Blunt hepatic injury: Minimal intervention is the policy of treatment

J. F. Fang, R. J. Chen, B. C. Lin, Y. B. Hsu, J. L. Kao, M. F. Chen

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Many publications recommend nonoperative treatment for stable blunt hepatic injury patients. Unstable hemodynamic status is the only indication for surgery. When operation is indicated, controversies exist regarding which operative procedure will be more beneficial to the patients. The purposes of this study are to compare the results of operative and nonoperative management of patients with blunt hepatic injuries and to identify the optimal surgical approach when surgery is indicated. Methods: Different prospective protocols of treating adult blunt hepatic injuries were conducted. From 1992 to 1993 (group I), urgent surgery would be performed in the presence of hemoperitoneum. The policy shifted to aggressive nonoperative approach between 1996 and 1997 (group II). The patients from each period were divided into three subgroups. Group A included the patients who received nonoperative treatment in either period. Group B consisted of the patients who received surgery in the first period and nonoperative management in the second period. Group C included the patients who were operated on in either group. Comparisons were made between matched groups. Results: Groups IA and IIA patients had minor injuries and could be successfully treated nonoperatively. The results of groups IB and IIB were similar concerning hospital stay, morbidity, and mortality. Transfusion requirements of group IIB patients were significantly higher (2.2 vs. 1.1 units, p = 0.01) than those of group IB. However, 25 (58%) celiotomies of group IB patients were nontherapeutic. When surgery was indicated, group IC patients had significantly higher liver-related mortality (14 of 49 vs. 3 of 55, p = 0.002). Anatomic resection was performed more frequently in that period. Conclusion: Nonoperative treatment significantly decreased the rate of nontherapeutic laparotomy but carried the risks of higher transfusion requirements and delaying operation. When surgery was indicated, the policy of minimal intervention positively affected the patients' outcomes. The goal of surgery should be hemorrhage control rather than resection of the injured liver tissues.

Original languageEnglish
Pages (from-to)722-728
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number4
Publication statusPublished - 2000
Externally publishedYes

Fingerprint

Nonpenetrating Wounds
Liver
Therapeutics
Hemoperitoneum
Operative Surgical Procedures
Hospital Mortality
Laparotomy
Publications
Length of Stay
Research Design
Hemodynamics

Keywords

  • Anatomic resection
  • Blunt hepatic injury
  • Nonoperative treatment

ASJC Scopus subject areas

  • Surgery

Cite this

Blunt hepatic injury : Minimal intervention is the policy of treatment. / Fang, J. F.; Chen, R. J.; Lin, B. C.; Hsu, Y. B.; Kao, J. L.; Chen, M. F.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 4, 2000, p. 722-728.

Research output: Contribution to journalArticle

Fang, J. F. ; Chen, R. J. ; Lin, B. C. ; Hsu, Y. B. ; Kao, J. L. ; Chen, M. F. / Blunt hepatic injury : Minimal intervention is the policy of treatment. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 4. pp. 722-728.
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N2 - Background: Many publications recommend nonoperative treatment for stable blunt hepatic injury patients. Unstable hemodynamic status is the only indication for surgery. When operation is indicated, controversies exist regarding which operative procedure will be more beneficial to the patients. The purposes of this study are to compare the results of operative and nonoperative management of patients with blunt hepatic injuries and to identify the optimal surgical approach when surgery is indicated. Methods: Different prospective protocols of treating adult blunt hepatic injuries were conducted. From 1992 to 1993 (group I), urgent surgery would be performed in the presence of hemoperitoneum. The policy shifted to aggressive nonoperative approach between 1996 and 1997 (group II). The patients from each period were divided into three subgroups. Group A included the patients who received nonoperative treatment in either period. Group B consisted of the patients who received surgery in the first period and nonoperative management in the second period. Group C included the patients who were operated on in either group. Comparisons were made between matched groups. Results: Groups IA and IIA patients had minor injuries and could be successfully treated nonoperatively. The results of groups IB and IIB were similar concerning hospital stay, morbidity, and mortality. Transfusion requirements of group IIB patients were significantly higher (2.2 vs. 1.1 units, p = 0.01) than those of group IB. However, 25 (58%) celiotomies of group IB patients were nontherapeutic. When surgery was indicated, group IC patients had significantly higher liver-related mortality (14 of 49 vs. 3 of 55, p = 0.002). Anatomic resection was performed more frequently in that period. Conclusion: Nonoperative treatment significantly decreased the rate of nontherapeutic laparotomy but carried the risks of higher transfusion requirements and delaying operation. When surgery was indicated, the policy of minimal intervention positively affected the patients' outcomes. The goal of surgery should be hemorrhage control rather than resection of the injured liver tissues.

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