
I
Papakostas
Pavlos
P
Dervenis
Christos
C