Paediatric Hepatobiliary

A review of paediatric liver resections in Johannesburg: Experiences and preferred technique

Jerome A Loveland, Felix Krog, Peter Beale

Abstract


Background. Liver resections are widely performed in paediatric surgery. Many techniques exist to achieve vascular control, minimise bleeding and complete the parenchymal division.

Methods. We retrospectively reviewed all liver resections performed in the Department of Paediatric Surgery at our institution between January 2005 and June 2012. Data pertaining to basic demographics, indications for surgery, parenchymal transection techniques, morbidity, mortality and histology were collated.

Results. Twenty-one resections were performed in children aged 6 weeks - 11 years; 18 for malignant liver disease (including 9 hepatoblastomas), and 3 for benign disease. We describe 1 peri-operative mortality secondary to torsion of the liver remnant, and no surgical morbidity. Three cases underwent total hepatic vascular exclusion with sharp parenchymal transection. The remaining patients underwent selective vascular inflow and outflow control using the Cavitron Ultra Sonic Aspirator and Harmonic Scalpel to divide the parenchyma.

Conclusion. Care for these patients should be multidisciplinary. High-volume units and access to liver transplantation offer optimal results. No technique is proven superior to the ‘clamp crush’ technique of parenchymal transection. Knowledge of hepatic anatomy is key to minimising morbidity, and surgeons should be familiar with and have the flexibility to use all techniques of vascular control.

Authors' affiliations

Jerome A Loveland, Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg

Felix Krog, Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg

Peter Beale, Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg

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Keywords

Liver Resection; Paediatrics

Cite this article

South African Medical Journal 2012;102(11):881-883. DOI:10.7196/SAMJ.6204

Article History

Date submitted: 2012-08-07
Date published: 2012-09-10

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