title: A review of paediatric liver resections in Johannesburg: experiences and preferred technique.
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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa. loveland@wol.co.za
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Loveland
authors.forename: Felix
authors.initials: F
authors.lastname: Krog
authors.forename: Peter
authors.initials: P
authors.lastname: Beale
mesh_terms: D002496:Central Venous Pressure; D002648:Child; D002675:Child, Preschool; D006498:Hepatectomy / Q000379:methods; D018197:Hepatoblastoma / Q000601:surgery; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D012189:Retrospective Studies; D013019:South Africa; D009396:Wilms Tumor / Q000601:surgery