title: Impact of pedicle clamping in pediatric liver resection.
abstract: BACKGROUND
  Vascular clamping techniques are commonly used but so far the impact on pediatric liver surgery has not been investigated. The purpose of this study was to analyze pedicle clamping during pediatric liver resection in terms of hepato-cellular injury and blood loss.
  
  
  METHODS
  Sixty-seven children undergoing liver resection were analyzed retrospectively. Vascular clamping was used in 28 cases (PC group), in 39 the resection was performed without clamping (NPC group). Major hepatectomies (resection of more than three segments) were carried out in 88%, minor hepatectomies (resection of three and less segments) in 12% of patients. Twenty-six children underwent extended liver resection. Patient data, liver function tests (LFTs) and blood loss were analyzed statistically.
  
  
  RESULTS
  There were no significant differences in patient preoperative and postoperative data and LFTs between the groups. Within the NPC group the amount of administered fresh frozen plasma (FFP) in total and per kilogram (FFP/kg) was significantly higher (p=0.023 and 0.028) than in the PC group. For patients with extended liver resection, operation times were significantly longer (p=0.016) in the group without vascular clamping (NPCext). In the NPCext group significantly more children required packed red cells, FFP and FFP/kg. LFTs showed no significant differences in all children regardless of vascular clamping.
  
  
  CONCLUSIONS
  For children undergoing liver resection, vascular clamping offers a blood saving surgical technique. Postoperative LFTs were not statistically different, regardless of vascular clamping. Pedicle clamping proved to be a safe method, not associated with an increase in perioperative complications.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. philipp.szavay@med.uni-tuebingen.de
authors.forename: Philipp O
authors.initials: PO
authors.lastname: Szavay
authors.forename: Tobias
authors.initials: T
authors.lastname: Luithle
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
authors.forename: Heinz
authors.initials: H
authors.lastname: Geerlings
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000098:blood supply* / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome