HEPATITIS & LIVER DISEASES

Biography

El Sherif A., Department of HPB Surgery, liver transplantation, National Liver Institute University of Menofia, Shebin El Kom

Abstract

Background: Hepatocellular carcinoma is one of the most common malignancies worldwide. It is frequently found in association with liver cirrhosis. Viral hepatitis B and C are particularly major risk factors for HCC with incidence varies according to geographic area. Many technological devices have been used to avoid intraoperative bleeding during hepatic parenchymal transaction and to avoid morbidity and mortality, but until now none is complete. The aim of this work is to analyze hepatic resection in cirrhotic patients treated with Habib Sealer and Cavitron Ultrasonic Surgical Aspirator (C.U.S.A) devices in order to evaluate its effectiveness. Patients and method: (413) consecutive patients, (193) cases in left lobe (220) cases in right lobe were randomized to one of different dissection strategies. from August 2007 and September 2016 were analyzed prospectively. The following variables were considered: age, sex, kind of disease, kind of liver resection, number of major/minor resections, total operative time and transaction time, number and time of clamping, blood loss, time of hospitalization, morbidity, and mortality. Results. Between August 2007 and September 2016, all patients were analyzed prospectively, (67% men, 31% woman, 2% pediatric). Ages ranged from months to 84 years. The procedures performed were 46 major hepatectomies (11.2%) and 367 minor hepatectomies (wedge) (88.8%). Hepatic transaction was performed in 35 to 150 min by Habib sealer. 38 cases (9.2%) underwent laparoscopic technique by Harmonic Scalpel with Habib sealer, 18 cases converted to open resection. Total operative time range from 120–480 min. The average blood loss was 325 ml (range 50–600 ml). The mean postoperative stays were nine days for cirrhotic patients and six days for non-cirrhotic patients. Conclusion. Habib sealer device is useful for reducing ischemia–reperfusion damage due to absence the Pringle maneuver and for reducing the risk of morbidity, however ultrasonic dissector (CUSA) easy, versatile take long respectable time, excess blood loss and blood transfusion, other as Harmonic scalpel., good haemostatic device, take short operative time not need Pringle maneuver less blood loss and transfusion. So, the difference in the postoperative morbidity and mortality was statistically significant.