title: Extrahepatic versus intrahepatic hilar control for right hepatectomy: an updated experience.
abstract: BACKGROUND
  Inflow control prior to transection for right hepatectomy may be achieved either by dissection and ligation of the individual hilar structures outside of the liver (EHD) or by mass stapling of the inflow structures within the hepatic parenchyma. Our preference is for the anterior intrahepatic approach (AIA) with mass stapling, in order to minimise the risk of inadvertent injury of the left-sided inflow and to preserve as much parenchyma as possible. In this paper, we present our experience over the last 10 years and compare it with results from the EHD technique.
  
  
  METHODS
  Data for a 10-year period from 2000 to 2010 were extracted retrospectively from a prospectively collected database. Results in each group were measured by a combination of technical and oncological outcomes. Groups were compared by way of descriptive statistics and differences tested for significance by appropriate statistical means.
  
  
  RESULTS
  411 right hepatectomies were performed for colorectal metastases. Of these, 242 were by AIA and 169 by EHD. Both groups were well matched in demographic terms and according to disease burden, although more extended resections were performed in the EHD group. Operative duration (433 vs. 350 min), blood loss (420 vs. 348 ml) and incidence of bile leaks (4 vs. 2) were all lower in the AIA group. All other technical and oncological outcomes were equivalent.
  
  
  CONCLUSIONS
  The AIA approach provides equivalent morbidity, mortality and oncological outcome to the EHD dissection technique and may confer the benefits of being safer and providing greater scope to preserve hepatic parenchyma.
authors.affiliation: Basingstoke Hepatobiliary Unit, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Habib
authors.forename: A Ben
authors.initials: AB
authors.lastname: Cresswell
authors.forename: Kandiah
authors.initials: K
authors.lastname: Chandrakumaran
authors.forename: Fenella K S
authors.initials: FK
authors.lastname: Welsh
authors.forename: Timothy G
authors.initials: TG
authors.lastname: John
authors.forename: Myrddin
authors.initials: M
authors.lastname: Rees
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D001652:Bile Ducts; D016063:Blood Loss, Surgical; D001810:Blood Volume; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors