Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma

Ray Jade Chen, Jen Feng Fang, Being Chuan Lin, Yu Bau Hsu, Jung Liang Kao, Yi Chin Kao, Miin Fu Chen

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Most blunt hepatic trauma patients can be managed nonoperatively. The current failure rate in adult blunt hepatic trauma is reportedly 0 to 19%. We wished to evaluate the applicability of laparoscopy and fibrin glue as a minimally invasive alternative to laparotomy in these unsuccessfully nonoperative cases. Methods: All adult patients with blunt hepatic trauma managed nonoperatively at Linkou, Chang Gung Memorial Hospital Medical Center, Taipei, Taiwan, over a 2-year period from July 1, 1994, to June 30, 1996, were eligible for the study. A laparoscopic examination was performed on those who failed conservative care before undertaking an exploratory laparotomy. Fibrin glue was sprayed over the wound surface if ongoing hemorrhage was evident from any liver laceration. The clinical data, operative and laparoscopic findings, operative methods, and outcomes of these patients were studied. Results: Of the 61 patients, 55 patients were successfully treated without operation. Of the six failures (10%) all were liver related. After the introduction of laparoscopy, the non-therapeutic laparotomy rate would have decreased from 100% (6 of 6) to 50% (3 of 6), and with the adjunctive use of fibrin glue, the laparotomy rate went down to 0% (0 of 6). There were no deaths among the six patients receiving laparoscopy and fibrin glues; and only one developed a liver abscess, for a morbidity rate of 17% (1 of 6). Conclusions: The selective use of laparoscopy and fibrin glue can effectively reduce the nontherapeutic laparotomy rate among blunt hepatic trauma patients who fail nonoperative management.

Original languageEnglish
Pages (from-to)691-695
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume44
Issue number4
DOIs
Publication statusPublished - Apr 1998
Externally publishedYes

Fingerprint

Fibrin Tissue Adhesive
Laparoscopy
Laparotomy
Liver
Wounds and Injuries
Liver Abscess
Lacerations
Taiwan
Hemorrhage
Morbidity

Keywords

  • Blunt hepatic trauma
  • Fibrin glue
  • Laparoscopy
  • Nontherapeutic laparotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma. / Chen, Ray Jade; Fang, Jen Feng; Lin, Being Chuan; Hsu, Yu Bau; Kao, Jung Liang; Kao, Yi Chin; Chen, Miin Fu.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 44, No. 4, 04.1998, p. 691-695.

Research output: Contribution to journalArticle

Chen, Ray Jade ; Fang, Jen Feng ; Lin, Being Chuan ; Hsu, Yu Bau ; Kao, Jung Liang ; Kao, Yi Chin ; Chen, Miin Fu. / Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 1998 ; Vol. 44, No. 4. pp. 691-695.
@article{4328e3f60678463dbaeb415a126a213d,
title = "Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma",
abstract = "Background: Most blunt hepatic trauma patients can be managed nonoperatively. The current failure rate in adult blunt hepatic trauma is reportedly 0 to 19{\%}. We wished to evaluate the applicability of laparoscopy and fibrin glue as a minimally invasive alternative to laparotomy in these unsuccessfully nonoperative cases. Methods: All adult patients with blunt hepatic trauma managed nonoperatively at Linkou, Chang Gung Memorial Hospital Medical Center, Taipei, Taiwan, over a 2-year period from July 1, 1994, to June 30, 1996, were eligible for the study. A laparoscopic examination was performed on those who failed conservative care before undertaking an exploratory laparotomy. Fibrin glue was sprayed over the wound surface if ongoing hemorrhage was evident from any liver laceration. The clinical data, operative and laparoscopic findings, operative methods, and outcomes of these patients were studied. Results: Of the 61 patients, 55 patients were successfully treated without operation. Of the six failures (10{\%}) all were liver related. After the introduction of laparoscopy, the non-therapeutic laparotomy rate would have decreased from 100{\%} (6 of 6) to 50{\%} (3 of 6), and with the adjunctive use of fibrin glue, the laparotomy rate went down to 0{\%} (0 of 6). There were no deaths among the six patients receiving laparoscopy and fibrin glues; and only one developed a liver abscess, for a morbidity rate of 17{\%} (1 of 6). Conclusions: The selective use of laparoscopy and fibrin glue can effectively reduce the nontherapeutic laparotomy rate among blunt hepatic trauma patients who fail nonoperative management.",
keywords = "Blunt hepatic trauma, Fibrin glue, Laparoscopy, Nontherapeutic laparotomy",
author = "Chen, {Ray Jade} and Fang, {Jen Feng} and Lin, {Being Chuan} and Hsu, {Yu Bau} and Kao, {Jung Liang} and Kao, {Yi Chin} and Chen, {Miin Fu}",
year = "1998",
month = "4",
doi = "10.1097/00005373-199804000-00024",
language = "English",
volume = "44",
pages = "691--695",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma

