title: Harmonic scalpel versus conventional dissection technique in pylorus-preserving partial duodenopancreatectomy.
abstract: OBJECTIVE
  Pancreatic head resection is performed with low mortality, but morbidity remains high. Extensive preparation, long operating times, intraoperative blood loss and the need for blood transfusions are risk factors for postoperative morbidity. The aim of our study was to evaluate the feasibility and safety of the ultrasonic dissection device in pylorus-preserving duodenopancreatectomy (PPPD).
  
  
  METHODS
  Fifty consecutive patients who underwent PPPD with an ultrasonic dissection device (group 1) were compared with a match-controlled group of 50 consecutive patients who underwent PPPD with conventional dissection techniques (group 2). Duration of surgery, intraoperative blood loss, blood units, complications, mortality and duration of hospital stay were analyzed.
  
  
  RESULTS
  There was no difference in age, gender or BMI between groups. In group 1, mean blood loss (446 ± 281.8 ml, p = 0.008) and number of blood units (0.32 ± 0.86, p = 0.001) were significantly lower than in group 2 (819 ± 915.4 ml; 1.36 ± 2.83 units). Duration of surgery was shorter in group 1 (345.6 vs. 373 min, p = 0.28). The rate of postoperative complications, mortality and hospital stay were not significantly different.
  
  
  CONCLUSIONS
  Use of an ultrasonic dissection device in PPPD might significantly reduce intraoperative blood loss and the need for blood transfusions. These results should be verified in a prospective randomized controlled trial.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany. Anna.Heverhagen@med.uni-marburg.de
authors.forename: A E
authors.initials: AE
authors.lastname: Heverhagen
authors.forename: K
authors.initials: K
authors.lastname: Dietzel
authors.forename: J
authors.initials: J
authors.lastname: Waldmann
authors.forename: P
authors.initials: P
authors.lastname: Langer
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.forename: D K
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011708:Pylorus; D018709:Statistics, Nonparametric; D014465:Ultrasonics