Laparoscopic versus open liver surgery: a single center analysis of post-operative in-hospital and post-discharge results.
OBJECTIVE
Laparoscopic hepatectomy (LH) is established as a safe and feasible surgical procedure for benign and malignant liver lesions showing many benefits in terms of short-term post-operative outcomes. Nevertheless, it remains unclear if these benefits extend beyond the hospital stay. The aim of this study was to compare in-hospital and post-discharge outcomes between two groups of patients who have undergone either laparoscopic or open hepatectomy (OH).


METHODS
Forty-six patients who have undergone LH from September 2008 to September 2011 were compared to 46 matched-pair control patients who have undergone OH. The two groups were compared in terms of in-hospital and 6-month outcomes. Post-discharge outcomes were analyzed in terms of the number of outpatient clinic appointments (OCAs) and readmissions (RAs). Analyses were performed excluding and including conversion cases.


RESULTS
The two groups resulted in homogeneous patients' and lesions' characteristics. Patients who underwent LH showed statistically lower intra-operative blood loss, less total and major morbidity and shorter hospital stay. Regarding post-discharge outcomes, significantly less patients of LH group compared to patients of OH group required more than two post-discharge OCAs (in the intention to treat analysis, 28.3 versus 63%, respectively; P = 0.006) or RA (4.3 versus 15.2%, respectively; P = 0.008). The benefits of LH appeared to be maximized in cirrhotic patients; those represented the large part of patients readmitted after hepatectomy regardless of the type of surgical approach (77.8%).


CONCLUSIONS
Advantages related to LH extend over the post-discharge period suggesting potential better patient's satisfaction and lower hospital cost.
Liver-Pancreas-Kidney Transplantation Surgical Unit, Department of General, HPB Surgery and Transplantation, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, Milan, Italy. abdallah.slim@ospedaleniguarda.it
Abdallah
A
Slim
Mattia
M
Garancini
Stefano
S
Di Sandro
Iacopo
I
Mangoni
Andrea
A
Lauterio
Alessandro
A
Giacomoni
Luciano
L
De Carlis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016896:Treatment Outcome