Abbasi Dezfouli Sepehr, Dooghaie Moghadam Arash, Sabetkish Nastaran, Khajeh Elias, Ramouz Ali, Majlesara Ali, Mieth Markus, Chang De Hua, Golriz Mohammad, Mehrabi Arianeb
Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany.
J Clin Med. 2025 Jun 1;14(11):3892. doi: 10.3390/jcm14113892.
Bile leakage remains a significant challenge following major liver resection, with potential for improvement depending on the transection technique used. In this study, we aimed to evaluate the effectiveness of our hybrid resection technique-utilizing both LigaSure and stapler devices-in reducing bile leakage after major liver resection compared to our conventional stapler-only technique. As a secondary aim, we compared overall morbidity, costs, and reimbursements. Patients who underwent major hepatectomy without biliary reconstruction using either the hybrid or stapler technique between August 2014 and December 2021 were included in the study. Propensity score matching was performed using a one-to-two algorithm. Perioperative data, bile leakage rates, and cost and reimbursement information based on the diagnosis-related group (DRG) system were analyzed. In total, data from 492 patients were evaluated (hybrid = 152; stapler = 340). After one-to-two propensity score matching, the operation time was significantly longer in the hybrid group ( = 0.005). A cost analysis showed no significant difference in total operative costs between the two techniques ( = 0.092). However, the hybrid group had a significantly lower rate of bile leakage ( = 0.002), as well as shorter intensive care unit (ICU) and overall hospital stays ( = 0.034 and = 0.007, respectively). Consequently, ICU and ward costs were significantly lower in the hybrid group ( = 0.024 and = 0.014, respectively) compared to the stapler group. The financial difference calculated as DRG reimbursement minus costs was two-fold higher in the hybrid group ( = 0.02). Although the hybrid technique resulted in a longer operating time, it proved superior to the stapler technique in reducing postoperative bile leakage and shortening ICU and hospital stays. Furthermore, the use of the hybrid technique was more cost efficient and resulted in a greater positive financial margin.
肝大部切除术后胆漏仍是一个重大挑战,其改善潜力取决于所采用的肝断面处理技术。在本研究中,我们旨在评估我们的混合切除技术(同时使用LigaSure和吻合器设备)与传统的单纯吻合器技术相比,在减少肝大部切除术后胆漏方面的有效性。作为次要目标,我们比较了总体发病率、成本和报销情况。本研究纳入了2014年8月至2021年12月期间使用混合或吻合器技术进行无胆道重建的肝大部切除术的患者。采用一对一算法进行倾向评分匹配。分析围手术期数据、胆漏发生率以及基于诊断相关组(DRG)系统的成本和报销信息。总共评估了492例患者的数据(混合组 = 152例;吻合器组 = 340例)。经过一对一倾向评分匹配后,混合组的手术时间明显更长(P = 0.005)。成本分析显示,两种技术的总手术成本无显著差异(P = 0.092)。然而,混合组的胆漏发生率显著更低(P = 0.002),重症监护病房(ICU)住院时间和总体住院时间也更短(分别为P = 0.034和P = 0.007)。因此,与吻合器组相比,混合组的ICU和病房成本显著更低(分别为P = 0.024和P = 0.014)。以DRG报销减去成本计算的财务差异在混合组中高出两倍(P = 0.02)。虽然混合技术导致手术时间延长,但在减少术后胆漏以及缩短ICU和住院时间方面,它被证明优于吻合器技术。此外,使用混合技术更具成本效益,并且产生了更大的正财务利润。