Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries.
BACKGROUND
Despite continuous advances in traumatology, juxtahepatic venous injuries are still the most difficult and deadly form of liver trauma. Most deaths result from exsanguination, and reported mortality ranges from 50% to 80%. This is an evaluation on our experience with the management of this high mortality injury following a refined operative strategy.


METHODS
This is a retrospective study of consecutive patients sustaining blunt juxtahepatic venous injuries. The management for these patients was mainly a refined operative strategy combined with a multidisciplinary approach. Preoperative conditions and the patient demographics were gathered. In addition, the number and type of interventional procedures, overall complications, and operative procedures were collected and analyzed.


RESULTS
From January, 1996 to March, 2004, 19 patients (M:F = 13:6) with juxtahepatic venous injuries were included and all were managed operatively. The operative procedures included hepatectomy by finger fracture technique for direct repair (8), perihepatic packing (1), packing and hepatic artery embolization (1), packing and hepatic artery ligation (1), hepatorrhaphy and packing (5), packing followed by hepatectomy (2) and atriocaval shunt for direct repair (1). The survival rate for the packing group was higher than that of the direct repair group (75% versus 45%), but was not statistically significant (p = 0.352). Injury to the retrohepatic vena cava influenced the patient's survival significantly (p = 0.041). The overall survival was 58% (11/19).


CONCLUSIONS
A well-defined operative strategy helps surgeons deal with the problem of blunt juxtahepatic venous injury, and its combination with multidisciplinary management will improve patient outcomes.
Liu
Po Ping
PP
Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. liupp@adm.cgmh.org.tw
Chen
Chao Long
CL
Cheng
Yu Fan
YF
Hsieh
Pei Min
PM
Tan
Bool Lee
BL
Jawan
Bruno
B
Ko
Sheung Fat
SF
D000328:Adult; D000465:Algorithms; D005260:Female; D006503:Hepatic Veins / Q000293:injuries* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000401:mortality / Q000601:surgery*