title: Glissonean pedicle approach in major liver resections.
abstract: OBJECTIVE
  Liver resections are still one of the most challenging operations. The aim of this study was to analyze the efficiency and safety of the intrahepatic Glissonean pedicle approach vs. classical Hilar dissection in major hepatectomies.
  
  
  METHODS
  Thirty-four patients were assigned to the Glissonean approach (GA, n=34), while the Hilar dissection were assessed as historical control, matched for the age, gender, comorbidities and Child-Pugh score (HD, n=34).
  
  
  RESULTS
  The GA was associated with significantly shorter surgery duration (191.18±41.10 vs. 246.62± 56.55), transection time (38.94±14.56 vs. 56.32±19.40) and ischemic duration (26.03±11.27 vs. 41.18±12.80) than HD (p<0.001 for all). The amount of blood loss was significantly lower in GA (245.59±169.39 vs. 344.71±166.25; p=0.018). The amount of blood transfusion was significantly lower in GA during surgery (322.86±102.07 vs. 414.76±135.48) as well as postoperatively than HD (246.67±5.77 vs. 336.67±120.55) (p=0.038 and p=0.026. respectively).
  
  
  CONCLUSIONS
  Major hepatectomy can be performed more easily using the Glissonean pedicle approach than by hilar dissection. En-masse transection of pedicles, as well as hepatic veins, using endo-GIA vascular stapler could be performed safely. Liver surgeons should know the Glissonean pedicle approach.
authors.affiliation: Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia. alekara@sbb.rs
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarković
authors.forename: Krstina
authors.initials: K
authors.lastname: Doklestić
authors.forename: Nataša
authors.initials: N
authors.lastname: Milić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Djukić
authors.forename: Vesna
authors.initials: V
authors.lastname: Bumbasirević
authors.forename: Ana
authors.initials: A
authors.lastname: Sijački
authors.forename: Pavle
authors.initials: P
authors.lastname: Gregorić
authors.forename: Djordje
authors.initials: D
authors.lastname: Bajec
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012189:Retrospective Studies; D055771:Serbia; D017792:Surgical Stapling; D013997:Time Factors; D016896:Treatment Outcome