Liver transection technique in living donor liver transplantation : a comparative study at king Hussien medical center-Jordan

الملخص EN

Objectives : the aim of this study is to compare clamp crushing technique to Cavitron ultrasonic surgical aspirator for parenchymal transection in terms of efficacy and safety in living donor liver transplantation.

Methods : this retrospective study has been conducted to compare Cavitron Ultrasonic Surgical Aspirator and clamp crushing technique.

During the period from July 2004 to September 2013, a total of 90 donors underwent liver resection for living donor liver transplantation using clamp crush technique or Cavitron Ultrasonic Surgical Aspirator were included in this study.

A total of 90 hepatectomies have been done (77 right hepatectomy، 10 left hepatectomy and 3 Left lateral segmentectomy).Data of both groups in term of intraoperative blood loss, need for blood transfusion, transection time, hospital stay, postoperative morbidity and mortality were analyzed.Cavitron Ultrasonic Surgical Aspirator with standard tip was used for parenchymal transection.

The primary endpoints were blood loss during parenchymal transection and resection time.

Secondary end points were the need for blood transfusion, the degree of postoperative hepatocyte injury, postoperative complication, Intensive care unit stay and hospital stay.

The liver resection time defined as the duration from the beginning of parenchymal transection until the completion of transection with complete achievement of hemostasis from the liver cut surface.

The remaining liver was assessed daily until hospital discharge, the assessment parameters include: bilirubin level, alanine aminotransferase , aspartate aminotransferase level and Partial thromboplastin time.

Results : a total number of 90 patient’s records were analyzed in this retrospective study.

Clamp crushing technique was used in 48 donors (group A); while Cavitron ultrasonic surgical aspirator was used in 42 donors (group B).

Mean blood loss was significantly lower in the clamp crushing technique group (310 ml) than the Cavitron ultrasonic surgical aspirator group (345ml) (P value 0.0092).

Transection time was shorter in the clamp crush group but not statically significant.

There were no significant differences between both groups in term of postoperative hepatocyte injury indicated by (aspartate aminotransferase and alanine aminotransferase levels), bilirubin and International randomized ratio .

There was no significant difference in the Intensive care unit and hospital stay in both groups.

No significant difference was found in the postoperative complications between both groups.

7 patient’s developed superficial wound infection,4 in group A and 3 in group B.

Atelectasis or pleural effusion occur in 11 patients, 6 in group A and 5 in group B.

1 patient in group A developed pneumonia.

Biloma occurred in 3 cases, one in group A and 2 in group B.

Incisional hernia occurred in 2 patients one in each group.

There was no mortality in both groups.

Conclusion : clamp-crush technique has been associated with less blood loss in comparison to Cavitron ultrasonic surgical aspirator.

However, there were no significant differences between the two groups regarding morbidity and mortality.