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.

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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 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 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 Evidence for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients: A Systematic Review

2020 ◽  
Author(s):  
Derek J. Roberts ◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
Chad G. Ball ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background: Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes).Methods: We searched 11 databases (1950-April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results: Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring >10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications.Conclusions: Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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

scholarly journals Povrede jetre - nasa iskustva u tretmanu

2010 ◽  
Vol 57 (1) ◽  
pp. 101-106
Author(s):  
G. Vukovic ◽  
B. Stefanovic ◽  
G. Kaljevic ◽  
V. Vukojevic ◽  
V. Resanovic ◽  
...  
Keyword(s):  
Liver Injury ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Young Population ◽  
Liver Injuries ◽  
Critical Patients ◽  
Care Problems ◽  
Isolated Liver ◽  
Standard Strategy

Background: Trauma is one of today's most serious and expensive health care problems, and it is the most common cause of mortality in young population. Non-operative treatment is standard strategy for management of blunt liver injuries in hemodynamically stable patients in last decade. Methods: Retrospective study included patients with liver trauma, admitted in the period december 1995-december 2005, in total 476. Results: 392 of 476 patients presenting with liver trauma had blunt and only 84 had penetrating injury. Isolated liver injury was identified in 27,5% and 72,5% had associated injuries. Average ISS value was 24.06 (SD=14.26). During the operation liver injury in patients was classified according to Moor. In 2% critical patients, due to hemodynamic unstability we performed 'damage control surgery'. Out of 476 patients 87,% were successfully managet, 6,1% died as 'mors in tabula' or during first 24 hours and 6,9% died during hospitalization. Conclusion: Higher proportion of nonoopertively treated is among patients with ISS less than and those with injuries grade I end II.

scholarly journals Epidemiological evaluation of hepatic trauma victims undergoing surgery

2016 ◽  
Vol 43 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Mitre Kalil ◽  
Isaac Massaud Amim Amaral
Keyword(s):  
Blunt Trauma ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Metropolitan Region ◽  
Trauma Patients ◽  
Hepatic Trauma ◽  
Female Ratio ◽  
Packed Red Blood Cells

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

scholarly journals Management of biliary complications following damage control surgery for liver trauma

2013 ◽  
Vol 39 (5) ◽  
pp. 511-516 ◽  
Author(s):  
M. Hommes ◽  
G. Kazemier ◽  
N. W. L. Schep ◽  
E. J. Kuipers ◽  
I. B. Schipper
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Biliary Complications
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