title: Disposable bipolar irrigated sealer (Aquamantys(®)) for liver resection: use with caution.
abstract: The disposable bipolar irrigated sealer has been demonstrated to reduce perioperative bleeding, but its role in preventing postoperative cut-surface complications has not been evaluated to date. A prospective observational study was performed between January and September 2013 to evaluate a disposable bipolar irrigated sealed (Aquamantys(®)) on a continuous series of 51 first liver resections without biliary reconstruction. Primary end-point was the occurrence of cut-surface complications during the postoperative period. Secondary endpoints were postoperative complications and the 1-year overall survival rate. The results were compared to a propensity score matched group of 153 liver resections performed with conventional monopolar cautery. A cut-surface complication occurred in 13/51 (25.5 %) resected patients. Bleeding, bile leakage and subphrenic abscess occurred in 7.8, 11.8 and 11.8 % patients, respectively. Compared to the matched group, the resected group had a higher rate of cut-surface complications (25.5 vs. 14.7 %, p < 0.01) and a higher rate of Clavien-Dindo type ≥3 postoperative complications (29.5 vs. 17.2 %, p < 0.01). In the multivariate analysis, preoperative chemotherapy (p = 0.03, 95 % CI 1.09-5.9, OR 2.53), blood transfusion (p = 0.02, 95 % CI 1.78-6.55, OR 2.78) and Aquamantys(®) use (p = 0.02, 95 % CI 1.21-6.7, OR 2.85) were independent of cut-surface complications within the first 90 postoperative days. The overall 1-year survival rates were not different between the two groups (p = 0.078). Aquamantys(®) use is associated with an increased rate of postoperative complications compared to classical monopolar cautery, and we recommend that it should be used with caution in this type of surgery.
authors.affiliation: Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France. andrea.patrizi@chu-rennes.fr.
authors.forename: Andrea
authors.initials: A
authors.lastname: Patrizi
authors.affiliation: Service des maladies du foie. Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jezequel
authors.affiliation: Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.affiliation: Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.|Service des maladies du foie. Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Rayar
authors.affiliation: Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D007507:Therapeutic Irrigation; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives
keywords: Aquamantys; Bile leakage; Bipolar irrigated sealer; Bleeding; Diaphragmatic perforation; Liver resection