Pancreaticoduodenectomy in portal hypertension: use of the Ligasure

Background Purpose. The Ligasure Vessel Sealing System (LVSS) is a new bipolar device, put on the market in 1999, which provides safe and quick hemostasis, sealing blood vessels up to 7mm in diameter or tissue bundles without dissection or isolation. We tested this instrument in a patient with portal hypertension who had to be submitted to a complex abdominal procedure. Methods. A male patient (aged 57 years) with well-compensated cirrhosis of the liver, related to hepatitis C virus (HCV) (Child A) was diagnosed with a neoplasm of the pancreatic head. We performed a Whipple pancreaticoduodenectomy and hemostasis was almost entirely performed with the LVSS. All the blood vessels up to 7mm in diameter were sealed in this way. Larger vessels were suture ligated primarily. Results. No post-application bleeding was seen. No postoperative hemorragic complications occurred. A significant reduction in blood loss and in surgical time was noted. Conclusions. We believe that the LVSS could be extremely useful in all the fields of hepatopancreatobiliary surgery, especially in patients with portal hypertension with large intestinal and omental varices. The LVSS guarantees excellent hemostasis, reducing the risk of serious blood loss and shortening the time of surgery, so improving the prognosis.Via Cimarosa 2/a, 80127 — Naples, ItalyAccepted at the fifth world congress of the International Hepato-Pancreato-Biliary Association — IHPBA