Delayed hepatic resection for major liver injury

Smadja, Claude; Traynor, O.; Blumgart, Leslie H.

doi:10.1002/bjs.1800690702

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…Therefore, surgeons overestimate the borders and extend the resection area. The patients with extensive liver necrosis should be brought for defi nitive surgical resection (25). In a previous study, the importance of resecting areas of devascularized liver has been stressed (24).…”

Section: Discussionmentioning

confidence: 99%

Methylene blue as an antioxidant agent in experimentally-induced injury in rat liver

Bozkurt¹,

Dumlu²,

Tokaç³

et al. 2015

BLL

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Background:We aimed to test the methylene blue (MB) as a dye and also to test its antioxidant activities in devascularization-induced liver injury. Methods: Twenty rats weighing 240-280 g were randomly divided into two groups, each containing 10 rats. High-grade liver injury was induced by using a pair of long pliers with blades. MB was injected into portal vein of the rats with no hepatic injury (Group 1; control group) and those with injured livers (Group 2; injury group). Liver and hepatic function tests, paraoxonase, stimulated paraoxonase, arylesterase activity, total antioxidant, and oxidant status were evaluated before and 24 h after MB injection. Results: MB did not stain the non-perfused area. Total antioxidant status decreased signifi cantly in Group 2 at hour 24 compared to Group 1. In Group 2, total antioxidant status was lower at hour 24 compared to hour 0. Total oxidant status in Group 2 at hour 0 increased signifi cantly compared to Group 1. Total oxidant status in Group 2 at hour 24 was lower compared to that at hour 0. Lipid peroxidation parameters did not alter due to devascularization. Conclusion: MB is useful in defi ning the devascularization area. Moreover, it showed to have a benefi cial effect on oxidant status (Tab. 3, Fig. 3, Ref. 25). Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 99%

Methylene blue as an antioxidant agent in experimentally-induced injury in rat liver

Bozkurt¹,

Dumlu²,

Tokaç³

et al. 2015

BLL

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“…It has been observed that these complications are associated with higher incidence of worse outcomes. Several studies suggested that patients with significant necrosis should undergo hepatic resection before the onset of complications [25, 26]. In addition, surgical debridement is also challenging and carries significant risk of morbidity.…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Major Liver Necrosis after Angioembolization in a Patient with Blunt Trauma

Abdelrahman

Ajaj

Atique

et al. 2013

Case Reports in Surgery

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Management of liver injury is challenging particularly for the advanced grades. Increased utility of nonoperative management strategies increases the risk of developing massive liver necrosis (MLN). We reported a case of a 19-year-old male who presented with a history of motor vehicle crash. Abdominal computerized tomography (CT) scan revealed large liver laceration (Grade 4) with blush and moderate free hemoperitoneum in 3 quadrants. Patient was managed nonoperatively by angioembolization. Two anomalies in hepatic arteries origin were reported and both vessels were selectively cannulated and bilateral gel foam embolization was achieved successfully. The patient developed MLN which was successfully treated conservatively. The follow-up CT showed progressive resolution of necrotic areas with fluid replacement and showed remarkable regeneration of liver tissues. We assume that patients with high-grade liver injuries could be managed successfully with a carefully designed protocol. Special attention should be given to the potential major associated complications. A tailored multidisciplinary approach to manage the subsequent complications would represent the best recommended strategy for favorable outcomes.

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“…After initial intraoperative resuscitation, the liver must be mobilized adequately to allow a thorough examination of the damaged area, unless the injury is already accessible through the incision 10,55,59 . The liver is mobilized by dividing the falciform, triangular and coronary ligaments, and by placing abdominal packs posteriorly to maintain this position 14 .…”

Section: Operation and Initial Control Of Bleedingmentioning

confidence: 99%