scholarly journals Damage Control Surgery for Hepatocellular Cancer Rupture in an Elderly Patient: Survival and Quality of Life

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Konstantinos Bouliaris ◽  
Grigorios Christodoulidis ◽  
Dimitrios Symeonidis ◽  
Alexandros Diamantis ◽  
Konstantinos Tepetes
Keyword(s):  
Elderly Patient ◽  
Liver Function ◽  
Spontaneous Rupture ◽  
Damage Control ◽  
Correct Diagnosis ◽  
Hypovolemic Shock ◽  
Future Liver Remnant ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Liver Remnant

Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare emergency condition with high mortality rate. Successful management depends on patients’ hemodynamic condition upon presentation and comorbidities, correct diagnosis, HCC status, liver function, and future liver remnant, as well as available sources. There is still a debate in the literature concerning the best approach in this devastating complication. Nevertheless, the primary goal should be a definitive bleeding arrest. In most cases, patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. In such cases, transcatheter arterial embolization (TAE) should be the treatment of choice. Emergency liver resection is an option when TAE fails or in cases with preserved liver function and limited tumors. Otherwise, damage control strategies, as in liver trauma, are a reasonable alternative. We report a case of an elderly patient with hemoperitoneum and hypovolemic shock from spontaneous rupture of undiagnosed HCC, who was treated successfully by emergency surgery and damage control approach.

scholarly journals Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

2017 ◽  
Vol 11 (1) ◽  
pp. 190-200
Author(s):  
Satoshi Koizumi ◽  
Kenta Katsumata ◽  
Tatsunori Ono ◽  
Kouhei Segami ◽  
Hiroyuki Hoshino ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Control Procedure ◽  
Severe Liver ◽  
Hepatic Hilus ◽  
Initial Strategy ◽  
Glissonean Pedicle ◽  
Definitive Surgery

The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

2005 ◽  
Vol 71 (3) ◽  
pp. 219-224 ◽  
Author(s):  
JosÉ A. Montalvo ◽  
JosÉ A. Acosta ◽  
Pablo RodrÍguez ◽  
Kathia Alejandro ◽  
AndrÉs SÁrraga
Keyword(s):  
Surgical Complications ◽  
Causes Of Death ◽  
Surgical Complication ◽  
Damage Control ◽  
Multiple Logistic Regression Analysis ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

scholarly journals Folinic Acid Potentiates the Liver Regeneration Process after Selective Portal Vein Ligation in Rats

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 371
Author(s):  
Jorge Gutiérrez Sáenz de Santa María ◽  
Borja Herrero de la Parte ◽  
Gaizka Gutiérrez-Sánchez ◽  
Inmaculada Ruiz Montesinos ◽  
Sira Iturrizaga Correcher ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Liver Regeneration ◽  
Folinic Acid ◽  
Hepatic Metastases ◽  
Future Liver Remnant ◽  
Control Group ◽  
Portal Vein Ligation ◽  
Nuclear Area ◽  
Liver Remnant

Liver resection remains the gold standard for hepatic metastases. The future liver remnant (FLR) and its functional status are two key points to consider before performing major liver resections, since patients with less than 25% FLR or a Child–Pugh B or C grade are not eligible for this procedure. Folinic acid (FA) is an essential agent in cell replication processes. Herein, we analyze the effect of FA as an enhancer of liver regeneration after selective portal vein ligation (PVL). Sixty-four male WAG/RijHsd rats were randomly distributed into eight groups: a control group and seven subjected to 50% PVL, by ligation of left portal branch. The treated animals received FA (2.5 m/kg), while the rest were given saline. After 36 h, 3 days or 7 days, liver tissue and blood samples were obtained. FA slightly but significantly increased FLR percentage (FLR%) on the 7th day (91.88 ± 0.61%) compared to control or saline-treated groups (86.72 ± 2.5 vs. 87 ± 3.33%; p < 0.01). The hepatocyte nuclear area was also increased both at 36 h and 7days with FA (61.55 ± 16.09 µm2, and 49.91 ± 15.38 µm2; p < 0.001). Finally, FA also improved liver function. In conclusion, FA has boosted liver regeneration assessed by FLR%, nuclear area size and restoration of liver function after PVL.

