Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss.

Abstract

Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800mL. Mean EBL decreased overtime from groups A to C: group A, 378±619mL; group B, 293±391mL; groups C, 257±366mL; P=0.127. Transfusion rate was 6.7% in group A, 5.5% in group B, and 4.8% in group C (P=0.743). Hypertension (odds ratio (OR) 2.82, 95% confidence interval CI 1.37-5.78; P=0.006), preoperative chemotherapy (OR 2.55, 95% CI 1.26-5.31; P=0.009), resection of posterosuperior segments (OR 3.73, 95% CI 1.33-12.17; P=0.012), and major hepatectomy (OR 4.21, 95% CI 1.64-13.02; P<0.001) independently predicted high EBL. Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.