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The management of the surgical complications of HELLP syndrome
S G Wilson1, A D White, A L Young
1Leeds Teaching Hospitals NHS Trust, UK.
Insights
Surgical complications of HELLP syndrome can be managed effectively. Haemodynamically stable patients with hepatic rupture can be treated conservatively, while unstable patients require specialized care.
Area of Science:
- Hepatobiliary surgery
- Obstetric emergencies
- Critical care medicine
Background:
- HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelet) presents surgical emergencies.
- A 10-year experience from a tertiary hepatobiliary center managing HELLP patients is reviewed.
- Selected cases and literature review highlight management strategies.
Observation:
- 1,002 cases reviewed, identifying 10 patients with surgical complications of HELLP syndrome.
- Seven patients had significant liver injury; 3 required surgical intervention.
- Four other patients needed surgery for non-liver related complications.
Findings:
- No maternal mortality was observed in this series.
- Conservative management is successful for hemodynamically stable HELLP patients with hepatic rupture.
- Perihepatic packing and transfer to a specialist liver unit are recommended for unstable patients.
Implications:
- This study provides a large series of successful HELLP complication management without maternal mortality.
- Highlights the importance of tailored management based on patient stability.
- Informs surgical and critical care approaches to HELLP syndrome complications.
Introduction:
Complications from HELLP (Haemolysis, Elevated Liver enzymes and Low Platelet) syndrome may present as an emergency to any surgeon. We review the ten-year experience of a tertiary hepatobiliary centre managing HELLP patients. Three selected cases are described to highlight our management strategy and a systematic review of the recent literature is presented.
Methods:
All patients with HELLP syndrome were identified from a prospectively maintained database and their details collated. Subsequently, a detailed search of PubMed was carried out to identify all case series of HELLP syndrome in the literature in the English language since 1999.
Results:
On review of 1,002 cases, 10 patients were identified with surgical complications of HELLP syndrome. Seven of these patients had a significant liver injury. Only three of these required surgical intervention for liver injury although four other patients required surgical intervention for other complications. There was no maternal mortality in this series. Review of the literature identified 49 cases in 31 publications. The management approaches of these patients were compared with ours.
Conclusions:
We have presented a large series of patients with surgical complications resulting from HELLP syndrome managed without maternal mortality. This review has confirmed that haemodynamically stable patients with HELLP syndrome associated hepatic rupture can be conservatively treated successfully. However, in unstable patients, perihepatic packing and transfer to a specialist liver unit is recommended.
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