AU - Chen, Ray Jade

AU - Fang, Jen Feng

AU - Lin, Being Chuan

AU - Hsu, Yu Bau

AU - Kao, Jung Liang

AU - Kao, Yi Chin

AU - Chen, Miin Fu

PY - 1998/4

Y1 - 1998/4

N2 - Background: Most blunt hepatic trauma patients can be managed nonoperatively. The current failure rate in adult blunt hepatic trauma is reportedly 0 to 19%. We wished to evaluate the applicability of laparoscopy and fibrin glue as a minimally invasive alternative to laparotomy in these unsuccessfully nonoperative cases. Methods: All adult patients with blunt hepatic trauma managed nonoperatively at Linkou, Chang Gung Memorial Hospital Medical Center, Taipei, Taiwan, over a 2-year period from July 1, 1994, to June 30, 1996, were eligible for the study. A laparoscopic examination was performed on those who failed conservative care before undertaking an exploratory laparotomy. Fibrin glue was sprayed over the wound surface if ongoing hemorrhage was evident from any liver laceration. The clinical data, operative and laparoscopic findings, operative methods, and outcomes of these patients were studied. Results: Of the 61 patients, 55 patients were successfully treated without operation. Of the six failures (10%) all were liver related. After the introduction of laparoscopy, the non-therapeutic laparotomy rate would have decreased from 100% (6 of 6) to 50% (3 of 6), and with the adjunctive use of fibrin glue, the laparotomy rate went down to 0% (0 of 6). There were no deaths among the six patients receiving laparoscopy and fibrin glues; and only one developed a liver abscess, for a morbidity rate of 17% (1 of 6). Conclusions: The selective use of laparoscopy and fibrin glue can effectively reduce the nontherapeutic laparotomy rate among blunt hepatic trauma patients who fail nonoperative management.

AB - Background: Most blunt hepatic trauma patients can be managed nonoperatively. The current failure rate in adult blunt hepatic trauma is reportedly 0 to 19%. We wished to evaluate the applicability of laparoscopy and fibrin glue as a minimally invasive alternative to laparotomy in these unsuccessfully nonoperative cases. Methods: All adult patients with blunt hepatic trauma managed nonoperatively at Linkou, Chang Gung Memorial Hospital Medical Center, Taipei, Taiwan, over a 2-year period from July 1, 1994, to June 30, 1996, were eligible for the study. A laparoscopic examination was performed on those who failed conservative care before undertaking an exploratory laparotomy. Fibrin glue was sprayed over the wound surface if ongoing hemorrhage was evident from any liver laceration. The clinical data, operative and laparoscopic findings, operative methods, and outcomes of these patients were studied. Results: Of the 61 patients, 55 patients were successfully treated without operation. Of the six failures (10%) all were liver related. After the introduction of laparoscopy, the non-therapeutic laparotomy rate would have decreased from 100% (6 of 6) to 50% (3 of 6), and with the adjunctive use of fibrin glue, the laparotomy rate went down to 0% (0 of 6). There were no deaths among the six patients receiving laparoscopy and fibrin glues; and only one developed a liver abscess, for a morbidity rate of 17% (1 of 6). Conclusions: The selective use of laparoscopy and fibrin glue can effectively reduce the nontherapeutic laparotomy rate among blunt hepatic trauma patients who fail nonoperative management.

KW - Blunt hepatic trauma

KW - Fibrin glue

KW - Laparoscopy

KW - Nontherapeutic laparotomy

UR - http://www.scopus.com/inward/record.url?scp=0031922481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031922481&partnerID=8YFLogxK

U2 - 10.1097/00005373-199804000-00024

DO - 10.1097/00005373-199804000-00024

M3 - Article

C2 - 9555844

AN - SCOPUS:0031922481

VL - 44

SP - 691

EP - 695

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -