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Retrohepatic vein injuries: experience with 20 cases
K J Buechter1, D Sereda, G Gomez
1University of Miami School of Medicine, Department of Surgery.
The Journal of Trauma
|December 1, 1989
Summary
Retrohepatic vein injuries have high mortality. Direct repair, not hepatic bypass shunts, offers better survival rates for these critical liver trauma cases.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Hepatobiliary Surgery
Background:
- Retrohepatic vein injuries are associated with high mortality rates, ranging from 50% to 100%.
- Hepatic bypass techniques, introduced in the 1960s, have not significantly improved survival outcomes for these injuries.
Purpose of the Study:
- To evaluate the outcomes of managing retrohepatic vein injuries.
- To compare the effectiveness of shunting versus direct repair in reducing mortality.
Main Methods:
- Retrospective review of 20 patients with retrohepatic vein injuries (1982-1987).
- Analysis of patient outcomes based on trauma type (penetrating vs. blunt) and surgical approach (shunted vs. non-shunted).
Main Results:
- Overall mortality rate was 75% (15 out of 20 patients).
- Patients treated with hepatic bypass shunts had a 90% mortality rate (9 out of 10), while non-shunted patients had a 60% mortality rate (6 out of 10).
- Exsanguination was the primary cause of intraoperative death.
Conclusions:
- Direct exposure and repair of retrohepatic vein injuries are associated with lower mortality compared to shunting techniques.
- Rapid application of direct repair may improve patient survival, even in hypotensive patients where total vascular occlusion of the liver is poorly tolerated.