[Hepatectomy in children using the trans-parenchymatous compressing suture as a hemostatic procedure]

Intraoperative hemorrhage during hepatic veins approach or during liver parenchyma transsection is the major risk of liver resection for children. We report a technique for hepatic resection based upon facility of safe ligation or clamping of vessels and ductules on a bloodless cut surface during transsection. This technique limits risk of extensive hemorrhage or damage to residual parenchyma, without heavy procedures of anatomical resections. Particularities of liver tissues and capsula of children are used. Perfect hemostasis of the cut edge is obtained by mattress sutures on Silastic * straps performed after clamping with specially designed liver clamps. The 3 main interests of this clamping are detailed. 21 liver resections were performed on children ranging in age from 9 months to 11 years. There was one intra-operative death and one within 30 days. Total blood loss during procedure was about 1/3 blood mass.