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Major hepatectomy in children: approaching blood transfusion-free
Chih-Che Lin1, Chao-Long Chen, Yu-Fan Cheng
1Liver Transplant Program, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan. clchen@adm.cgmh.org.tw
Insights
Blood transfusion-free major hepatectomy in children is achievable with specific intraoperative techniques. This approach minimizes blood loss and reduces postoperative complications in pediatric patients undergoing liver surgery.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Surgical Oncology
Background:
- Major hepatectomy in children can lead to significant blood loss, necessitating transfusions.
- Blood transfusions in pediatric surgery are associated with increased morbidity and mortality.
- Minimizing blood loss is crucial for improving outcomes in pediatric liver resections.
Purpose of the Study:
- To describe intraoperative techniques and postoperative management for achieving blood transfusion-free major hepatectomy in children.
- To evaluate the safety and efficacy of transfusion-free major hepatectomy in a pediatric cohort.
- To present a method for reducing complications associated with major liver resections in pediatric patients.
Main Methods:
- Analysis of demographic data, surgical techniques, and intraoperative management in 14 pediatric patients undergoing major hepatectomy.
- Application of preoperative imaging, hemihepatic inflow control, intraoperative ultrasonography, and ultrasonic dissection.
- Implementation of a low central venous pressure strategy (5 cm H2O) through fluid restriction during liver transection.
Main Results:
- No operative mortality or major complications were observed in the study cohort.
- Mean blood loss was minimal (68 ml/kg), with no intraoperative blood transfusions required.
- Two patients received transfusions due to a liberal strategy and one due to preoperative tumor bleeding, but overall transfusion rates were low.
Conclusions:
- Major hepatectomy in children can be performed safely without blood transfusion, despite technical challenges.
- Implementing specific surgical techniques and management strategies significantly reduces blood loss.
- Transfusion-free major hepatectomy in pediatric patients is associated with decreased postoperative complications.
Introduction:
Major hepatectomy complicated with massive blood loss requires blood transfusion, which may result in increased morbidity and mortality. Intraoperative techniques and postoperative management that achieves blood transfusion-free major hepatectomy in children are described.
Methods:
Fourteen children with a mean age of 3.1 years and mean body weight of 14 kg underwent major hepatectomy between May 1994 and September 2002. Demographic information, surgical techniques, and intraoperative management were analyzed.
Results:
Hepatectomy included right trisegmentectomy in seven cases, extended right lobectomy in three, right lobectomy in two, and left lobectomy in two. Preoperative imaging, hemihepatic inflow control, intraoperative ultrasonography, and ultrasonic dissection were routinely applied. Fluid was restricted to target a low central venous pressure (5 cm H(2)O) during transection. Postoperative low hemoglobin (>6.3 g/dl) was tolerated in pediatric patients. There was no operative mortality or major complications and only two cases of pleural effusion. The mean blood loss was 68 ml (range 1.25-13.0 ml/kg), and no blood transfusions were required intraoperatively. Blood transfusion was given because of a liberal strategy for major operation in two patients and preoperative tumor bleeding in one.
Conclusions:
Despite being technically challenging, major hepatectomy can be performed with minimal blood loss and without blood transfusion in children to decrease postoperative complications.
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