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Background New instruments and techniques for hepatectomy have been shown to reduce blood loss during liver resection. The present study aims to evaluate the feasibility and result of our techniques of liver resection without routine inflow occlusion (the Pringle manoeuver). Methods The cavitron ultrasonic surgical aspirator (CUSA) and saline-linked radio-frequency dissecting sealer (TissueLink) were used together for open hepatectomy, whereas a bipolar vessel sealing device (Ligasure) and TissueLink were used for laparoscopic hepatectomy. Between June 2003 and May 2007, 248 consecutive cases of liver resection were carried out using the above techniques without the routine Pringle manoeuver. The operative and clinical outcome data were prospectively collected and analysed. Results During the study period, a total of 220 cases of open hepatectomy and 28 cases of laparoscopic hepatectomy were performed. The Pringle manoeuver was eventually applied in six patients (2.4%): two for portal vein tumour thrombus extraction and four as a result of heavy bleeding. Median blood loss was 300 ml (20–2700 ml) and the blood transfusion rate was 7.7%. In most of the cases, the liver function tests showed improvement on post-operative day 1 or 2, and the median post-operative hospital stay was 7 days. There were two post-operative deaths (0.8%). Complications occurred in 63 patients (25.4%) and most complications were minor. Conclusions Refined techniques and instruments for liver resection allow hepatectomy to be done safely without using the routine Pringle manoeuver. Most patients had a quick recovery of liver function and were discharged early.

Background Radiofrequency ablation (RFA) has been used to treat hepatocellular carcinoma (HCC) and liver metastases for more than 10 years with promising early outcomes. Preliminary results comparing percutaneous and surgical approaches have shown no difference in short‐term outcomes. In this study, the longer‐term outcomes were presented. Methods Patients with liver malignancies treated by RFA were prospectively studied from 2003 to 2011. Post‐ablation assessment by computed tomography (CT) scan and serum biochemistry was performed at regular intervals. Recurrence rates and long‐term survival were analysed. Results A total of 233 patients with liver malignancies (75.5% HCC and 24.5% liver metastases) were analysed. Three RFA approaches were used (percutaneous 58.4%, laparoscopic 9.4% and open 32.2%). The median follow‐up time was 29 months. Complete ablation was achieved in 83.7%, with no difference between the two approaches. More wound and chest complications were observed in the surgical group. Intra‐hepatic recurrences were observed in 69.5%; extra‐hepatic recurrences were detected in 22.3%, with no difference between the two groups. There was no statistical difference between the two approaches in overall 1‐, 3‐ and 5‐year survival. Conclusion An extended period of follow‐up in patients with liver malignancies showed that RFA is an effective treatment. No difference was demonstrated between the percutaneous and surgical approach, in terms of recurrence and survival.

BackgroundRecurrent pyogenic cholangitis (RPC) is still a common disease in East Asia. The present study reviews the operative results for this disease in a single centre.MethodsThe records of 85 patients who underwent surgical treatment for RPC from August 1995 to March 2008 were retrospectively reviewed.ResultsPatients included 35 men and 50 women with a median age of 61 years. Types of surgery included: hepatectomy (65.9%); hepatectomy plus drainage (9.4%); drainage alone (14.1%), and percutaneous choledochoscopy (10.6%). There was no operative mortality. Complications occurred in 40% of patients and half the complications involved wound infections. The overall incidences of residual stone, stone recurrence and biliary sepsis recurrence were 21.2%, 16.5% and 21.2%, respectively, over a median follow-up of 45.4 months. The drainage-alone group and percutaneous choledochoscopy group had higher incidences of residual stone, stone recurrence and biliary sepsis recurrence. In hepatectomy patients, regardless of whether or not a drainage procedure had been performed, rates of residual stone, stone recurrence and biliary sepsis recurrence were 15.6%, 7.8% and 9.4%, respectively, over a median follow-up of 42.7 months.ConclusionsHepatectomy is safe and yields the best treatment outcome for RPC. It should be considered as the treatment of choice for suitable patients with RPC.