Limits...
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

Damage Control Surgery in blunt liver trauma (DCS I –Initial laparotomy). A 41 year old exsanguinating man with AAST grade V blunt liver injury (a). In order to control life-threatening hemorrhage emergency laparotomy was followed by direct liver vessel repair with bleeding vessels sutured prior to liver packing and hemostatic fibrin gel on liver surface (b). We performed liver packing with four abdominal swabs to provide liver compression (c, d)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Damage Control Surgery in blunt liver trauma (DCS I –Initial laparotomy). A 41 year old exsanguinating man with AAST grade V blunt liver injury (a). In order to control life-threatening hemorrhage emergency laparotomy was followed by direct liver vessel repair with bleeding vessels sutured prior to liver packing and hemostatic fibrin gel on liver surface (b). We performed liver packing with four abdominal swabs to provide liver compression (c, d)

Mentions: There was no statistically significant difference in the application of surgical approach (p= > 0.05) (Table 3). Range of blood removed from peritoneal cavity was 500–1500 ml. Definitive hepatic repair was performed in 62(51.2 %) patients (Table 3). Liver resection was performed in 12(9.9 %) patients: non-anatomic resection in 6(4.9 %) patients and major resection (≥3 Couinauds segments) in 6(4.9 %) (Fig. 1, 2). DCS with perihepatic packing and planned re-laparotomy after 48 h was used in 59(48.8 %) (Table 3). In DC strategy we used different additional procedures in combination with liver packing (Fig. 3).Table 3


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)

Damage Control Surgery in blunt liver trauma (DCS I –Initial laparotomy). A 41 year old exsanguinating man with AAST grade V blunt liver injury (a). In order to control life-threatening hemorrhage emergency laparotomy was followed by direct liver vessel repair with bleeding vessels sutured prior to liver packing and hemostatic fibrin gel on liver surface (b). We performed liver packing with four abdominal swabs to provide liver compression (c, d)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Damage Control Surgery in blunt liver trauma (DCS I –Initial laparotomy). A 41 year old exsanguinating man with AAST grade V blunt liver injury (a). In order to control life-threatening hemorrhage emergency laparotomy was followed by direct liver vessel repair with bleeding vessels sutured prior to liver packing and hemostatic fibrin gel on liver surface (b). We performed liver packing with four abdominal swabs to provide liver compression (c, d)
Mentions: There was no statistically significant difference in the application of surgical approach (p= > 0.05) (Table 3). Range of blood removed from peritoneal cavity was 500–1500 ml. Definitive hepatic repair was performed in 62(51.2 %) patients (Table 3). Liver resection was performed in 12(9.9 %) patients: non-anatomic resection in 6(4.9 %) patients and major resection (≥3 Couinauds segments) in 6(4.9 %) (Fig. 1, 2). DCS with perihepatic packing and planned re-laparotomy after 48 h was used in 59(48.8 %) (Table 3). In DC strategy we used different additional procedures in combination with liver packing (Fig. 3).Table 3

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