BACKGROUND: Most publications during the past decade have condemned the use of anatomic resection for liver trauma and advocated a conservative surgical approach when operative intervention was required. This policy has been supported by the high mortality rate reported by most authorities. The purpose of this study was to assess the results of anatomic hepatic resection for liver trauma in an institution in which the hepatobiliary surgeons are responsible for the management of severe liver injuries. METHODS: During the period 1983 to 1996, 287 patients with liver injuries were admitted to the hospital and 37 patients with severe liver trauma underwent anatomic resection. Demographic, clinical, operative, and postoperative data were collected and analyzed. The resections performed included right hemihepatectomy (n = 27), left hemihepatectomy (n = 1), left lateral segment resection (n = 5), and segmental resection (n = 4). RESULTS: There were three postoperative deaths after right hemihepatectomy (11.1%) and an overall mortality rate of 8.1%. There were no intraoperative deaths. Postoperative complications occurred in 22 patients (60%) and were most frequent in patients with concomitant injuries to other systems. Liver-related morbidity occurred in seven patients (19%). The median postoperative stay was 20 days. CONCLUSIONS: Anatomic hepatic resection for trauma is associated with low mortality and liver-related morbidity rates when performed by experienced hepatobiliary surgeons, and its role in the management of severe hepatic trauma should be reevaluated.
BACKGROUND: Most publications during the past decade have condemned the use of anatomic resection for liver trauma and advocated a conservative surgical approach when operative intervention was required. This policy has been supported by the high mortality rate reported by most authorities. The purpose of this study was to assess the results of anatomic hepatic resection for liver trauma in an institution in which the hepatobiliary surgeons are responsible for the management of severe liver injuries. METHODS: During the period 1983 to 1996, 287 patients with liver injuries were admitted to the hospital and 37 patients with severe liver trauma underwent anatomic resection. Demographic, clinical, operative, and postoperative data were collected and analyzed. The resections performed included right hemihepatectomy (n = 27), left hemihepatectomy (n = 1), left lateral segment resection (n = 5), and segmental resection (n = 4). RESULTS: There were three postoperative deaths after right hemihepatectomy (11.1%) and an overall mortality rate of 8.1%. There were no intraoperative deaths. Postoperative complications occurred in 22 patients (60%) and were most frequent in patients with concomitant injuries to other systems. Liver-related morbidity occurred in seven patients (19%). The median postoperative stay was 20 days. CONCLUSIONS: Anatomic hepatic resection for trauma is associated with low mortality and liver-related morbidity rates when performed by experienced hepatobiliary surgeons, and its role in the management of severe hepatic trauma should be reevaluated.
Authors: Jing-mou Gao; Ding-yuan Du; Xing-ji Zhao; Guo-long Liu; Jun Yang; Shan-hong Zhao; Xi Lin Journal: World J Surg Date: 2003-05-13 Impact factor: 3.352
Authors: Federico Coccolini; Raul Coimbra; Carlos Ordonez; Yoram Kluger; Felipe Vega; Ernest E Moore; Walt Biffl; Andrew Peitzman; Tal Horer; Fikri M Abu-Zidan; Massimo Sartelli; Gustavo P Fraga; Enrico Cicuttin; Luca Ansaloni; Michael W Parra; Mauricio Millán; Nicola DeAngelis; Kenji Inaba; George Velmahos; Ron Maier; Vladimir Khokha; Boris Sakakushev; Goran Augustin; Salomone di Saverio; Emanuil Pikoulis; Mircea Chirica; Viktor Reva; Ari Leppaniemi; Vassil Manchev; Massimo Chiarugi; Dimitrios Damaskos; Dieter Weber; Neil Parry; Zaza Demetrashvili; Ian Civil; Lena Napolitano; Davide Corbella; Fausto Catena Journal: World J Emerg Surg Date: 2020-03-30 Impact factor: 5.469