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Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy

BACKGROUND: According to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma. METHODS: From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of...

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Autores principales: Rocca, Aldo, Andolfi, Enrico, Zamboli, Anna Ginevra Immacolata, Surfaro, Giuseppe, Tafuri, Domenico, Costa, Gianluca, Frezza, Barbara, Scricciolo, Marta, Amato, Maurizio, Bianco, Paolo, Brongo, Sergio, Ceccarelli, Graziano, Giuliani, Antonio, Amato, Bruno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: De Gruyter 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534101/
https://www.ncbi.nlm.nih.gov/pubmed/31157303
http://dx.doi.org/10.1515/med-2019-0038
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author Rocca, Aldo
Andolfi, Enrico
Zamboli, Anna Ginevra Immacolata
Surfaro, Giuseppe
Tafuri, Domenico
Costa, Gianluca
Frezza, Barbara
Scricciolo, Marta
Amato, Maurizio
Bianco, Paolo
Brongo, Sergio
Ceccarelli, Graziano
Giuliani, Antonio
Amato, Bruno
author_facet Rocca, Aldo
Andolfi, Enrico
Zamboli, Anna Ginevra Immacolata
Surfaro, Giuseppe
Tafuri, Domenico
Costa, Gianluca
Frezza, Barbara
Scricciolo, Marta
Amato, Maurizio
Bianco, Paolo
Brongo, Sergio
Ceccarelli, Graziano
Giuliani, Antonio
Amato, Bruno
author_sort Rocca, Aldo
collection PubMed
description BACKGROUND: According to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma. METHODS: From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first – line strategy for damage control surgery (DCS) in liver trauma. RESULTS: 26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure. In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%). CONCLUSIONS: The improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.
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spelling pubmed-65341012019-05-31 Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy Rocca, Aldo Andolfi, Enrico Zamboli, Anna Ginevra Immacolata Surfaro, Giuseppe Tafuri, Domenico Costa, Gianluca Frezza, Barbara Scricciolo, Marta Amato, Maurizio Bianco, Paolo Brongo, Sergio Ceccarelli, Graziano Giuliani, Antonio Amato, Bruno Open Med (Wars) Research Article BACKGROUND: According to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma. METHODS: From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first – line strategy for damage control surgery (DCS) in liver trauma. RESULTS: 26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure. In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%). CONCLUSIONS: The improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding. De Gruyter 2019-05-21 /pmc/articles/PMC6534101/ /pubmed/31157303 http://dx.doi.org/10.1515/med-2019-0038 Text en © 2019 Aldo Rocca et al. published by De Gruyter http://creativecommons.org/licenses/by-nc-nd/4.0 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
spellingShingle Research Article
Rocca, Aldo
Andolfi, Enrico
Zamboli, Anna Ginevra Immacolata
Surfaro, Giuseppe
Tafuri, Domenico
Costa, Gianluca
Frezza, Barbara
Scricciolo, Marta
Amato, Maurizio
Bianco, Paolo
Brongo, Sergio
Ceccarelli, Graziano
Giuliani, Antonio
Amato, Bruno
Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title_full Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title_fullStr Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title_full_unstemmed Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title_short Management of Complications of First Instance of Hepatic Trauma in a Liver Surgery Unit: Portal Vein Ligation as a Conservative Therapeutic Strategy
title_sort management of complications of first instance of hepatic trauma in a liver surgery unit: portal vein ligation as a conservative therapeutic strategy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534101/
https://www.ncbi.nlm.nih.gov/pubmed/31157303
http://dx.doi.org/10.1515/med-2019-0038
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