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.
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.
Similar content being viewed by others
References
Madding, G.F., Kennedy, P.A.: Trauma to the liver. In Major Problems in Clinical Surgery, J.E. Dunphy, editor, W.B. Saunders and Co., Philadelphia, 1965, pp. 1–10
Balasegaram, M., Joishy, K.: Hepatic resection: The logical approach to surgical management of major trauma to the liver. Am. J. Surg.142:580, 1981
Byrd, W.M., McAffee, D.K.: Emergency hepatic lobectomy in massive injury of the liver. Surg. Gynecol. Obstet.113:103, 1961
McClelland, R., Shires, T., Poulos, E.: Hepatic resection for massive trauma. J. Trauma4:282, 1964
Poulos, E.: Hepatic resection for massive liver injuries. Ann. Surg.157:525, 1963
Moore, F.A., Moore, E.E., Seagraves, A.: Non-resectional management of major hepatic trauma. Am. J. Surg.150:725, 1985
Carmona, R.H., Lim, R.C., Clark, G.C.: Morbidity and mortality in hepatic trauma, a 5 year study. Am. J. Surg.144:88, 1982
Douglas, R.G., Holdaway, C.M., Shaw, J.H.F.: Hepatic trauma in Auckland. Aust. N.Z. J. Surg.58:307, 1988
Feliciano, D.V., Jordan, G.L., Bitondo, C.G., Mattox, K.L., Burch, J.M., Cruse, P.A.: Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann. Surg.204:439, 1986
Hanna, S.S., Maheshwari, Y., Harrison, A.W., Taylor, G.A., Miller, H.A.B., Maggisano, R.: Blunt liver trauma at the Sunnybrook Regional Trauma Unit. Can. J. Surg.28:220, 1985
Moore, E.E.: Critical decisions in the management of liver trauma. Am. J. Surg.148:712, 1984
Trunkey, D.D., Shires, G.T., McClelland, R.: Management of liver trauma in 811 consecutive patients. Ann. Surg.179:722, 1974
Walt, J.A.: The mythology of hepatic trauma—Or Bable revisited. Am. J. Surg.135:12, 1978
Pachter, H.L., Spencer, F.C., Hoffstetter, S.R., Coppa, G.F.: Experience with the finger fracture technique to achieve haemostasis in 75 patients with severe liver injuries. Ann. Surg.197:771, 1983
Pachter, H.L., Spencer, F.C.: Recent concepts in the management of hepatic trauma. Ann. Surg.190:423, 1979
Little, J.M., Fernandes, A., Tait, N.: Liver trauma. Aust. N.Z. J. Surg.56:613, 1986
Blaisdell, F.W., Lim, R.C.: Liver resection. In Major Problems in Clinical Surgery, J.E. Dunphy, editor, W.B. Saunders and Co., London, 1971, pp. 131–145
Longmire, W.P., Cleveland, R.J.: Anatomy and trauma to the liver. Surg. Clin. North Am.52:687, 1972
Donovan, A.J., Michaelian, M.J., Yellin, A.E.: Hepatic lobectomy in trauma to the liver. Surgery73:833, 1973
Mays, E.T.: Hepatic trauma. Curr. Probl. Surg.10:1, 1973
Cox, E.F., Flancbaum, L., Dauterive, A.H., Paulson, R.L.: Blunt trauma to the liver. Analysis of management and mortality in 323 consecutive cases. Ann. Surg.207:126, 1988
Pretre, R., Mentha, G., Huber, O., Meyer, P., Vogel, J., Rohner, A.: Hepatic trauma: Risk factors influencing outcome. Br. J. Surg.75:520, 1988
Watson, D.I., Williams, J.A.R.: Management of the traumatised liver: An appraisal of 63 cases. Aust. N.Z. J. Surg.59:137, 1989
Schrock, T., Blaisdell, F.W., Mathewson, C.: Management of blunt trauma to the liver and hepatic veins. Arch. Surg.96:698, 1968
Mays, E.T.: The hazards of suturing certain wounds of the liver. Surg. Gynecol. Obstet.143:201, 1976
Olsen, W.R.: Late complications of central liver injuries. Surgery92:733, 1982
Carmona, R.H., Peck, D.Z., Lim, R.C.: The role of packing and planned re-operation in severe hepatic trauma. J. Trauma24:779, 1984
Hollands, M.J., Little, J.M.: Perihepatic packing: Its role in the management of liver trauma. Aust. N.Z. J. Surg.59:21, 1988
Svoboda, J.H., Peter, E.T., Dang, C.V., Parks, S.N., Ellyson, J.H.: Severe liver trauma in the face of coagulopathy. A case for temporary packing and early re-exploration. Am. J. Surg.144:717, 1982
Calne, R.Y., McMaster, P., Pentlow, B.D.: The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment. Br. J. Surg.66:338, 1979
Mays, E.T.: Lobar dearterialisation for exsanguinating wounds of the liver. J. Trauma12:397, 1972
Flint, L.M., Polk, H.C.: Selective hepatic arterial ligation: Limitations and failures. J. Trauma19:319, 1979
Claggett, G.P., Olsen, W.R.: Non-mechanical haemorrhage in severe liver injury. Ann. Surg.187:369, 1978
Brotman, S., Oliver, G., Oster-Granite, M.-L., Cowley, R.A.: The treatment of 179 blunt trauma-induced liver injuries in a statewide trauma centre. Am. Surg.50:603, 1984
Lim, R.C., Lau, G., Steele, M.: Prevention of complications after liver trauma. Am. J. Surg.132:156, 1976
Howard, R.J., Simmons, R.L.: Acquired immunologic deficiencies after trauma and surgical proceedures. Surg. Gynecol. Obstet.139:771, 1974
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hollands, M.J., Little, J.M. The role of hepatic resection in the management of blunt liver trauma. World J. Surg. 14, 478–482 (1990). https://doi.org/10.1007/BF01658671
Issue Date:
DOI: https://doi.org/10.1007/BF01658671