title: Surgical separation of shared liver with cotton tourniquets in conjoined twins: simple and effective hemostasis.
abstract: OBJECTIVE
  Surgical separation of the fused liver is extremely risky and sometimes life-threatening in conjoined twins because of the potential risks of hypovolemia and hemorrhagic shock.
  
  
  METHODS
  Three pairs of symmetrical conjoined twins sharing fused livers were successfully separated by using a simple but effective local blockade measure without disturbing the portal circulation.
  
  
  RESULTS
  The volume of intraoperative blood loss was minimal, and no major complications occurred. All the separated babies survived the procedure and remained healthy, both physically and mentally, after discharge. Two babies died of pneumonia associated with their preexisting cardiac defects.
  
  
  CONCLUSIONS
  Cotton tourniquets temporally and securely blocked the local blood supply to the narrow gap dissecting interface with minimal interference with the remaining segments, in addition to orienting the transection of the fused liver and minimizing blood loss from the liver dissection.
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Third Military Medical University, Chongqing 400037, People's Republic of China.
authors.forename: Tonghan
authors.initials: T
authors.lastname: Yang
authors.forename: Lu
authors.initials: L
authors.lastname: Zheng
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Huang
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Guohua
authors.initials: G
authors.lastname: Zuo
authors.forename: Keqiang
authors.initials: K
authors.lastname: Han
authors.forename: Ping
authors.initials: P
authors.lastname: Liang
mesh_terms: D004210:Dissection; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000002:abnormalities / Q000601:surgery*; D008297:Male; D014111:Tourniquets; D014428:Twins, Conjoined / Q000601:surgery*