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Disposable bipolar irrigated sealer (Aquamantys®) for liver resection: use with caution

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Abstract

The disposable bipolar irrigated sealer has been demonstrated to reduce perioperative bleeding, but its role in preventing postoperative cut-surface complications has not been evaluated to date. A prospective observational study was performed between January and September 2013 to evaluate a disposable bipolar irrigated sealed (Aquamantys®) on a continuous series of 51 first liver resections without biliary reconstruction. Primary end-point was the occurrence of cut-surface complications during the postoperative period. Secondary endpoints were postoperative complications and the 1-year overall survival rate. The results were compared to a propensity score matched group of 153 liver resections performed with conventional monopolar cautery. A cut-surface complication occurred in 13/51 (25.5 %) resected patients. Bleeding, bile leakage and subphrenic abscess occurred in 7.8, 11.8 and 11.8 % patients, respectively. Compared to the matched group, the resected group had a higher rate of cut-surface complications (25.5 vs. 14.7 %, p < 0.01) and a higher rate of Clavien–Dindo type ≥3 postoperative complications (29.5 vs. 17.2 %, p < 0.01). In the multivariate analysis, preoperative chemotherapy (p = 0.03, 95 % CI 1.09–5.9, OR 2.53), blood transfusion (p = 0.02, 95 % CI 1.78–6.55, OR 2.78) and Aquamantys® use (p = 0.02, 95 % CI 1.21–6.7, OR 2.85) were independent of cut-surface complications within the first 90 postoperative days. The overall 1-year survival rates were not different between the two groups (p = 0.078). Aquamantys® use is associated with an increased rate of postoperative complications compared to classical monopolar cautery, and we recommend that it should be used with caution in this type of surgery.

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Authors and Affiliations

  1. Service de chirurgie hépatobiliaire et digestive, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France

    Andrea Patrizi, Laurent Sulpice, Bernard Meunier, Michel Rayar & Karim Boudjema

  2. Service des maladies du foie. Hôpital Pontchaillou, Université de Rennes 1, Rennes, France

    Caroline Jezequel & Bernard Meunier

Authors
  1. Andrea Patrizi
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  2. Caroline Jezequel
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  3. Laurent Sulpice
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  4. Bernard Meunier
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  5. Michel Rayar
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  6. Karim Boudjema
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Correspondence to Andrea Patrizi.

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The authors declare that they have no conflict of interest.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Patrizi, A., Jezequel, C., Sulpice, L. et al. Disposable bipolar irrigated sealer (Aquamantys®) for liver resection: use with caution. Updates Surg 68, 171–177 (2016). https://doi.org/10.1007/s13304-016-0367-y

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  • DOI: https://doi.org/10.1007/s13304-016-0367-y

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