title: Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma.
abstract: BACKGROUND
  Most blunt hepatic trauma patients can be managed nonoperatively. The current failure rate in adult blunt hepatic trauma is reportedly 0 to 19%. We wished to evaluate the applicability of laparoscopy and fibrin glue as a minimally invasive alternative to laparotomy in these unsuccessfully nonoperative cases.
  
  
  METHODS
  All adult patients with blunt hepatic trauma managed nonoperatively at Linkou, Chang Gung Memorial Hospital Medical Center, Taipei, Taiwan, over a 2-year period from July 1, 1994, to June 30, 1996, were eligible for the study. A laparoscopic examination was performed on those who failed conservative care before undertaking an exploratory laparotomy. Fibrin glue was sprayed over the wound surface if ongoing hemorrhage was evident from any liver laceration. The clinical data, operative and laparoscopic findings, operative methods, and outcomes of these patients were studied.
  
  
  RESULTS
  Of the 61 patients, 55 patients were successfully treated without operation. Of the six failures (10%) all were liver related. After the introduction of laparoscopy, the nontherapeutic laparotomy rate would have decreased from 100% (6 of 6) to 50% (3 of 6), and with the adjunctive use of fibrin glue, the laparotomy rate went down to 0% (0 of 6). There were no deaths among the six patients receiving laparoscopy and fibrin glues; and only one developed a liver abscess, for a morbidity rate of 17% (1 of 6).
  
  
  CONCLUSIONS
  The selective use of laparoscopy and fibrin glue can effectively reduce the nontherapeutic laparotomy rate among blunt hepatic trauma patients who fail nonoperative management.
authors.affiliation: Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
authors.forename: R J
authors.initials: RJ
authors.lastname: Chen
authors.forename: J F
authors.initials: JF
authors.lastname: Fang
authors.forename: B C
authors.initials: BC
authors.lastname: Lin
authors.forename: Y B
authors.initials: YB
authors.lastname: Hsu
authors.forename: J L
authors.initials: JL
authors.lastname: Kao
authors.forename: Y C
authors.initials: YC
authors.lastname: Kao
authors.forename: M F
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D008100:Liver Abscess / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000601:surgery*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives