title: Spray Diathermy Versus Harmonic Scalpel Technique for Hepatic Parenchymal Transection of Living Donor.
abstract: Liver parenchymal transection is the most invasive and challenging part in the living donor operation. The study was planned to compare the safety, efficacy, and outcome of harmonic scalpel versus spray diathermy as a method of parenchymal liver transection in donor hepatectomy.
  
  
  
  Eighty consecutive patients, who were treated by living donor liver transplantation (LDLT), were included in the study. The study population was divided into two groups according to the method of liver transection: group A by harmonic scalpel (HS) and group B by spray diathermy (SD). The primary outcome was the volume of blood loss during transection. Secondary outcomes were time of transection, number of ligatures needed during transection, pathological changes at cut surface, postoperative morbidities, cost, and hospital stay RESULTS: Blood loss during overall liver transection and in each zone was significantly less in the SD than in the HS group (P = 0.015). The number of ligatures was significantly less in the SD than in the HS group (P = 0.0001). The SD group had significantly higher level of serum bilirubin, serum glutamic pyruvic transaminase (SGPT), and international normalized ratio (INR) levels on postoperative day 3 than the HS group. Lateral tissue coagulation and hepatic necrosis are significantly less in HS group. The overall incidence of postoperative morbidities was the same in both groups. The cost was higher in HS group than SD group (US$760 vs. US$40 P = 0.0001).
  
  
  
  Spray diathermy is an effective method of parenchymal transection with significantly lower blood loss and lower cost compared to HS with no increase in morbidity. HS is associated with earlier recovery of liver functions.
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Mohamed
authors: M
authors: El Shobary
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Tarek
authors: T
authors: Salah
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt. elnakeebayman@yahoo.com.
authors: Ayman
authors: A
authors: El Nakeeb
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Ahmad M
authors: AM
authors: Sultan
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Ahmed
authors: A
authors: Elghawalby
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Omar
authors: O
authors: Fathy
authors: Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
authors: Mohamed Abdel
authors: MA
authors: Wahab
authors: Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt.
authors: Amro
authors: A
authors: Yassen
authors: Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt.
authors: Mohamed
authors: M
authors: Elmorshedy
authors: Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt.
authors: Wagdi F
authors: WF
authors: Elkashef
authors: Radiology Department, Gastroenterology Surgical Center, Mansoura University, Daqahlia, Egypt.
authors: Usama
authors: U
authors: Shiha
authors: Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt.
authors: Mohamed
authors: M
authors: Elsadany
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003972:Diathermy; D058625:End Stage Liver Disease / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008111:Liver Function Tests; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
keywords: Biliary leak; End-stage liver disease (ESLD); Hepatocellular carcinoma (HCC); Liver parenchyma; Living donor liver transplantation