Comparison of the Rex-recess approach with the standard approach in left lateral sectionectomy of the liver.

BACKGROUNDS/AIMS: Left lateral sectionectomy (LLS) is a commonly performed liver resection. The Rex-recess technique, an extrahepatic Glissonian approach through the umbilical fissure, provides earlier extrahepatic vascular control, potentially resulting in safer and faster resections. However, comparative data between these approaches is limited. This study aims to compare the Rex-recess technique with the standard technique for LLS regarding operative parameters, intraoperative blood loss, and postoperative outcomes.

METHODS

This retrospective cohort study included 48 consecutive adult patients who underwent open LLS at a tertiary hepatobiliary centre between January 2021 and November 2025. Patients were categorized based on the surgical technique used: standard technique (n = 25) and Rex-recess technique (n = 23). Primary outcomes assessed included operative time, blood loss, transfusion requirements, and postoperative complications. Secondary outcomes focused on selected early postoperative recovery parameters.

RESULTS

Baseline demographics were comparable between groups. The Rex-recess technique significantly reduced operative time (90 ± 17.1 minutes vs. 162 ± 27.2 minutes; p < 0.0001) and intraoperative blood loss (80 ± 42.3 mL vs. 250 ± 67.2 mL; p < 0.0001).Other postoperative outcomes, including complication rates and length of hospital stay, were comparable between the two groups.

CONCLUSIONS

The Rex-recess approach appears to be a feasible and anatomically sound technique for LLS, offering advantages in operative efficiency, such as reduced operative time and blood loss. However, due to the retrospective design and non-randomized allocation, these findings should be interpreted with caution. Further prospective studies are needed to validate these results.