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

Keywords

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

ASJC Scopus subject areas

  • Surgery

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