Large and giant tumors, especially hepatoblastomas, are more frequently presented in pediatric patients. At about two-third of hepatoblastomas at the time of diagnosis are unresectable and liver transplantation is considered as a treatment of choice because of insufficient future liver remnant volume. In selected cases, 2-staged hepatectomy may be the unique chance for curative resection except hepatectomy followed by liver replacement. Despite the overwhelming spread of minimally invasive liver surgery, the laparoscopic approach remains uncommon in children. A case of successful partial associating liver partition with portal vein ligation for staged hepatectomy firstly accomplished pure laparoscopically on the first stage in an infant is presented. Described experience suggests both: the feasibility of laparoscopic procedures and the effectiveness of partial in situ liver splitting to reach appropriate future liver remnant volume and to avoid liver transplantation and its disadvantages.
Aim. To analyze the short-term outcomes of сentral segments liver resection in children, according to the initial experience.Мethods. The data of patients with different centrally located liver neoplasms were analyzed. This retrospective study included three patients with hepatoblastoma, one observation of mesenchymal hamartoma of the liver and one patient with hepatocellular carcinoma. Different types of central liver resections were carried out in these patients between March and October 2018. The technical aspects and the short-term results are described.Results. Median age of patients was 78 months (9 months – 12 years). Patients underwent: segmentectomy 4b, bisegmentectomy 4b, 5, threesegmentectomy 4, 5, 6, mesohepatectomy (anatomical segmentectomy 4, 5, 8) with biliary reconstruction for posterior liver segments, mesohepatectomy with anatomical segmentectomy 6 and atypical S2, 3 resection. Dindo–Clavien grade IIIa postoperative complication developed in one patient. Vascular complications and posthepatectomy liver failure were absent. The hospital stay ranged between 9 to 14 days. The median follow-up period came to 8 months (7–14 months). The overall and event free survival at the time of writing is 100%.Conclusion. Resections of central liver segments in children are feasible and should be carried out in experiences in liver surgery centers.
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