Impact of pedicle clamping in pediatric liver resection.
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.
Szavay
Philipp O
PO
Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. philipp.szavay@med.uni-tuebingen.de
Luithle
Tobias
T
Warmann
Steven W
SW
Geerlings
Heinz
H
Ure
Benno M
BM
Fuchs
Jörg
J
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