title: Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study.
abstract: BACKGROUND
  In liver surgery different transection techniques are available without clear evidence regarding indication and advantage for each technique. The aim of this study was to identify the most superior liver transection technique between the different techniques (stapler, water-jet and electrocautery). Comparative analyses were performed for minor and major hepatectomies.
  
  
  METHODS
  In a single-center study, all liver resections performed between July 2007 and July 2012 were prospectively recorded and analysed.
  
  
  RESULTS
  366 liver resections were included according to predefined eligibility criteria. No clear benefit for one particular technique in minor or major hepatectomy could be shown. Cost-effectiveness analysis revealed disadvantages for stapler-hepatectomies. However, minor hepatectomies were performed with significantly lower morbidity (p < 0.001), lower operating time (p = 0.001), fewer need of transfusion (p < 0.0001) and shorter ICU stay (p = 0.001) than major hepatectomies.
  
  
  CONCLUSIONS
  If possible, minor hepatectomies should be chosen. Competing techniques, selected according to surgeon's preference, revealed no significant differences in primary outcome measures.
authors.affiliation: Department of Surgery, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. Electronic address: Carina.Riediger@uniklinikum-dresden.de.
authors.forename: Carina
authors.initials: C
authors.lastname: Riediger
authors.forename: Michael W
authors.initials: MW
authors.lastname: Mueller
authors.forename: Florian
authors.initials: F
authors.lastname: Geismann
authors.forename: Andreas
authors.initials: A
authors.lastname: Lehmann
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Michalski
authors.forename: Klaus
authors.initials: K
authors.lastname: Kuhn
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004564:Electrocoagulation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D055815:Young Adult
keywords: Electrocautery; Hepatectomy; Liver transection techniques; Stapler; Water-jet