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World Journal of Surgery

, Volume 14, Issue 4, pp 478–482 | Cite as

The role of hepatic resection in the management of blunt liver trauma

  • Michael J. Hollands
  • J. Miles Little
Progress Symposium—Nontumor Lesions of the Liver

Abstract

Forty-two (14%) of 306 patients with liver injuries presenting to Westmead Hospital over a 10-year period required hepatic resection as their definitive treatment. Two types of resection were performed: Resectional debridement utilized the plane of injury as the line of resection while anatomical resection utilized anatomical planes. Resectional debridement was used in 35 patients. In 29, the major technical problem was bleeding and 21 of these patients had associated hepatic vein injuries. In 5, the major problem was devitalized parenchyma, and, in 1, it was an intrahepatic bile duct injury. Anatomical resection was performed in 7 patients: 3 with bleeding, 2 with devitalized parenchyma, and 2 with intrahepatic bile duct injuries.

Overall, 15 patients died (36%). The most common cause of death was bleeding in 9 of the 15 patients. Survivors spent a median of 32 days in hospital (range: 11–162 days) and sustained a median of 2 complications (range: 0–6). The most common complications were respiratory infection and/or failure, coagulopathy, and sepsis.

Resection successfully addressed bleeding, devitalized parenchyma, and intrahepatic bile duct injuries with an acceptable mortality in critically ill patients who would otherwise have died.

Keywords

Hepatic Vein Hepatic Resection Como Cual Cela 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Sur 306 patients ayant une lésion traumatique du foie s'étant présentés à l'hôpital Westmead (Sydney) en 10 ans, 42 (14%) ont eu besoin d'une résection hépatique. Parage et résection utilisant le plan de la lésion comme ligne de résection a été effectué chez 35 patients. Chez 29 le problème technique essentiel était l'hémorragie et 21 d'entre eux avaient des lésions associées des veines hépatiques. Chez 5 patients, le plus grand problème a été la dévitalisation du parenchyme et chez un autre, une lésion intrahépatique des voies biliares. La résection anatomique, en passant par les plans anatomiques, a été accomplie chez 7 patients: 3 avec hémorragie, 2 avec parenchyme dévitalisé, et 2 avec lésions des voies biliaires intrahépatiques.

Quinze patients (36%) en tout sont morts. La cause de décès la plus fréquente a été l'hémorragie pour 9 des 15 patients. La médiane de séjour hospitalier pour les survivants a été de 32 jours (11–162 jours) et celle des complications, de 2 (0–6). Les complications les plus fréquentes étaient infection et/ou défaillance respiratoire, coagulopathie, et septicémie.

La résection a été utilisée avec succès pour hémorrhagie, parenchyme dévitalisé et lésions intrahépatiques des voies biliares avec un taux de mortalité acceptable chez des malades graves qui sans cela seraient morts.

Resumen

Cuarenta y dos (14%) de 306 pacientes con trauma hepático atendidos en el Westmead Hospital en un periodo de 10 años requirieron resección hepática como modalidad definitiva de tratamiento. Dos tipos de resección fueron empleados: En la resección por desbridamiento se hace uso del piano de la lesión como línea de resección, mientras que en la resección anatómica se utilizan los pianos anatómicos. El desbridamiento reseccional se utilizó en 35 pacientes; en 29 el mayor problema técnico fue el sangrado y 21 de éstos pacientes presentaban lesiones asociadas de las venas hepáticas. En 5 el mayor problema fue parénquima desvitalizado y en uno fue una lesión de un canal biliar intrahepático. Se efectuó la resección anatómica en 7 pacientes, 3 con sangrado, 2 con parenquima desvitalizado, y 2 con lesiones de canales biliares intrahepáticos.

La mortalidad global fue de 15 pacientes (36%); la causa de muerte más común fue sangrado, el cual ocurrió en 9. Los sobrevivientes tuvieron una hospitalización promedio de 32 días (rango de 11 a 162 días) y presentaron un promedio de 2 complicaciones (rango de 0 a 6). Las complicaciones más comunes fueron la infección respiratoria y/o falla respiratoria, la coagulopatía, y la sepsis.

La resección fue efectiva en el control del sangrado, del parenquima desvitalizado, y de las lesiones de los canales biliares, con una mortalidad aceptable en pacientes en estado crítico que, de otra manera, habrían fallecido.

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Copyright information

© Société Internationale de Chirurgie 1990

Authors and Affiliations

  • Michael J. Hollands
    • 1
  • J. Miles Little
    • 1
  1. 1.Department of Surgery and Trauma Research UnitWestmead HospitalSydneyAustralia

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