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Comparison Of Transection Techniques In Pediatric Major Hepatectomy: A Matched Pair Analysis



Comparison Of Transection Techniques In Pediatric Major Hepatectomy: A Matched Pair Analysis

March 8, 2023

HEIDELBERG, GERMANY – On February 23, 2023, Liver Surgery Research’s new article, “Comparison Of Transection Techniques In Pediatric Major Hepatectomy: A Matched Pair Analysis," authored by Juri Fuchs, Fabian Ruping, Anastasia Murtha-Lemekhova, Markus Kessler, Patrick Günther, Arianeb Mehrabi, and Katrin Hoffmann was published. This manuscript was published by the peer reviewed and open access journal, HPB (IHPBA); which has an impact factor of 3.842.


Background: Evidence on safety and efficacy of different liver transection techniques in pediatric major hepatectomy is completely lacking, as no study has been conducted so far. The use of stapler hepatectomy has never before been reported in children.

Methods: Three liver transection techniques were compared: (1) ultrasonic dissector (CUSA), (2) tissue sealing device (LigaSure™), and (3) stapler hepatectomy. All pediatric hepatectomies performed at a referral center in a 12-year study period were analyzed, patients were pair-matched in a 1:1:1-fashion. Intraoperative weight-adjusted blood loss, operation time, use of inflow occlusion, liver injury (peak-transaminase levels), postoperative complications (CCI), and long-term outcome were compared.

Results: Of 57 pediatric liver resections, 15 patients were matched as triples based on age, weight, tumor stage, and extent of resection. Intraoperative blood loss was not significantly different between the groups (p = 0.765). Stapler hepatectomy was associated with significantly shorter operation time (p = 0.028). Neither postoperative death nor bile leakage occurred, and no reoperation due to hemorrhage was needed in any patient.

Conclusion: This is the first comparison of transection techniques in pediatric liver resection and the first report on stapler hepatectomy in children. All three techniques can be safely applied and may harbor individual advantages in pediatric hepatectomy each.

About Liver Surgery Research

Liver Surgery Research (LSR) is a medical research group, located at Heidelberg University in Heidelberg, Germany. LSR specializes in research investigating liver regeneration after hepatectomy (liver resection) and post-hepatectomy liver failure, HCC development and treatment (especially in the context of MAFLD [metabolically associated fatty liver disease]), and rare liver lesions and diseases. LSR is the founder and leader of the RELIVE (RarE LIVEr) Initiative; a multidisciplinary project to establish evidence-based therapies for rare liver diseases. LSR is currently working on over 20 research projects and has over 100 peer reviewed published authorships. To learn more about Liver Surgery Research, visit


Nicholas Murtha

Communications Manager

Liver Surgery Research at Heidelberg University


Fuchs, J., Ruping, F., Murtha-Lemekhova, A., Kessler, M., Günther, P., Mehrabi, A., & Hoffmann, K. (2023). Comparison of transection techniques in pediatric major hepatectomy: a matched pair analysis. HPB : the official journal of the International Hepato Pancreato Biliary Association, S1365-182X(23)00050-3. Advance online publication.

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