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Spray Diathermy Versus Harmonic Scalpel Technique for Hepatic Parenchymal Transection of Living Donor

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Liver parenchymal transection is the most invasive and challenging part in the living donor operation. The study was planned to compare the safety, efficacy, and outcome of harmonic scalpel versus spray diathermy as a method of parenchymal liver transection in donor hepatectomy.

Patient and Method

Eighty consecutive patients, who were treated by living donor liver transplantation (LDLT), were included in the study. The study population was divided into two groups according to the method of liver transection: group A by harmonic scalpel (HS) and group B by spray diathermy (SD). The primary outcome was the volume of blood loss during transection. Secondary outcomes were time of transection, number of ligatures needed during transection, pathological changes at cut surface, postoperative morbidities, cost, and hospital stay

Results

Blood loss during overall liver transection and in each zone was significantly less in the SD than in the HS group (P = 0.015). The number of ligatures was significantly less in the SD than in the HS group (P = 0.0001). The SD group had significantly higher level of serum bilirubin, serum glutamic pyruvic transaminase (SGPT), and international normalized ratio (INR) levels on postoperative day 3 than the HS group. Lateral tissue coagulation and hepatic necrosis are significantly less in HS group. The overall incidence of postoperative morbidities was the same in both groups. The cost was higher in HS group than SD group (US$760 vs. US$40 P = 0.0001).

Conclusion

Spray diathermy is an effective method of parenchymal transection with significantly lower blood loss and lower cost compared to HS with no increase in morbidity. HS is associated with earlier recovery of liver functions.

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Author Contributions

Mohamed El Shobary and Ayman El Nakeeb designed the research. Mohamed El Shobary, Tarek salah, Ayman El Nakeeb, Ahmad M Sultan, Ahmed Elghawalby, Omar Fathy, Mohamed Abdel Wahab, Amro Yassen, Mohamed Elmorshedy, Wagdi F. Elkashef, Usama Shiha, and Mohamed Elsadany performed the research. Mohamed El Shobary, Ayman El Nakeeb, and Ahmed M Sultan analyzed the data. Mohamed El Shobary and Ayman El Nakeeb wrote the paper.

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Authors and Affiliations

  1. Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt

    Mohamed El Shobary, Tarek salah, Ayman El Nakeeb, Ahmad M. Sultan, Ahmed Elghawalby, Omar Fathy & Mohamed Abdel Wahab

  2. Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt

    Amro Yassen & Mohamed Elmorshedy

  3. Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt

    Wagdi F. Elkashef

  4. Radiology Department, Gastroenterology Surgical Center, Mansoura University, Daqahlia, Egypt

    Usama Shiha

  5. Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt

    Mohamed Elsadany

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  1. Mohamed El Shobary
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  2. Tarek salah
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  4. Ahmad M. Sultan
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  7. Mohamed Abdel Wahab
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  10. Wagdi F. Elkashef
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Correspondence to Ayman El Nakeeb.

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This manuscript has neither been submitted for publication in any other journal and will not subsequently be submitted for potential publication in another journal until a decision has been made nor has it been published previously in any media.

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El Shobary, M., salah, T., El Nakeeb, A. et al. Spray Diathermy Versus Harmonic Scalpel Technique for Hepatic Parenchymal Transection of Living Donor. J Gastrointest Surg 21, 321–329 (2017). https://doi.org/10.1007/s11605-016-3312-y

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  • DOI: https://doi.org/10.1007/s11605-016-3312-y

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