Abstract
Introduction Central hepatectomy or mesohepatectomy (MH) is a complex surgical technique rarely
used in children. It is indicated in central tumors to preserve functioning liver
mass avoiding an extended right hepatectomy. The purpose of this article is to analyze
our experience with this technique.
Methods We reviewed five patients who underwent MH in the period from 2008 to 2014. Diagnoses
were hepatoblastoma PRETEXT III (two cases), hepatic embryonal sarcoma (one case),
focal nodular hyperplasia (one case), and vascular tumor with rapid growth in a newborn
causing an acute liver failure, compartment syndrome, and multiple organ failure (one
case). In all cases, the tumor was centrally located, including the segment IVb, with
large displacement of the hepatic pedicle in two cases.
Results MH was standard in three cases and under total vascular exclusion in two cases. All
children are alive with a mean follow-up of 38 (6–70) months. None of the children
required reoperation because of bleeding. One child developed a biliary fistula in
the cutting area that closed spontaneously. The newborn with the vascular tumor required
the placement of a Gore-Tex patch (W. L. Gore & Associates, Inc, Flagstaff, Arizona,
United States) to relieve the compartment syndrome. He subsequently underwent partial
embolization of the tumor and MH under vascular exclusion.
Conclusions In selected patients, MH is an alternative to trisegmentectomy and should be available
in advanced pediatric hepatobiliary units.
Keywords
mesohepatectomy - central hepatectomy - hepatic tumor in children
