This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial of stapler versus clamp‐crushing transection in elective liver resection. BJS 2014; 101: 200-207.

Published: 8th January 2014

Authors: N. N. Rahbari, H. Elbers, M. Koch, P. Vogler, F. Striebel, T. Bruckner et al.

Background

Various devices have been developed to facilitate liver transection and reduce blood loss in liver resections. None of these has proven superiority compared with the classical clamp‐crushing technique. This randomized clinical trial compared the effectiveness and safety of stapler transection with that of clamp‐crushing during open liver resection.

Method

Patients admitted for elective open liver resection between January 2010 and October 2011 were assigned randomly to stapler transection or the clamp‐crushing technique. The primary endpoint was the total amount of intraoperative blood loss. Secondary endpoints included transection time, duration of operation, complication rates and resection margins.

Results

A total of 130 patients were enrolled, 65 to clamp‐crushing and 65 to stapler transection. There was no difference between groups in total intraoperative blood loss: median (i.q.r.) 1050 (525–1650) versus 925 (450–1425) ml respectively (P = 0·279). The difference in total intraoperative blood loss normalized to the transection surface area was not statistically significant (P = 0·092). Blood loss during parenchymal transection was significantly lower in the stapler transection group (P = 0·002), as were the parenchymal transection time (mean(s.d.) 30(21) versus 9(7) min for clamp‐crushing and stapler transection groups respectively; P < 0·001) and total duration of operation (mean(s.d.) 221(86) versus 190(85) min; P = 0·047). There were no significant differences in postoperative morbidity (P = 0·863) or mortality (P = 0·684) between groups.

Conclusion

Stapler transection is a safe technique but does not reduce intraoperative blood loss in elective liver resection compared with the clamp‐crushing technique. Registration number: NCT01049607 (http://www.clinicaltrials.gov).

Full text

You may also be interested in

Systematic review

Systematic review of functional outcome and quality of life after total pancreatectomy.

Authors: L. Scholten, T. F. Stoop, M. Del Chiaro, O. R. Busch, C. van Eijck, I. Q. Molenaar et al.

Original article

Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy.

Authors: S. Lof, A. L. Moekotte, B. Al‐Sarireh, B. Ammori, S. Aroori, D. Durkin et al.

Systematic review

Meta‐analysis of recurrence pattern after resection for pancreatic cancer.

Authors: M. Tanaka, A. L. Mihaljevic, P. Probst, M. Heckler, U. Klaiber, U. Heger et al.

Original article

Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments. BJS 2019; 106: 1512-1522.

Authors: G. Berardi, D. Aghayan, Å. A. Fretland, H. Elberm, F. Cipriani, A. Spagnoli et al.

Original article

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less.

Authors: W. Jung, T. Park, Y. Kim, H. Park, Y. Han, J. He et al.

Original article

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.

Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.

Original article

Benign hilar bile duct strictures resected as perihilar cholangiocarcinoma. BJS 2019; 106: 1504-1511.

Authors: S. Otsuka, T. Ebata, Y. Yokoyama, T. Igami, T. Mizuno, J. Yamaguchi et al.

Systematic review

Meta‐analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases.

Authors: X.‐Y. Wang, R. Zhang, Z. Wang, Y. Geng, J. Lin, K. Ma et al.

Original article

Mortality after liver surgery in Germany. BJS 2019; 106: 1523-1529.

Authors: N. Filmann, D. Walter, E. Schadde, C. Bruns, T. Keck, H. Lang et al.

Original article

Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. BJS 2019; 106: 1372-1380.

Authors: Å. A. Fretland, V. J. Dagenborg, G. M. Waaler Bjørnelv, D. L. Aghayan, A. M. Kazaryan, L. Barkhatov et al.

Original article

Safety and efficacy of transarterial embolization of hepatocellular adenomas. BJS 2019; 106: 1362-1371.

Authors: B. V. van Rosmalen, A. J. Klompenhouwer, J. Jaap de Graeff, M. P. D. Haring, V. E. de Meijer, L. Rifai et al.

Original article

Perioperative outcomes and long‐term quality of life after total pancreatectomy.

Authors: A. Pulvirenti, A. Pea, N. Rezaee, C. Gasparini, G. Malleo, M. J. Weiss et al.