Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Inguinal hernioplasty by laparoscopic total extraperitoneal versus open lichtenstein techniques: a randomized prospective study

Different techniques of laparoscopic inguinal hernioplasty are performed. The total extraperitoneal approach [TEP] represents an important such techniquc. In a randomized prospective study, we compared the TEP with the standard open repair. namely Lichtenstein hernioplasty. Thirty two adult males with inguinal hernia were included in the study. They were randomly and equally divided into two groups: open Lichtenstein [OL] group and laparoscopic [TEP] group. Data were collected regarding operative time, complications. positoperative pain, hospital stay, and resumption of normal activities. The mean follow up period was 15 months ranging from 10 to 23 months. The OL group included two direct hernias, while the TEP group included three direct hernias while the rest were indirect. The operative time for the OL group was significantly shorter the TEP group with a mean and range of 44 [30-80] versus 95 [60-160] respectively. TEP group had significantly less postoperative pain and analgesic needs compared to OL group. TEP patients resumed their normal activities significantly sooner than OL patients. Hospital stay did not differ between the two groups. Intraoperative bleeding from the inferior epigastric artery occurred once in the TEP group and was well controlled. Minor postoperative complications in the form or seroma, wound infection, and urinary retention were reported in both groups with no statistically significant differences and resolved spontaneously. Although requires longer operative time than open Lichtenstein inguinal hernioplasty, laparoscopic TEP hernioplasty results in less postoperative pain. analgestic, requirements. and earlier return to normal activities with comparable hospital stay and postoperative complications. Consequently, laparoscopic TEP inguinal hernioplasty could be considered as a strong competitor to the standard Lichtenstein technique. Still larger comparative studies with longer follow up are needed to objectively prefer one technique over the other