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Clamp-Crush Technique Versus Harmonic Scalpel for Hepatic Parenchymal Transection in Living Donor Hepatectomy: a Randomized Controlled Trial

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Hepatic parenchymal transection is the most invasive step in donor operation. During this step, blood loss and unintended injuries to the intrahepatic structures and hepatic remnant may occur. There is no evidence to prove the ideal techniques for hepatic parenchymal transection. The aim of this study is to compare the safety, efficacy, and outcome of clamp-crush technique versus harmonic scalpel as a method of parenchymal transection in living-donor hepatectomy.

Methods

Consecutive living liver donors, undergoing right hemi-hepatectomy, during the period between May 2015 and April 2016, were included in this prospective randomized study. Cases were randomized into two groups; group (A) harmonic scalpel group and group (B) Clamp-crush group.

Results

During the study period, 72 cases underwent right hemi-hepatectomy for adult living donor liver transplantation and were randomized into two groups. There were no statistically significant differences between the two groups regarding preoperative demographic and radiological data. Longer operation time and hepatectomy duration were found in group B. There were no significant differences between the two groups regarding blood loss, blood loss during hepatectomy, and blood transfusion. More unexpected bleeding events occurred in group A. Higher necrosis at the cut margin of the liver parenchyma was noted in group A. There were no statistically significant differences between the two groups regarding postoperative ICU stay, hospital stay, postoperative morbidities, and readmission rates.

Conclusion

Clamp-crush technique is advocated as a simple, easy, safe, and cheaper method for hepatic parenchymal transection in living donors.

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Author information

Authors and Affiliations

  1. Liver Transplantation Unit, Gastrointestinal Surgery Center, Department of Surgery, College of Medicine, Mansoura University, Gastrointestinal Surgery Center, Gehan Street, Mansoura, 35516, Egypt

    Ahmad Mohamed Sultan, Ahmed Shehta, Tarek Salah, Mohamed Elshoubary, Ahmed Nabieh Elghawalby, Rami Said, Omar Fathy & Mohamed Abdel Wahab

  2. Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed Elmorshedi

  3. Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed Marwan

  4. Diagnostic & Interventional Radiology Department, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt

    Usama Shiha

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  1. Ahmad Mohamed Sultan
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  2. Ahmed Shehta
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Contributions

The conception and design of the manuscript: Sultan AM, Shehta A.

The acquisition, analysis, or interpretation of data of the manuscript: Sultan AM, Shehta A, Monier A.

Drafting the manuscript or revising it critically for important intellectual content: all authors.

Final approval of the version of the manuscript to be published: all authors.

Corresponding author

Correspondence to Ahmed Shehta.

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Sultan, A.M., Shehta, A., Salah, T. et al. Clamp-Crush Technique Versus Harmonic Scalpel for Hepatic Parenchymal Transection in Living Donor Hepatectomy: a Randomized Controlled Trial. J Gastrointest Surg 23, 1568–1577 (2019). https://doi.org/10.1007/s11605-019-04103-5

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  • DOI: https://doi.org/10.1007/s11605-019-04103-5

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