Pre-resectional inflow vascular control: extrafascial dissection of Glissonean pedicle in liver resections

Background/aims: We are evaluated technique of anatomic major and minor hepatic resections usingsuprahilar-extrafascial dissection of Glissonean pedicle with vascular stapling device for transection of hepaticvessels intending to minimize operative time, and blood loss.Methodology: We prospectively analyzed the clinical records of 170 patients who underwent hepaticresection by suprahilar-extrafascial pedicle isolation and stapling technique in our clinic for emergencysurgery in Belgrade. Patients who underwent hilar extrahepatic intrafascial dissection were excluded from thestudy.Results: We performed 102 minor liver resections and 68 major hepatectomies. The minor liver resectionswere associated with significantly shorter surgery duration (95.1±31.1 vs. 186.6±56.5) and transection time(35.9±14.5 vs. 65.3±17.2) than major hepatectomies (P 0.001 for all). The mean blood loss was 255.6±129.9 mLin minor resection and 385.7±200.1 mL in major resection (P=0.003). The mean blood transfusion requirementwas 300.8±99.5 mL for the patients with minor hepatectomy and 450.9±89.6 mL for those with major liverresection (P=0.067). There was no significant difference in morbidity and mortality between the groups(P=0.989; P=0.920). Major as well as minor liver resection were a superior oncologic operation with nosignificant difference in the 3-year overall survival rates.Conclusions: Extrafascial dissection of Glissonean pedicle with vascular stapling represents both aneffective and safe surgical technique of anatomical liver resection. Presented approach allows early and easyischemic delineation of appropriate anatomical liver territory to be removed (hemiliver, section, segment)with selective inflow vascular control. Also, it is not time consuming and it is very useful in re-resection, aswell as oncologically reasonable.