New technique in hepatic parenchymal transection for living related liver donor and liver neoplasms

Abstract

Background. Many different surgical techniques have been described for hepatic parenchymal transection. A retrospective analysis of perioperative mortality, length of hospitalization and blood transfused during operation in two patient groups undergoing liver resection was carried out. In group A, we developed a new technique to resect hepatic parenchyma, using an ultrasonic surgical aspirator with monopolar floating ball cautery, while in group B the crushing clamp technique was used. Methods. In all, 42 patients with liver resection were enrolled in group A and 107 resections in group B. All patients had hepatic neoplasms except for seven living transplant donors. In group A 43% of resections involved ≥3 segments and 57% involved ≤2 segments; in group B 36.4% involved ≥3 segments and 63.6% consisted of ≤2 segments. Statistical analysis utilised independent T square (Pearson Q square) and Mann-Whitney U test. Results. In group A 2.4% of patients died perioperatively, while 3.7% died in group B; mean length of stay (LOS) was 10.9 days in group B and 8.0 days in group A. The length of procedure was 7.5 h in group B and 6.7 h in group A. In group A, 79% did not undergo blood transfusion intraoperatively as opposed to 61% in group B. A mean of 0.5 U of blood was utilized in group A and 1.60 U in group B. Discussion. The new method of parenchymal transection seems to reduce the LOS, length of procedure and need for intraoperative blood transfusion. © 2004 Taylor & Francis.