Outcomes and Cost of Major Liver Resection Using Combined LigaSure and Stapler: A Propensity Score Matching Study

Area of Science:

• Hepatobiliary Surgery
• Surgical Techniques
• Medical Economics

Background:

• Bile leakage is a significant complication following major liver resections.
• The choice of liver transection technique influences postoperative outcomes.
• Evaluating novel techniques is crucial for improving patient care and reducing complications.

Purpose of the Study:

• To compare the effectiveness of a hybrid resection technique (LigaSure and stapler) versus a stapler-only technique in reducing bile leakage after major liver resection.
• To assess secondary outcomes including overall morbidity, healthcare costs, and reimbursements.

Main Methods:

• Retrospective analysis of patients undergoing major hepatectomy without biliary reconstruction.
• Comparison between hybrid (LigaSure and stapler) and stapler-only techniques (August 2014 - December 2021).
• Propensity score matching (one-to-two) and analysis of perioperative data, bile leakage rates, and diagnosis-related group (DRG) based costs and reimbursements.

Main Results:

• The hybrid technique group showed a significantly lower rate of bile leakage (p=0.002).
• Patients in the hybrid group experienced shorter intensive care unit (ICU) and overall hospital stays (p=0.034, p=0.007).
• The hybrid technique resulted in lower ICU and ward costs (p=0.024, p=0.014) and a two-fold higher financial margin (p=0.02).

Conclusions:

• The hybrid resection technique is superior to the stapler-only technique in minimizing postoperative bile leakage and reducing patient length of stay.
• Despite a longer operative time, the hybrid approach offers significant cost efficiencies and improved financial outcomes.
• This technique represents a valuable advancement in major liver resection, enhancing both clinical and economic results.