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Impact of pedicle clamping in pediatric liver resection
Philipp O Szavay1, Tobias Luithle, Steven W Warmann
1Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. philipp.szavay@med.uni-tuebingen.de
Insights
Vascular clamping in pediatric liver surgery reduces blood loss without impacting liver function. This safe technique is beneficial for children undergoing liver resection, especially major or extended procedures.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Surgical Techniques
Background:
- Vascular clamping is common in surgery, but its effect on pediatric liver resections was unstudied.
- Assessing pedicle clamping's impact on hepatocellular injury and blood loss in children is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of pedicle clamping during pediatric liver resection.
- To analyze the impact of vascular clamping on blood loss and liver function.
Main Methods:
- Retrospective analysis of 67 children undergoing liver resection.
- Comparison between 28 patients with pedicle clamping (PC group) and 39 without (NPC group).
- Statistical analysis of patient data, liver function tests (LFTs), and blood loss.
Main Results:
- No significant differences in LFTs or patient data between PC and NPC groups.
- The non-clamping group (NPC) required significantly more fresh frozen plasma (FFP).
- Extended resections without clamping (NPCext) had longer operation times and higher transfusion requirements.
Conclusions:
- Pedicle clamping is a blood-saving surgical technique for pediatric liver resection.
- Vascular clamping is safe, with no increased perioperative complications or impact on postoperative LFTs.
- This method is particularly advantageous for major and extended liver resections in children.
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.