Abstract
Background
Evidence on safety and efficacy of different liver transection techniques in pediatric
major hepatectomy is completely lacking, as no study has been conducted so far. The
use of stapler hepatectomy has never before been reported in children.
Methods
Three liver transection techniques were compared: (1) ultrasonic dissector (CUSA),
(2) tissue sealing device (LigaSure™), and (3) stapler hepatectomy. All pediatric
hepatectomies performed at a referral center in a 12-year study period were analyzed,
patients were pair-matched in a 1:1:1-fashion. Intraoperative weight-adjusted blood
loss, operation time, use of inflow occlusion, liver injury (peak-transaminase levels),
postoperative complications (CCI), and long-term outcome were compared.
Results
Of 57 pediatric liver resections, 15 patients were matched as triples based on age,
weight, tumor stage, and extent of resection. Intraoperative blood loss was not significantly
different between the groups (p = 0.765). Stapler hepatectomy was associated with significantly shorter operation
time (p = 0.028). Neither postoperative death nor bile leakage occurred, and no reoperation
due to hemorrhage was needed in any patient.
Conclusion
This is the first comparison of transection techniques in pediatric liver resection
and the first report on stapler hepatectomy in children. All three techniques can
be safely applied and may harbor individual advantages in pediatric hepatectomy each.
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Article info
Publication history
Published online: February 23, 2023
Accepted:
February 13,
2023
Received:
November 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
