Surgical management and outcome of blunt major liver injuries: Experience of damage control laparotomy with perihepatic packing in one trauma centre

Being Chuan Lin, Jen Feng Fang, Ray Jade Chen, Yon Cheong Wong, Yu Pao Hsu

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methods From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p <0.05. Results Of the 58 patients, 20 (35%) were classified as AAST-OIS grade III, 24 (41%) as grade IV, and 14 (24%) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n = 21), hepatorrhaphy (n = 19), selective hepatic artery ligation (n = 11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p = 0.019), prolonged initial prothrombin time (PT) (p = 0.004), active partial thromboplastin time (APTT) (p <0.0001) and decreased platelet count (p = 0.005). Conclusions The mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.

Original languageEnglish
Pages (from-to)122-127
Number of pages6
JournalInjury
Volume45
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Trauma Centers
Laparotomy
Liver
Wounds and Injuries
Mortality
Partial Thromboplastin Time
Prothrombin Time
Platelet Count
Hepatic Artery
Operative Surgical Procedures
Hepatectomy
Debridement
Chi-Square Distribution
Nonparametric Statistics
Resuscitation
Ligation
Survivors
Sepsis
Retrospective Studies
Demography

Keywords

  • Blunt major liver injuries
  • Damage control laparotomy
  • Damage control resuscitation
  • Injury severity score
  • Perihepatic packing
  • Transarterial embolization

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Surgical management and outcome of blunt major liver injuries : Experience of damage control laparotomy with perihepatic packing in one trauma centre. / Lin, Being Chuan; Fang, Jen Feng; Chen, Ray Jade; Wong, Yon Cheong; Hsu, Yu Pao.

In: Injury, Vol. 45, No. 1, 01.2014, p. 122-127.

Research output: Contribution to journalArticle

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abstract = "Introduction This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methods From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p <0.05. Results Of the 58 patients, 20 (35{\%}) were classified as AAST-OIS grade III, 24 (41{\%}) as grade IV, and 14 (24{\%}) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n = 21), hepatorrhaphy (n = 19), selective hepatic artery ligation (n = 11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52{\%} mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30{\%} (6/20), grade IV: 54{\%} (13/24), and grade V: 79{\%} (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p = 0.019), prolonged initial prothrombin time (PT) (p = 0.004), active partial thromboplastin time (APTT) (p <0.0001) and decreased platelet count (p = 0.005). Conclusions The mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.",
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T2 - Experience of damage control laparotomy with perihepatic packing in one trauma centre

AU - Lin, Being Chuan

AU - Fang, Jen Feng

AU - Chen, Ray Jade

AU - Wong, Yon Cheong

AU - Hsu, Yu Pao

PY - 2014/1

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N2 - Introduction This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methods From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p <0.05. Results Of the 58 patients, 20 (35%) were classified as AAST-OIS grade III, 24 (41%) as grade IV, and 14 (24%) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n = 21), hepatorrhaphy (n = 19), selective hepatic artery ligation (n = 11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p = 0.019), prolonged initial prothrombin time (PT) (p = 0.004), active partial thromboplastin time (APTT) (p <0.0001) and decreased platelet count (p = 0.005). Conclusions The mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.

AB - Introduction This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methods From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p <0.05. Results Of the 58 patients, 20 (35%) were classified as AAST-OIS grade III, 24 (41%) as grade IV, and 14 (24%) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n = 21), hepatorrhaphy (n = 19), selective hepatic artery ligation (n = 11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p = 0.019), prolonged initial prothrombin time (PT) (p = 0.004), active partial thromboplastin time (APTT) (p <0.0001) and decreased platelet count (p = 0.005). Conclusions The mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.

KW - Blunt major liver injuries

KW - Damage control laparotomy

KW - Damage control resuscitation

KW - Injury severity score

KW - Perihepatic packing

KW - Transarterial embolization

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