Yoshikuni Kawaguchi1,2,3, Takeo Nomi4, David Fuks4, Frederic Mal4, Norihiro Kokudo5, Brice Gayet6. 1. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. yokawaguchi-tky@umin.ac.jp. 2. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. yokawaguchi-tky@umin.ac.jp. 3. Department of Surgery, Asahi General Hospital, Chiba, Japan. yokawaguchi-tky@umin.ac.jp. 4. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. 5. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 6. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. brice.gayet@imm.fr.
Abstract
BACKGROUND: Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. METHODS: The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL. RESULTS: Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P < 0.001) independently predicted high EBL. CONCLUSIONS: Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.
BACKGROUND: Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. METHODS: The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL. RESULTS: Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P < 0.001) independently predicted high EBL. CONCLUSIONS: Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.
Authors: Thomas Aloia; Mylène Sebagh; Marylène Plasse; Vincent Karam; Francis Lévi; Sylvie Giacchetti; Daniel Azoulay; Henri Bismuth; Denis Castaing; René Adam Journal: J Clin Oncol Date: 2006-11-01 Impact factor: 44.544
Authors: Joseph F Buell; Daniel Cherqui; David A Geller; Nicholas O'Rourke; David Iannitti; Ibrahim Dagher; Alan J Koffron; Mark Thomas; Brice Gayet; Ho Seong Han; Go Wakabayashi; Giulio Belli; Hironori Kaneko; Chen-Guo Ker; Olivier Scatton; Alexis Laurent; Eddie K Abdalla; Prosanto Chaudhury; Erik Dutson; Clark Gamblin; Michael D'Angelica; David Nagorney; Giuliano Testa; Daniel Labow; Derrik Manas; Ronnie T Poon; Heidi Nelson; Robert Martin; Bryan Clary; Wright C Pinson; John Martinie; Jean-Nicolas Vauthey; Robert Goldstein; Sasan Roayaie; David Barlet; Joseph Espat; Michael Abecassis; Myrddin Rees; Yuman Fong; Kelly M McMasters; Christoph Broelsch; Ron Busuttil; Jacques Belghiti; Steven Strasberg; Ravi S Chari Journal: Ann Surg Date: 2009-11 Impact factor: 12.969