World Journal of Surgery

, Volume 40, Issue 7, pp 1695–1701 | Cite as

Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis

  • Nikolaos Arkadopoulos
  • Georgios GemenetzisEmail author
  • Nikolaos Danias
  • Panagiotis Kokoropoulos
  • Ioanna Koukopoulou
  • Christos Bartsokas
  • Georgia Kostopanagiotou
  • Vassilios Smyrniotis
Original Scientific Report



Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost-effectiveness of this protocol.

Study design

We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes.


Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 ± 21 min (mean ± SD), estimated blood loss was 310 ± 159 ml (mean ± SD), and hospital stay was 7 ± 5 days (mean ± SD). Six patients required admission in the ICU postoperatively. 90-day mortality was 2.74 %, and 8.9 % of patients developed grade III/IV postoperative complications (Clavien–Dindo classification). Total in-hospital cost excluding physician fees was 6987.63 ± 3838.51 USD (mean ± SD).


Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.


Liver Resection Standard Deviation Hepatic Vein Laparoscopic Liver Resection Future Liver Remnant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards

Conflict of interest

All authors declare no conflicts of interest.


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Nikolaos Arkadopoulos
    • 1
  • Georgios Gemenetzis
    • 1
    Email author
  • Nikolaos Danias
    • 1
  • Panagiotis Kokoropoulos
    • 1
  • Ioanna Koukopoulou
    • 2
  • Christos Bartsokas
    • 1
  • Georgia Kostopanagiotou
    • 2
  • Vassilios Smyrniotis
    • 1
  1. 1.4th Surgical ClinicAttikon University HospitalAthensGreece
  2. 2.2nd Anesthesiology ClinicAttikon University HospitalAthensGreece

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