Ligasure impact™ might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study
Ligasure impact™ might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study
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DOI：
10.1177/1457496919828237
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发表时间：
2020-06-01
影响因子：
2.4
通讯作者：
Koskivuo, I
中科院分区：
文献类型：
--
作者：
Giordano, S.;Kangas, R.;Koskivuo, I
背景和目的：腹壁成形术中提升皮瓣最有效的解剖技术仍然存在争议，特别是在高风险的体重减轻患者中。LigaSure Impact（（TM））血管闭合系统（Medtronic，都柏林，爱尔兰）是一种在不同外科专业中常用的能量器械，用于降低发病率和实现结局。本研究的目的是调查的有效性LigaSure影响腹部整形术相比，传统的技术，diathermia.Material和方法：患者进行了主要腹部整形术后，大规模减肥在一个单一的中心，从2008年1月1日至2015年5月31日，并进行了回顾性分析。共有94例符合研究条件的患者根据解剖技术分为两组：LigaSure Impact组（29例患者）和传统技术组（65例患者）。术中总失血量是主要终点。手术持续时间、围手术期并发症和再次手术作为次要终点。结果：两组基线特征平衡良好。术中失血量存在显著差异，有利于LigaSure Impact组（259.6 ± 198.8 mL vs 377.9 ± 190.0 mL，p = 0.004）和输血率（13.8% vs 35.4%，p = 0.047）。相比之下，LigaSure Impact组的手术时间显著更长（168.6 +/- 121.2 vs 179.7 +/- 57.6 min，p = 0.005），而LigaSure Impact组的住院时间有缩短的趋势（3.6 +/- 1.1天vs 4.6 +/- 3.2天，p = 0.081）。LigaSure Impact组的总体并发症发生率、Clavien-Dindo II级（24.1% vs 55.4%）和III级（13.8% vs 30.8%）并发症显著较低（分别为p = 0.005，p = 0.007，p = 0.016）。LigaSure Impact组的晚期（>30天）再手术率显著较低（6.9% vs 27.70%，p = 0.0028）。结论：LigaSure Impact血管闭合系统可能有助于改善体重减轻患者的腹壁成形术结局，因为它可能减少失血量、输血需求、并发症和再次手术。
Background and Aims:The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact((TM)) vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia.Material and Methods:Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.Results:Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 +/- 198.8 mL vs 377.9 +/- 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 +/- 121.2 vs 179.7 +/- 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 +/- 1.1 days vs 4.6 +/- 3.2 days, p = 0.081). Overall complications occurrence, Clavien-Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.Conclusion:LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.