Effective and Safe Living Donor Hepatectomy Under Intermittent Inflow Occlusion and Outflow Pressure Control
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We read the article provided by Sultan et al.1 showing better performance in harmonic scalpel, with statistically significant shorter operative time (360 min vs. 440 min, p < 0.01) statistically non-significant but smaller amount of blood loss (300 ml vs. 500 ml, p = 0.11), and similar grade III complication rate (11.1% vs. 16.7%, p = 0.49) compared with clamp-crush technique for living donor hepatectomy (LDH). Contradictory to the results, they concluded clamp-crush technique as a simple, easy, safe, and cheaper method for LDH. It is true that clamp-crush is cheaper as the authors concluded. However, simplicity, easiness, or proficiency in surgical processes should be associated with operative time and blood loss, and safety with complications. We are concerned about the inconsistency between the actual results and the conclusion with preference in clamp-crush technique.
Moreover, we regret possible rooms for improving their surgical outcomes regardless of the instruments used for...
KeywordsLiving donor liver transplantation Living donor hepatectomy Pringle’s maneuver Vena cava clamping
Living donor hepatectomy
- 1.Sultan AM, Shehta A, Salah T, Elshoubary M, Elghawalby AN, Said R, et al. Clamp-crush technique versus harmonic scalpel for hepatic parenchymal transection in living donor hepatectomy: a randomized controlled trial. J Gastrointest Surg 2019 doi: https://doi.org/10.1007/s11605-019-04103-5. [Epub ahead of print]