Abstract

Introduction: Common indications of hepatic resection in children are primary liver tumours, localized secondaries in the liver, trauma, localized Caroli’s disease etc. Refinements in the understanding of surgical anatomy of the liver along with better imaging modalities have accounted for greater percentage of resectable tumours and reduced blood loss resulting in significantly reduced mortality in recent times.

Materials: From October 2015 until September 2017, hepatic resections were performed in four children between 23 months to 10 years of age at different surgery unit of Hospitals. Two of these patients had Mesenchymal hamartomas, one had malignant mesenchymoma and the other one patient had type IV Choledochal cyst, the intrahepatic part confined to left lobe of the liver.

Results: Right hepatic lobectomy was done in three patients and left hepatic lobectomy in one patient. There was no operative mortality.  Mean operating time was 285 minutes (210 to 360 minutes); average bypass time was 105 minutes (90 to 120 minutes); average operating blood loss was 750 ml (500 to 1000ml). Average hospital stay was 12 days (8 to 16 days).The patient with malignant mesenchymoma had died 6 weeks following surgery due to complications of chemotherapy. The other three patients had uneventful recovery. One patient of mesenchymal hamartoma lost to follow up after 3 months of surgery. The other patients are on regular follow up for 24 months, 16 months, 6 months respectively, and all of them are doing well.

Conclusion:  Hepatic resections in children are challenging problem. Although malignant tumours of the liver are the commonest indications of major liver resections, only one of our patients had malignant tumour. Late presentation with disseminated disease may be the reason for low incidence of malignant tumours needing hepatic resection under cardiopulmonary bypass in our series.