scholarly journals Management of complications of first instance of hepatic trauma in a liver surgery unit: Portal vein ligation as a conservative therapeutic strategy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 376-383 ◽  
Author(s):  
Aldo Rocca ◽  
Enrico Andolfi ◽  
Anna Ginevra Immacolata Zamboli ◽  
Giuseppe Surfaro ◽  
Domenico Tafuri ◽  
...  
Keyword(s):  
Portal Vein ◽  
Damage Control ◽  
Pathological Finding ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
The Other ◽  
Portal Vein Ligation ◽  
Bleeding Site ◽  
Hepatic Trauma ◽  
Management Of Complications

AbstractBackgroundAccording to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma.MethodsFrom June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first – line strategy for damage control surgery (DCS) in liver trauma.Results26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%).ConclusionsThe improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.

scholarly journals Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections

2020 ◽  
pp. 1-8
Author(s):  
Yuzo Yamamoto
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Volume Ratio ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Ligation ◽  
Liver Remnant

<b><i>Background:</i></b> Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. <b><i>Summary:</i></b> FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, <sup>99m</sup>Tc-labeled galactosyl human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either <sup>99m</sup>Tc-GSA or <sup>99m</sup>Tc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. <b><i>Key Messages:</i></b> Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.

scholarly journals Liver Trauma Management

2021 ◽  
Author(s):  
Henrique A. Wiederkehr ◽  
Julio Wiederkehr ◽  
Barbara A. Wiederkehr ◽  
Lucas M. Sarquis ◽  
Oona T. Daronch ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Hepatic Veins ◽  
Trauma Management ◽  
Conservative Approach ◽  
The Third ◽  
Wide Range ◽  
Polytrauma Patients ◽  
Complex Lesions

Liver trauma is responsible for the majority of penetrating abdominal trauma and is the third most common injury caused by firearms. Presenting a 20% mortality rate, it is an organ with wide and complex vascularization, receiving blood from the hepatic veins and portal vein, as well as from the hepatic arteries. The diagnosis is not always simple in polytrauma patients and contains a wide range of exams such as computerized tomography and diagnostic peritoneal lavage. Treatment depends mostly on a few factors such as the patient’s hemodynamic stability, the degree of injury according to the AAST classification, the resources available, and the surgeon’s expertise. Considering these factors, minor lesions can be treated mostly with a conservative approach in hemodynamically stable patients. Embolization by arteriography has shown good results in major lesions in clinically stable patients as well. On the other hand, more complex lesions associated with hemodynamically unstable patients may indicate damage control surgery applying techniques such as temporary liver packing and clamping the pedicle to restore the hemodynamic status. This chapter aims to describe those techniques and their indications in liver trauma.

scholarly journals Damage Control Surgery for Liver Trauma

2020 ◽  
Author(s):  
Ioannis A. Ziogas ◽  
Ioannis Katsaros ◽  
Georgios Tsoulfas
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma

Liver-fat and liver-function indices derived from Gd-EOB-DTPA-enhanced liver MRI for prediction of future liver remnant growth after portal vein occlusion

2016 ◽  
Vol 85 (4) ◽  
pp. 843-849 ◽  
Author(s):  
Borna K. Barth ◽  
Michael A. Fischer ◽  
Patryk Kambakamba ◽  
Mickael Lesurtel ◽  
Caecilia S. Reiner
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Future Liver Remnant ◽  
Liver Fat ◽  
Liver Mri ◽  
Liver Remnant ◽  
Portal Vein Occlusion ◽  
Vein Occlusion

scholarly journals Damage control in penetrating carotid artery trauma: changing a 100-year paradigm

2021 ◽  
Vol 52 (2) ◽  
pp. e4054807
Author(s):  
José Julian Serna ◽  
Carlos Alberto Ordoñez ◽  
Michael W Parra ◽  
Yaset Caicedo ◽  
Alberto Rosero ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Damage Control ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Altered Mental Status ◽  
Massive Bleeding ◽  
Carotid Artery Injuries ◽  
Therapeutic Decision Making ◽  
Non Operative Management

Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. An urgent surgical intervention is indicated if the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.

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