Recent experiences with a multidisciplinary approach to complex hepatic trauma.
BACKGROUND
The selection of an appropriate time to terminate damage control efforts when faced with haemorrhagic shock from severe hepatic trauma can be challenging. At our centre, trauma surgeons have increasingly been favouring an operative approach simply involving early perihepatic packing (without extensive use of intraoperative measures aimed at achieving definitive haemostasis) and temporary abdominal closure. This is often followed by hepatic arteriography with angioembolization, resuscitation, and early re-exploration under more optimal physiological conditions. This study describes the initial outcomes of this approach.


METHODS
All patients with high-grade liver injury requiring operative intervention due to refractory haemodynamic instability, presenting to our trauma centre between 1995 and 2001 were reviewed. Two treatment groups: definitive laparotomy (DL), and early packing (EP) with angioembolization and re-exploration were compared, using a retrospective audit.


RESULTS
Thirty-seven patients were identified with severe liver injuries requiring operative intervention (DL 30, EP 7). Patient demographics between groups were similar. The EP group was found to have lower mortality (0% versus 36.7%), but increased length of hospital stay, transfusion requirements, and complication rates.


CONCLUSIONS
A multidisciplinary approach to complex hepatic trauma involving brief damage control laparotomy with perihepatic packing only, followed by angioembolization, and early re-exploration may confer a survival benefit over early operative attempts at definitive haemostasis but is associated with complications.
MacKenzie
Shawn
S
Department of General Surgery, University of Calgary, Calgary, Alta., Canada T2N 2T9.
Kortbeek
John B
JB
Mulloy
Robert
R
Hameed
S Morad
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010347:Patient Care Planning; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014194:Traumatology / Q000379:methods*; D016896:Treatment Outcome