Randomized clinical trial of vessel sealing system (LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension

• Published in: The American journal of surgery Vol. 202; no. 1; pp. 82 - 90
• Main Authors: Yao, Hou Shan, M.D, Wang, Wei Jun, M.D, Wang, Qiang, M.D, Gao, Wen Chao, M.D, Xiang, Hong Gang, M.D, Hu, Zhi Qian, M.D, Gao, Jia Dong, M.D, Chen, Xue Yun, M.D, Wang, Wei Min, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Bleeding; Blood; Blood Loss, Surgical; Clinical trials; Complications; Double-Blind Method; Drainage measurement; Electrocoagulation - instrumentation; Endoscopy; Esophageal and Gastric Varices - surgery; Esophagogastric devascularization; Esophagus; Esophagus - blood supply; Esophagus - surgery; Evaluation; Female; Fever; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - surgery; General aspects; Grading; Hemorrhage; Hemostasis, Surgical - instrumentation; Homeostasis; Humans; Hypertension; Hypertension, Portal - etiology; Illnesses; Laparoscopy; Liver; Liver Cirrhosis - complications; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pain; Patients; Portal hypertension; Portal vein; Sealing; Sealing compounds; Spleen; Splenectomy; Statistical analysis; Stomach - blood supply; Stomach - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thromboembolism; Thrombosis; Thyroid gland; Time Factors; Time measurement; Ultrasonic imaging; Veins & arteries; Vessel sealing system; Splenectomy; Vessel sealing system; Esophagogastric devascularization; Portal hypertension; Human; devascularization; Portal circulation disease; Esophagogastric; Cardiovascular disease; Patient; Vascular disease; Medicine; Randomization; Treatment; Surgery; Blood vessel; Digestive diseases; Clinical trial; Circulatory system
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.10.016

Abstract Background The LigaSure vessel sealing system (Valleylab, Boulder, CO) has been tested, with excellent results, in different fields of surgery. However, no study has evaluated the efficiency of the LigaSure in open esophagogastric decongestion and splenectomy in a randomized trial to date. Methods Patients scheduled to undergo esophagogastric decongestion and splenectomy were assigned to the use of either the LigaSure or a conventional clamp-and-tie technique. Primary outcome measures were operating time and intraoperative blood loss. Secondary outcome measures were postoperative drainage volume, complications such as spleen fever, bleeding, portal vein thrombosis, length of incision, pain, and time to discharge. Results Sixty patients were randomized to the LigaSure (n = 30) and clamp-and-tie (n = 30) groups. The groups were well matched with respect to liver function, associated illnesses, and grading of esophageal varices. Postoperative outcomes in drainage and major complications did not differ between the groups, while operative time and the volume of blood loss were significantly decreased in the LigaSure group compared with the clamp-and-tie group ( P < .001). Conclusions The use of the LigaSure is safe and effective in vessel division and homeostasis in the esophagogastric decongestion and splenectomy, with statistically significant decreases in operative time and intraoperative blood loss and without significantly modifying postoperative results.