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[The "damage control" in severe hepatic injuries: our experience]
G Tugnoli1, M Casali, S Villani
1Ospedale Maggiore, Unità Operativa di Chirurgia d'Urgenza e del Trauma, Azienda USL Città di Bologna.
Annali Italiani Di Chirurgia
|May 14, 2004
Summary
Damage control surgery, including perihepatic packing, is a critical approach for severe liver injuries. This strategy, while effective for bleeding control, necessitates careful patient selection due to associated high mortality rates.
Area of Science:
- Trauma Surgery
- Hepatobiliary Surgery
- Emergency Medicine
Background:
- Complex hepatic injuries present significant management challenges.
- Severe liver trauma often involves substantial hemorrhage, acidosis, and hypothermia.
Purpose of the Study:
- To assess the 12-year outcomes of treating severe liver injuries using perihepatic packing and damage control principles.
- Evaluate the efficacy and limitations of damage control resuscitation in major hepatic trauma.
Main Methods:
- Retrospective review of 21 patients with Grade IV-V liver injuries.
- Analysis of patients admitted to a major trauma center between 1989 and 2001.
- Inclusion criteria: severe hemorrhage, hypothermia, and acidosis.
Main Results:
- The study included patients with major blunt hepatic trauma (mean age 39.6, ISS 41.5).
- Perihepatic packing controlled bleeding in 16 patients, but 10 required further intervention for recurrent or new bleeding.
- Mortality was high (57.2%), with survival linked to Injury Severity Score (ISS), Glasgow Coma Scale (GCS), blood loss, and acidosis.
Conclusions:
- The traditional surgical approach may be inadequate for complex hepatic injuries.
- Damage control surgery is recommended as a preferred alternative in selected cases of severe liver trauma.
- Careful patient selection is crucial for optimizing outcomes with damage control strategies.