Management of major hepatic resection in infants and children. Report of sixteen cases.

EXTENSIVE ItEPATECTOMY has always been a challenge to both the surgeon and the anaesthetist. Even today, peroperative and post-operative mortality is as high as 30 per cent to 40 per cent. ~-7 Although the surgical techniques have been greatly improved by Quattlebaum, I Pack, 2 McDermott, 3 Longrnire 4 and others, the operative complications remain numerous. Sudden, massive and uncontrollable haemorrhage ~,6,s,9 is the most serious of these and sometimes is fatal. As the blood volume of the neonate, the infant and the child is small, blood loss may easily be under-rated or over-estimated; in either case, the consequences could be serious. At Ste. Justine Hospital for children in Montreal (S.J.H.M.) 16 patients had major hepatic resections between 1965 and 1972. These cases will be presented. Preoperative evaluation and operative management will be reviewed and some of the early post-operative complications will be summarized. In our series there were seven females and nine males. Their ages ranged from 14 days to 13 years and their weight from 2.3 to 48 kg. Their expected blood volumes varied from 184 ml to 3840 ml, based on an average of 80 ml /kg of body weight for all age groups. There were eleven cases of hepatic tumour and five post-traumatic hepatic lacerations. Twelve had resection of the right hepatic lobe, and four of the left. The anaesthetic agents were halothane in ten cases, droperidol .or narcotics in four cases, methoxyflurane in one case and oxygen only in one patient who was comatose. Moderate hypothermia (between 29 ~ C and 33 ~ C) was used during operation on nine occasions. The average age in this group was 3 years and 10 months and the average operating time was 7 hours and 30 minutes. The other seven patients were operated upon without hypothermia; their average age was 7 years and 3 months, and the average operating time was 4 hours and 25 minutes.