Nonanatomic hepatic resection with a pledgetted suturing technique

Background/Purpose: Anatomic hepatic resection is dependent on the segmenta l infrastructure of the liver, whereas nonanatomic resection is independent of structural planes and is often fraught with excessive bleeding. The aut hors describe their experience with a novel technique using pledgetted sutu ring for extensive liver resection in patients with benign or malignant hep atic tumors. Methods: Four children, (mean age, 24.7 +/- 12.5 months) underwent liver re section for the following hepatic lesions: hepatoblastoma, invasive Wilms' tumor, Caroli's disease, and infantile hemangioendothelioma. In the child w ith hepatoblastoma, the lesion was considered unresectable by segmental ana tomy. A surgical technique was designed in which nonabsorbable 2-0 Teflon f elt pledgetted sutures were placed through the liver parenchyma in a nonana tomic resection plane. The mattress sutures were sequentially tied until th e resection plane was defined. The resection was sharply completed with a s calpel along the line of pledgetted sutures, independent of hepatic segment al anatomy. Results: Complete surgical resections of the hepatic lesions were obtained in all cases. Estimated blood loss was minimal with a mean of 5.3 +/- 0.9 m L/kg. No patient received a blood transfusion as a result of the hepatic re section. There were no postoperative hepatic complications resulting from t he resection. The child with hepatoblastoma had a delayed recovery, resulti ng in reexploration that ruled out a subphrenic abscess. Conclusions: The pledgetted suturing technique for hepatic resection is rel atively bloodless, safe, easy to perform, and may enable a complete surgica l resection of otherwise unresectable lesions. We advocate this technique w hen approaching a large hepatic lesion that would entail a difficult or inc omplete anatomic resection in infants. J Pediatr Surg 36:209-212. Copyright (C) 2001 by W.B. Saunders Company.