Hepatic parenchymal transection with vascular staplers: a comparative analysis with the crush-clamp technique.

BACKGROUND: This retrospective study compares the safety and efficacy of hepatic parenchymal transection using vascular staplers (VS) and the crush-clamp (CC) technique. METHODS: Demographics, clinicopathologic data, treatments, and postoperative outcomes from patients who underwent VS or CC hepatic parenchymal transection were compared. RESULTS: From 1996-2006, 99 and 112 patients underwent hepatic transection with VS and CC, respectively. Compared to CC, VS transection was associated with less operative time (median 210 vs 275 minutes), blood loss (median 250 vs 500 mL), and postoperative red blood cell (RBC) transfusion (29% vs 44%), all P < .05. VS transection was not associated with RBC transfusion on multivariate analysis. There were no differences in rates of positive resection margins (9% vs 13%), postoperative mortality (2% vs 4%), overall morbidity (32% vs 29%), and severe morbidity (20% vs. 23%), all P > .05. CONCLUSION: Hepatic parenchymal transection with VS can be accomplished with similar safety and efficacy as CC transection.

Duke Scholars

Author Andrew Serghios Barbas Surgery, Abdominal Transplant Surgery