title: Major hepatectomy in children: approaching blood transfusion-free.
abstract: BACKGROUND
  Major hepatectomy complicated with massive blood loss requires blood transfusion, which may result in increased morbidity and mortality. Intraoperative techniques and postoperative management that achieves blood transfusion-free major hepatectomy in children are described.
  
  
  METHODS
  Fourteen children with a mean age of 3.1 years and mean body weight of 14 kg underwent major hepatectomy between May 1994 and September 2002. Demographic information, surgical techniques, and intraoperative management were analyzed.
  
  
  RESULTS
  Hepatectomy included right trisegmentectomy in seven cases, extended right lobectomy in three, right lobectomy in two, and left lobectomy in two. Preoperative imaging, hemihepatic inflow control, intraoperative ultrasonography, and ultrasonic dissection were routinely applied. Fluid was restricted to target a low central venous pressure (5 cm H(2)O) during transection. Postoperative low hemoglobin (>6.3 g/dl) was tolerated in pediatric patients. There was no operative mortality or major complications and only two cases of pleural effusion. The mean blood loss was 68 ml (range 1.25-13.0 ml/kg), and no blood transfusions were required intraoperatively. Blood transfusion was given because of a liberal strategy for major operation in two patients and preoperative tumor bleeding in one.
  
  
  CONCLUSIONS
  Despite being technically challenging, major hepatectomy can be performed with minimal blood loss and without blood transfusion in children to decrease postoperative complications.
authors.affiliation: Liver Transplant Program, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan. clchen@adm.cgmh.org.tw
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsaio
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D011300:Preoperative Care