title: Hepatic parenchyma resection using stapling devices: peri-operative and long-term outcome.
abstract: 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.
authors: Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-Agia Olga Hospital, Athens, Greece. sgdelis55@yahoo.gr
authors: Spiros G
authors: SG
authors: Delis
authors: Andreas
authors: A
authors: Bakoyiannis
authors: Dimitrios
authors: D
authors: Karakaxas
authors: Kostantinos
authors: K
authors: Athanassiou
authors: Nikolaos
authors: N
authors: Tassopoulos
authors: Emanouel
authors: E
authors: Manesis
authors: Ioannis
authors: I
authors: Ketikoglou
authors: Pavlos
authors: P
authors: Papakostas
authors: Christos
authors: C
authors: Dervenis