[Treatment of hepatic trauma by hepatotomy with selective vasculo-biliary control. Technical aspects and outcomes].
Severe hemorrhage from liver parenchyma in hepatic trauma remains a formidable challenge even for the most experienced trauma surgeons. One therapeutic option when dealing with such hemorrhage is hepatotomy with selective vasculo-biliary control. The aim of this study was to evaluate the outcomes of hepatotomy with selective vasculo-biliary control for hepatic trauma. We used this technique in 27 patients with deep hepatic lacerations secondary to trauma. There were 19 penetrating and 8 blunt injuries. The lesions were graded as grade III--19 lesions, grade IV--6 lesions and grade V--2 lesions. The Pringle maneuver was applied in all cases (mean time 26 min). Hepatotomy was performed in all cases using a finger fracture technique; the average for this part of the procedure was 11.2 min. The resulting defect was treated by insertion of a viable omental pack in 11 patients and by hepatorrhaphy in 10 cases. There were 4 post-operative complications (14.8%) directed related to hepatic trauma--2 hemorrhages, one hepatic abscess and one biliary fistula. We recorded two deaths (7.4%), one by exsanguination and one by multiple organ failure. The low rates of morbidity and mortality, the wide range of application (grade III to V, penetrating and blunt) and the speed of execution suggest that hepatotomy with selective vasculo-biliary control is a safe and efficient technique for controlling hemorrhage from deep lacerations.
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Clinica de Urgenţe Chirurgicale, Spitalul Clinic de Urgenţe Iaşi, Universitatea de Medicină si Farmacie "Gr. T. Popa" Iaşi. slunca@hotmail.com
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D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006431:Hemobilia / Q000209:etiology / Q000517:prevention & control*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery