title: Extra-Glissonian approach in liver resection.
abstract: BACKGROUND
  In this study we analyzed our most recent experience in the use of the extraglissonian approach to the hilar structures in two circumstances: pedicle transection during major liver resections, and selective clamping in minor hepatectomies.
  
  
  METHODS
  The major liver resections study group consisted of 89 cases. Extraglissonian approach and stapler transection of hilar structures was used in 61 (69%). The study group of minor liver resections consisted of 103 cases. Extraglissonian approach and selective clamping was used in 27 cases (26%).
  
  
  RESULTS
  In major hepatectomies pedicle stapling and hilar dissection demonstrated a similar operative time (240 vs. 260 min; P = 0.230); no differences were observed in the amount of haemorrhage (800 ml vs. 730 ml; P = 0.699), number of patients transfused (16 vs. 6; P = 0.418) and volume of blood transfused (4 PRC vs. 4 PRC; P = 0.521). Duration of vascular pedicle occlusion was 35 vs. 30 min respectively (P = 0.293). Major complications (grade >or=3a) occurred in 18 (20%) patients and mortality rates (4.9% vs. 3.5%; P = 0.882) were similar for both group. In minor liver resections there were no differences between Pringle and selective clamping in operative time (240 vs. 240 min; P = 0.321), haemorrhage (435 ml vs. 310 ml; P = 0.575), number of patients transfused (18 vs. 7; P = 0.505) and volume blood transfused (4 PRC vs. 3 PRC; P = 0.423). Major complications (grade >or=3a) occurred in 14 (14%) patients, and mortality (2.6% vs. 3.7%; P = 0.719) were similar for both groups. However, the duration of pedicle clamping was significantly longer in the selective clamping group (26 +/- 21 minutes vs. 44 +/- 18 minutes) (P = 0.001).
  
  
  CONCLUSIONS
  The extraglissonian approach can be extremely useful in liver surgery. Selective clamping with extraglissonian approach avoids ischemia to the other hemiliver. Selective clamping it is also important from the homodynamic point of view because there is no splanchnic stasis and low fluid replacement.
authors.affiliation: Hepato-Biliary Surgery Unit, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Giordano
authors.forename: Santiago
authors.initials: S
authors.lastname: Lopez-Ben
authors.forename: Antoni
authors.initials: A
authors.lastname: Codina-Barreras
authors.forename: Berta
authors.initials: B
authors.lastname: Pardina
authors.forename: Laia
authors.initials: L
authors.lastname: Falgueras
authors.forename: Silvia
authors.initials: S
authors.lastname: Torres-Bahi
authors.forename: Maite
authors.initials: M
authors.lastname: Albiol
authors.forename: Ernest
authors.initials: E
authors.lastname: Castro
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D003250:Constriction; D004210:Dissection; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013030:Spain; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome