The role of liver resection in the management of severe blunt liver trauma.

Autor:	Küçükaslan H; Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Tayar S; Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Oğuz Ş; Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Topaloglu S; Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Geze Saatci S; Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Şenel AC; Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye., Calik A; Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon-Türkiye.
Jazyk:	angličtina
Zdroj:	Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES [Ulus Travma Acil Cerrahi Derg] 2022 Dec; Vol. 29 (1), pp. 122-129.
DOI:	10.14744/tjtes.2021.89678
Abstrakt:	Background: The management of hepatic trauma has a historical progress from mandatory operation with selective non-operative treatment, to non-operative treatment with selective operation. Liver resection (LR) seems to have a minimal role in the management of liver injury. However, surgical treatment becomes the only life-saving treatment in cases with severe liver trauma. Methods: It is a retrospective presentation of five cases with severe blunt liver injury whose were admitted at our center during the 8-year period. Results: The median age of patients was 30.8 (23-43). The most frequent mechanism of injury was pedestrian struck (60%). Two of five cases were transferred to our hospital from rural state hospitals after initial attempt to achieving hemostasis. The majority of liver injury was grade V (80%). The right lobe of the liver was injured in different extensions. Major vascular injury was associated to liver injury in four of five cases. The right hepatectomy (n=1), resectional debridement of segments 5, 6, and 7 (n=1), posterior sectorectomy (n=2), and segment 7 resection (n=1) were performed for hemostasis. Vascular injuries in the junction of inferior vena cava and right hepatic vein (n=1), the anterior surface of the right hepatic vein (n=1), the junction of segment 7 hepatic vein and right hepatic vein (n=1), the main portal vein (n=1), and the right renal vein (n=1) were repaired. Median operation time was 162 min (120-180 min). Operative mortality was 20%. Reoperation was needed in three of four survived cases. In-hospital complications were observed in two of four survived cases. Median stay in intensive care unit and hospital was 12.4 days (1-48 days) and 28.2 days (1-65 days), respectively. Conclusion: When a severe liver injury is unresponsive to packing, the surgeon must always keep in mind that extensive maneuvers for vascular control and LR are required for bleeding control.
Databáze:	MEDLINE
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