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Secondary surgery for liver trauma.

D J Sherlock1, H Bismuth

  • 1Hepato-Biliary and Liver Transplantation Unit, South Paris Faculty of Medicine, Paul Brousse Hospital, Villejuif, France.

The British Journal of Surgery
|November 1, 1991
PubMed
Summary

This study on liver trauma found that a conservative surgical approach, including limited liver resections, resulted in a low mortality rate for referred patients. Segmentectomy is recommended over major hepatectomy for specific liver injuries.

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Area of Science:

  • Trauma Surgery
  • Hepatobiliary Surgery
  • Surgical Outcomes

Background:

  • 46 patients with liver injuries were referred from other hospitals over a 10-year period.
  • Many referred patients had prior surgery, with uncontrollable bleeding and sepsis with biliary leakage being primary concerns.

Purpose of the Study:

  • To evaluate the outcomes of managing complex liver injuries referred after initial treatment elsewhere.
  • To assess the effectiveness of a conservative surgical strategy in liver trauma.

Main Methods:

  • Review of 46 referred liver injury cases from 1980 onwards.
  • Analysis of surgical interventions, including limited liver resections and segmentectomies.
  • Evaluation of patient outcomes, focusing on mortality and morbidity.

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Main Results:

  • A low mortality rate (2 deaths) was observed in patients treated with a conservative approach, including limited resections.
  • Segmentectomy was found suitable for injuries in liver segments 6 and 7, associated with bleeding.
  • Liver transplantation was considered for refractory cases, with one attempt for postoperative hepatic failure.

Conclusions:

  • A conservative surgical approach, emphasizing limited resections and segmentectomy, is effective in managing referred liver trauma.
  • Segmentectomy is a preferred method for specific liver injuries, potentially reducing mortality compared to major hepatectomy.
  • Liver transplantation may offer a salvage option for intractable liver injuries.