Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review I njuries to the liver, extrahepatic biliary tree and pancreas (i.e., the "surgical soul") are often deadly and always challenging. These scenarios will engage all of your senses, test your skills, and demand great teamwork from you and your colleagues. In an effort to offer a continuing medical education review of this topic that consolidates the current published advice on treating hepato-pancreato-biliary (HPB) injuries, we performed a narrative scoping analysis of the literature. Our literature search protocol was developed according to recommendations for designing scoping reviews. 1 Three independent investigators searched MEDLINE, EMBASE, PubMed, Web of Science, Scopus and the Cochrane Library (English language) from their inception dates through to May 1, 2019, without restrictions. Disagreements were resolved by consensus. Literature on bile duct injuries during elective/ emergency cholecystectomy and/or pediatric trauma was excluded. The grey literature (conference abstracts (1988-2019) of the American Association for the Surgery of Trauma, Australasian Trauma Society, Eastern Association for the Surgery of Trauma, Trauma Association of Canada, Western Trauma Association, and 24 textbook chapters) was also searched for discussions not reported in peer-reviewed articles. General results Of the 8438 citations identified, 183 (11.6%) unique articles focused on HPB trauma were included in the scoping review. Agreement among investigators regarding selection of abstracts for full-text review (k-statistic 0.91, 95% confidence interval [CI] 0.88-0.94) and inclusion of articles in the scoping review (k-statistic 0.90, 95% CI 0.89-0.92) was excellent.
Summary
The Pringle manoeuvre (vascular inflow occlusion) has been a mainstay technique in trauma surgery and hepato-pancreato-biliary surgery since it was first described in the early 1900s. We sought to determine how frequently the manoeuvre is used today for both elective and emergent cases in these disciplines. To reflect on its evolution, we evaluated the Pringle manoeuvre over a recent 10-year period (2010–2020). We found it is used less frequently owing to more frequent nonoperative management and more advanced elective hepatic resection techniques. Continuing educational collaboration is critical to ensure continued insight into the impact of hepatic vascular inflow occlusion among trainees who observe this procedure less frequently.
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