title: Randomized clinical trial of stapler versus clamp-crushing transection in elective liver resection.
abstract: BACKGROUND
  Various devices have been developed to facilitate liver transection and reduce blood loss in liver resections. None of these has proven superiority compared with the classical clamp-crushing technique. This randomized clinical trial compared the effectiveness and safety of stapler transection with that of clamp-crushing during open liver resection.
  
  
  METHODS
  Patients admitted for elective open liver resection between January 2010 and October 2011 were assigned randomly to stapler transection or the clamp-crushing technique. The primary endpoint was the total amount of intraoperative blood loss. Secondary endpoints included transection time, duration of operation, complication rates and resection margins.
  
  
  RESULTS
  A total of 130 patients were enrolled, 65 to clamp-crushing and 65 to stapler transection. There was no difference between groups in total intraoperative blood loss: median (i.q.r.) 1050 (525-1650) versus 925 (450-1425) ml respectively (P = 0·279). The difference in total intraoperative blood loss normalized to the transection surface area was not statistically significant (P = 0·092). Blood loss during parenchymal transection was significantly lower in the stapler transection group (P = 0·002), as were the parenchymal transection time (mean(s.d.) 30(21) versus 9(7) min for clamp-crushing and stapler transection groups respectively; P < 0·001) and total duration of operation (mean(s.d.) 221(86) versus 190(85) min; P = 0·047). There were no significant differences in postoperative morbidity (P = 0·863) or mortality (P = 0·684) between groups.
  
  
  CONCLUSIONS
  Stapler transection is a safe technique but does not reduce intraoperative blood loss in elective liver resection compared with the clamp-crushing technique.
  
  
  BACKGROUND
  NCT01049607 (http://www.clinicaltrials.gov).
authors.affiliation: Department of General, Visceral and Transplant Surgery, Heidelberg, Germany.
authors.forename: N N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: H
authors.initials: H
authors.lastname: Elbers
authors.forename: M
authors.initials: M
authors.lastname: Koch
authors.forename: P
authors.initials: P
authors.lastname: Vogler
authors.forename: F
authors.initials: F
authors.lastname: Striebel
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
authors.forename: P
authors.initials: P
authors.lastname: Schemmer
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: J
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D017792:Surgical Stapling; D016896:Treatment Outcome