Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study.
BACKGROUND
In liver surgery different transection techniques are available without clear evidence regarding indication and advantage for each technique. The aim of this study was to identify the most superior liver transection technique between the different techniques (stapler, water-jet and electrocautery). Comparative analyses were performed for minor and major hepatectomies.


METHODS
In a single-center study, all liver resections performed between July 2007 and July 2012 were prospectively recorded and analysed.


RESULTS
366 liver resections were included according to predefined eligibility criteria. No clear benefit for one particular technique in minor or major hepatectomy could be shown. Cost-effectiveness analysis revealed disadvantages for stapler-hepatectomies. However, minor hepatectomies were performed with significantly lower morbidity (p < 0.001), lower operating time (p = 0.001), fewer need of transfusion (p < 0.0001) and shorter ICU stay (p = 0.001) than major hepatectomies.


CONCLUSIONS
If possible, minor hepatectomies should be chosen. Competing techniques, selected according to surgeon's preference, revealed no significant differences in primary outcome measures.
['Riediger|Carina|C|', 'Mueller|Michael W|MW|', 'Geismann|Florian|F|', 'Lehmann|Andreas|A|', 'Schuster|Tibor|T|', 'Michalski|Christoph W|CW|', 'Kuhn|Klaus|K|', 'Friess|Helmut|H|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D004564:Electrocoagulation D005260:Female D006498:Hepatectomy D006801:Humans D008099:Liver D008107:Liver Diseases D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011446:Prospective Studies D055815:Young Adult
Liver transection techniques Stapler Water-jet Electrocautery Hepatectomy