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Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience.

Doklestić K, Stefanović B, Gregorić P, Ivančević N, Lončar Z, Jovanović B, Bumbaširević V, Jeremić V, Vujadinović ST, Stefanović B, Milić N, Karamarković A - World J Emerg Surg (2015)

Bottom Line: There was no statistically significant difference in terms of the surgical approach.Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001).All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Belgrade and Clinical Center of Serbia, Clinic for Emergency Surgery, University of Belgrade, Serbia, Pasteur Str.2, Belgrade, 11000 Serbia.

ABSTRACT

Background: Severe liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection.

Material and method: This is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III-V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding.

Results: Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p = 0.000; p = 0.0001). Definitive hepatic repair was performed in 62(51.2 %) patient. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59(48.8 %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Overall mortality rate was 33.1 %. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001).

Conclusion: All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

No MeSH data available.


Related in: MedlinePlus

Intraoperative finding in penetrating liver injury. A 36 year old male suffered a penetrating abdominal injury (stab wound to the right upper abdomen) with AAST grade IV liver injury. Non-anatomic liver resection was performed
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Fig1: Intraoperative finding in penetrating liver injury. A 36 year old male suffered a penetrating abdominal injury (stab wound to the right upper abdomen) with AAST grade IV liver injury. Non-anatomic liver resection was performed

Mentions: The general characteristics of all 121 patients with severe liver trauma who were included in our study with comparison between the survivors and non-survivors summarizes in Table 1. In this study 81(66.9 %) patients survived, while 40(33.1 %) of them died. In this study there were 90(74.4 %) males and 31(25.6 %) females (Table 1). Blunt hepatic injury was the leading mechanism of trauma, seen in 98(80.9 %) patients (Table 1). Road traffic accident was the leading cause of blunt trauma recorded in 80 (66.1 %) patients, and among them were 37(30.6 %) drivers, 36 (29.7 %) pedestrians and 7(5.8 %) passengers (data not shown). The remaining 10 (8.2 %) patients with blunt liver trauma were injured by falling from a roof and eight were hiting by assailant (6.6 %). Pentrating liver injury was recorded in 23 (19.0 %), with equal distribution between the groups: 15(19.0 %) suffered stab wounds, while 8(6.6 %) injured by firearms (Fig. 1). A total of 108(89.2 %) had liver trauma associated with injury >2 body regions, there was no difference between survivors and non-survivors (Table 1). Total of 82(67.8 %) patients had a ISS>34 (Table 2).Table 1


Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience.

Doklestić K, Stefanović B, Gregorić P, Ivančević N, Lončar Z, Jovanović B, Bumbaširević V, Jeremić V, Vujadinović ST, Stefanović B, Milić N, Karamarković A - World J Emerg Surg (2015)

Intraoperative finding in penetrating liver injury. A 36 year old male suffered a penetrating abdominal injury (stab wound to the right upper abdomen) with AAST grade IV liver injury. Non-anatomic liver resection was performed
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522150&req=5

Fig1: Intraoperative finding in penetrating liver injury. A 36 year old male suffered a penetrating abdominal injury (stab wound to the right upper abdomen) with AAST grade IV liver injury. Non-anatomic liver resection was performed
Mentions: The general characteristics of all 121 patients with severe liver trauma who were included in our study with comparison between the survivors and non-survivors summarizes in Table 1. In this study 81(66.9 %) patients survived, while 40(33.1 %) of them died. In this study there were 90(74.4 %) males and 31(25.6 %) females (Table 1). Blunt hepatic injury was the leading mechanism of trauma, seen in 98(80.9 %) patients (Table 1). Road traffic accident was the leading cause of blunt trauma recorded in 80 (66.1 %) patients, and among them were 37(30.6 %) drivers, 36 (29.7 %) pedestrians and 7(5.8 %) passengers (data not shown). The remaining 10 (8.2 %) patients with blunt liver trauma were injured by falling from a roof and eight were hiting by assailant (6.6 %). Pentrating liver injury was recorded in 23 (19.0 %), with equal distribution between the groups: 15(19.0 %) suffered stab wounds, while 8(6.6 %) injured by firearms (Fig. 1). A total of 108(89.2 %) had liver trauma associated with injury >2 body regions, there was no difference between survivors and non-survivors (Table 1). Total of 82(67.8 %) patients had a ISS>34 (Table 2).Table 1

Bottom Line: There was no statistically significant difference in terms of the surgical approach.Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001).All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Belgrade and Clinical Center of Serbia, Clinic for Emergency Surgery, University of Belgrade, Serbia, Pasteur Str.2, Belgrade, 11000 Serbia.

ABSTRACT

Background: Severe liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection.

Material and method: This is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III-V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding.

Results: Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p = 0.000; p = 0.0001). Definitive hepatic repair was performed in 62(51.2 %) patient. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59(48.8 %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Overall mortality rate was 33.1 %. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001).

Conclusion: All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

No MeSH data available.


Related in: MedlinePlus