Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Department of Pediatric Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany.
Sci Rep. 2020 Jul 22;10(1):12143. doi: 10.1038/s41598-020-69211-8.
Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS-FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS-FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS-FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS-FLF group (p = 0.114). One patient in the MILS-FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.
在肝外科手术后，缝合肝切除面是否会降低发病率仍不清楚。尽管如此，目前仍有多种方法和材料用于此过程。在这里，我们描述了我们在德国一所大学医院的同一个手术团队在微创肝手术（MILS）中使用可移动镰状韧带瓣的简单技术的经验。我们回顾性分析了 2011 年至 2019 年间接受过微创肝切除术的 46 例患者的图表，这些患者均来自同一外科手术团队。24 例患者接受腹腔镜肝切除术，22 例患者接受机器人辅助肝切除术。腹腔镜组的 16 例和机器人组的 14 例患者在肝切除术后使用镰状韧带瓣（FLF）覆盖切除面。我们的队列因此分为两组：接受（MILS+FLF）和不接受 FLF（MILS-FLF）的腹腔镜和机器人患者。我们队列中的 28 例（60.9%）患者为男性。总体平均年龄为 56.8 岁（标准差 16.8）。MILS+FLF 组的平均手术时间为 249 分钟，而 MILS-FLF 组的平均手术时间为 235 分钟（p=0.682）。MILS+FLF 组的平均失血量为 301 毫升，而 MILS-FLF 组的平均失血量为 318 毫升（p=0.859）。MILS+FLF 组的总发病率为 3.3%，而 MILS-FLF 组的发病率为 18.8%（p=0.114）。MILS-FLF 组中有 1 例患者（总发病率为 2.2%），行机器人肝手术后发生胆漏，但在 MILS+FLF 组中未发生胆漏。在微创肝切除术后用 FLF 覆盖肝脏切除面是一种简单且具有成本效益的技术，不会延长手术时间或对其他围手术期参数产生负面影响。事实上，它是 MILS 中的一个安全附加步骤，可能会降低术后发病率。需要更大队列的进一步研究来证实我们的概念验证和结果。
