Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?

BackgroundWe evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy. Material and MethodWe use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246. ResultsWe evaluated 26 liver resections done in last three years. 19 liver resections were done using extrafascial transfissural approach for various liver tumors and 7 living donor hepatectomies were done using itrafascial technique with clamp crush methods. Mean age of patients was 50.73 years.16 patients were males and 10 were females. Mean blood loss was 273.9 ml and mean operative duration was 184.7 minutes. 22 were major resections, 4 were minor liver resections. All minor liver resections were in transfissural approach however there was no statistical significant difference between them. Being live liver doners patients in intrafacial group they were younger than extrafascial transfissural group. (p=0.01). There was no statistical significant difference in blood loss, blood products requirements, morbidity, in hospital and 90 days mortality in both the groups. However extrafascial transfissural with finger fracture technique was associated with significant less operative time. (168.13 minutes vs 222.86 minutes) (p=0.006). 90 days mortality was associated with higher ASA grade (0.018) and blood loss (0.008). However in multivariate analysis no factor indepedently predicted mortality. ConclusionExtrafascial transfissural approach significantly reduces operative time, without affecting morbidity and mortality in liver resection.