Wen-Xi Wang1, Sheung-Tat Fan. 1. Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Abstract
OBJECTIVE: The aim of this study was to analyse the outcome of hepatectomy using the Endo-GIA vascular stapler and to derive a strategy to avoid complications from its use. METHODS: From October 1998 to December 2001, 156 patients underwent major hepatectomy for hepatocellular carcinoma. There were 124 men and 32 women, with a median age of 52.5 years. The Endo-GIA vascular stapler was used for division of the hepatic vein and hepatic duct. Intra- and postoperative clinical data were evaluated. RESULTS: The overall morbidity and mortality rates were 32.1% and 8.3%, respectively. Seventy-six percent of patients did not require blood transfusion. The median blood loss volume was 1 L. There were no complications related to the use of the Endo-GIA vascular stapler in dividing the hepatic veins. One patient (0.6%) had a complication from the use of the stapler for right hepatic duct transection and recovered uneventfully after hepaticojejunostomy. Intraoperative cholangiography was performed in subsequent patients undergoing right trisegmentectomy to avoid biliary complications. CONCLUSIONS: The Endo-GIA vascular stapler is a safe and useful tool to divide the hepatic vein, but surgeons should exercise particular caution to avoid complications when it is used for hepatic duct division.
OBJECTIVE: The aim of this study was to analyse the outcome of hepatectomy using the Endo-GIA vascular stapler and to derive a strategy to avoid complications from its use. METHODS: From October 1998 to December 2001, 156 patients underwent major hepatectomy for hepatocellular carcinoma. There were 124 men and 32 women, with a median age of 52.5 years. The Endo-GIA vascular stapler was used for division of the hepatic vein and hepatic duct. Intra- and postoperative clinical data were evaluated. RESULTS: The overall morbidity and mortality rates were 32.1% and 8.3%, respectively. Seventy-six percent of patients did not require blood transfusion. The median blood loss volume was 1 L. There were no complications related to the use of the Endo-GIA vascular stapler in dividing the hepatic veins. One patient (0.6%) had a complication from the use of the stapler for right hepatic duct transection and recovered uneventfully after hepaticojejunostomy. Intraoperative cholangiography was performed in subsequent patients undergoing right trisegmentectomy to avoid biliary complications. CONCLUSIONS: The Endo-GIA vascular stapler is a safe and useful tool to divide the hepatic vein, but surgeons should exercise particular caution to avoid complications when it is used for hepatic duct division.
Authors: David A Geller; Allan Tsung; Vivek Maheshwari; Lisa A Rutstein; John J Fung; J Wallis Marsh Journal: HPB (Oxford) Date: 2005 Impact factor: 3.647