Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90 days using a propensity method

Abstract

Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH.

Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis

“…severity of complications arising in the course of a disease process [15,16]. Fewer general surgery patients were attended and admitted from the ED between February and May 2020 relative to the same period in 2019, yet those that were seen in 2020 did not present higher level of acuity than those seen in the period without pandemic.…”

Segmentectomía lateral izquierda laparoscópica en donante vivo para trasplante hepático adulto-pediátrico.

“…La fístula logró su cierre de manera exitosa. La mediana de hospitalización fue de 4 días (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). No hubo mortalidad intra ni post-hospitalaria, así como tampoco re-hospitalizaciones a 30 días.…”

“…Por otra parte, la laparoscopía ha revolucionado la cirugía hepatobiliar en las últimas décadas. En comparación al abordaje abierto, sus beneficios han sido demostrados en múltiples estudios; disminución del sangrado intraoperatorio 6 , menor tasa de complicaciones médicas (mayoritariamente respiratorias) y quirúrgicas 7 , menor estadía hospitalaria 8 e incluso menores costos asociados 9 .…”

Impact of microscopic incomplete resection for colorectal liver metastases on surgical margin recurrence: R1‐Contact vs R1 < 1 mm margin width

“…Laparoscopic approach was introduced in 2008 and it was progressively implemented during the study period. In case of laparoscopic liver resection, the patient was placed on dorsal hyperextension position, and an extra‐corporeal Pringle maneuver was used; parenchymal transection was performed using ultrasonic dissection (Cavitron Ultrasonic Surgical Aspirator—CUSA; Valleylab Inc., Boulder, USA) and hemostasis using an argon beamer, bipolar energy, and clips as previously described 17,18 . Conversion was defined by the need of a laparotomy to complete the laparoscopic operation in case of technical complexity or complications.…”