Prospective, randomized trial of bipolar electrosurgery vs ultrasonic coagulation for division of short gastric vessels during laparoscopic Nissen fundoplication
Ra. Underwood et al., Prospective, randomized trial of bipolar electrosurgery vs ultrasonic coagulation for division of short gastric vessels during laparoscopic Nissen fundoplication, SURG ENDOSC, 13(8), 1999, pp. 763-768
Citations number
47
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
Background: Division of the short gastric vessels (SGV) during laparoscopic
Nissen fundoplication (LNF) may improve outcome. Several techniques are av
ailable for SGV division. The aim of this study was to compare in a prospec
tive randomized trial bipolar electrocautery with cutting blade versus ultr
asonic coagulation of the SGV during LNF.
Methods: In all, 86 consecutive patients undergoing LNF were prospectively
randomized into two similar groups that underwent division of the SGV, resp
ectively, using bipolar cutting forceps (BPCF) or harmonic coagulating shea
rs (HCS). Operative time, bleeding episodes, complications, equipment probl
ems, and surgeon's subjective scoring of satisfaction and ease of use were
assessed.
Results: Mean (+/-SD) time for fundic mobilization and division of the SGV
was not significantly different between the two groups (BPCF = 20 +/- 12 mi
n vs. HCS = 22 +/- 12 min). Bleeding events, estimated blood loss, surgeon
satisfaction, and subjective ease of use were similar, and no transfusions
were required. Complications in the BPCF group included a delayed gastric p
erforation requiring reoperation and two gastric serosal burns repaired int
raoperatively. There was one splenic capsular tear using the HCS and one sp
lenic capsular tear using the BPCF, both of which were controlled intraoper
atively. The number of functional equipment problems were few and statistic
ally similar. In the authors' institution, the per case total costs with ca
pital expenditures amortized over 100 cases indicate savings of approximate
ly $202/case with use of the BPCF versus the HCS. Regression analysis demon
strated a significant correlation between body mass index (BMI) and total c
ase length and time for division of the SGVs.
Conclusions: The BPCF and HCS appear to be equally efficacious for SGV divi
sion during LNF. Judicious application of both energy forms and heightened
vigilance for gastric serosal injury are required with use of both the BPCF
and HCS in cases of tight gastrosplenic adhesions or short SGVs. The BPCF
carries a potential cost advantage over the HCS in the authors' institution
. The BMI directly correlates with time required to divide SGVs and total l
ength of LNF.