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

• Published in: Journal of gastrointestinal surgery 2017-02, Vol.21 (2), p.321-329
• Main Authors: El Shobary, Mohamed, salah, Tarek, El Nakeeb, Ayman, Sultan, Ahmad M., Elghawalby, Ahmed, Fathy, Omar, Wahab, Mohamed Abdel, Yassen, Amro, Elmorshedy, Mohamed, Elkashef, Wagdi F., Shiha, Usama, Elsadany, Mohamed
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Blood Loss, Surgical - prevention & control; Diathermy; End Stage Liver Disease - etiology; End Stage Liver Disease - pathology; End Stage Liver Disease - surgery; Female; Gastroenterology; Hepatectomy; Hepatectomy - adverse effects; Hepatectomy - instrumentation; Hepatectomy - methods; Humans; Length of Stay; Ligation; Liver cancer; Liver diseases; Liver Function Tests; Liver Transplantation; Living Donors; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications - etiology; Postoperative Complications - pathology; Postoperative Complications - prevention & control; Surgery; Tissue and Organ Harvesting - adverse effects; Tissue and Organ Harvesting - instrumentation; Tissue and Organ Harvesting - methods; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-016-3312-y

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.