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Safety and Risk Factors of Pure Laparoscopic Living Donor Right Hepatectomy: Comparison to Open Technique in Propensity Score-Matched Analysis.

BACKGROUND
The innovative pure laparoscopic living donor right hepatectomy (LLDRH) procedure for liver transplantation has never been fully compared to open living donor right hepatectomy (OLRDH). We aimed to compare the donor safety and graft results of pure LLDRH to those of OLRDH.


METHODS
From May 2013 to July 2017, 288 consecutive donors underwent either OLRDH (n = 197) or pure LLDRH (n = 91). After propensity score matching, 72 donors were included in each group. The primary outcome was postoperative complications during a 90-day follow-up period. Comprehensive complication index, duration of hospital stay, need for additional pain control, readmission, and donor outcomes were also compared.


RESULTS
The incidence of major complication during the 90-day follow-up was higher in the OLDRH group than the LLDRH group (6.6% vs. 15.4%, P = 0.017) but was not statistically significant in propensity-matched analysis (11.1% vs. 13.9%, odds ratio [OR], 1.29; 95% confidence interval [CI], 0.47-3.51; P = 0.62). A right hepatic duct less than 1 cm was independently associated with complication in the pure LLDRH group (OR, 4.01; 95% CI, 1.08-14.99; P = 0.04).


CONCLUSION
In the initial 91 pure LLDRH cases, incidence of major complication was higher than in the OLDRH group, but the difference was not significant in propensity-matched analysis. A right hepatic duct verified as less than 1 cm may be related to increased frequency of complications in pure LLDRH donors. Further analysis is needed.