[Hanging manuever in liver trauma]

Area of Science:

• Trauma Surgery
• Surgical Innovation
• Hepatobiliary Surgery

Context:

• Liver trauma management has evolved significantly.
• Historically, aggressive surgical approaches yielded high mortality rates (up to 60%) for major liver resections in trauma.
• Advancements in diagnostic imaging, anesthesia, and surgical techniques have reshaped patient care.

Purpose:

• To evaluate the shift from aggressive surgical management to a more tailored approach in liver trauma.
• To highlight the role of non-operative management for less severe injuries.
• To introduce and assess the efficacy of the Belghiti hanging maneuver for severe liver trauma.

Summary:

• Computerized tomography (CT) and focused abdominal ultrasound in trauma (FAST) have enabled non-operative management for approximately 70% of liver trauma cases (Grades I-III).
• Severe injuries (Grades IV-V), particularly those involving juxtahepatic structures, necessitate complex surgical intervention.
• The Belghiti hanging maneuver, an anterior approach for liver resection, offers a rapid solution for life-threatening hemorrhage in unstable patients, minimizing complications associated with conventional methods.

Impact:

• Improved patient outcomes through selective non-operative management.
• Reduced mortality and morbidity in liver trauma patients.
• Enhanced surgical techniques for managing complex and severe liver injuries.