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Recent experiences with a multidisciplinary approach to complex hepatic trauma.
Shawn MacKenzie1, John B Kortbeek, Robert Mulloy
1Department of General Surgery, University of Calgary, Calgary, Alta., Canada T2N 2T9.
Injury
|August 11, 2004
Summary
Early packing and angioembolization for severe liver trauma may improve survival by avoiding early definitive surgery. However, this approach is linked to increased hospital stay and complications, necessitating careful consideration in managing hepatic trauma.
Area of Science:
- Trauma Surgery
- Hepatobiliary Surgery
- Surgical Critical Care
Background:
- Managing severe hepatic trauma with hemorrhagic shock presents challenges in determining the optimal timing for damage control.
- A shift towards early perihepatic packing and temporary abdominal closure, followed by angioembolization and re-exploration, has been observed.
Purpose of the Study:
- To evaluate the initial outcomes of an operative approach involving early packing and angioembolization for severe liver trauma.
Main Methods:
- A retrospective audit compared definitive laparotomy (DL) with early packing (EP) with angioembolization and re-exploration.
- Patients with high-grade liver injury and refractory hemodynamic instability between 1995 and 2001 were reviewed.
Main Results:
- The early packing (EP) group (7 patients) had 0% mortality compared to 36.7% in the definitive laparotomy (DL) group (30 patients).
- The EP group experienced longer hospital stays, higher transfusion needs, and increased complication rates.
Conclusions:
- A multidisciplinary strategy using damage control laparotomy with packing, angioembolization, and early re-exploration may enhance survival in complex hepatic trauma.
- This approach, while potentially improving survival, is associated with a higher incidence of complications.