Liver trauma: What current management?

Tarchouli, Mohamed; Elabsi, M.; Njoumi, Noureddine; Essarghini, Mohamed; Echarrab, M.; Chkoff, M. R.

doi:10.1016/j.hbpd.2018.01.013

Cited by 31 publications

(43 citation statements)

References 47 publications

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“…Poor outcomes of hepatic resections in the emergency setting and the understanding of the hemorrhagic shock have led us towards the concept of damage control laparotomy with perihepatic packing. This approach, combined with advances in resuscitation and interventional radiology, has delivered a decline in overall mortality rates [15].…”

Section: Discussionmentioning

confidence: 99%

New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

et al. 2019

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BackgroundThe liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V).Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death.MethodsWe designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2).ResultsBoth pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP.ConclusionsWe establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.

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Section: Discussionmentioning

confidence: 99%

New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

et al. 2019

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“…[17][18][19] During the past three decades, multiple studies have shown that NOM of abdominal solid organ injuries is effective, with a success rate of 90%. [20][21][22][23] Although a large number of series had attempted to examine the management of blunt solid organ injuries, there are only few studies present based upon the clinical surveillance regarding the long term follow-up after discharge.…”

Section: Discussionmentioning

confidence: 99%

Are radiological modalities really necessary for the long-term follow-up of patients having blunt solid organ injuries? A single center study

İlhan

Sönmez

Kut

et al. 2019

World Journal of Emergency Medicine

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“…Despite its well-protected position, the liver is the most frequently affected abdominal organ by blunt or penetrating trauma [1,2]. Over the past decades, the improvements in the assessment and management of hepatic injury have evolved significantly, thus resulting in better outcomes for affected patients [3]. The majority of such injuries develop following high-energy traffic accidents or violent behaviors [4].…”

Section: Introductionmentioning

confidence: 99%

Damage Control Surgery for Liver Trauma

Ziogas¹,

Katsaros²,

Tsoulfas³

2021

Trauma and Emergency Surgery - The Role of Damage Control Surgery

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The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the "lethal triad" (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place, along with permanent closure of the abdominal wall.

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Liver trauma: What current management?

Cited by 31 publications

References 47 publications

New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

Are radiological modalities really necessary for the long-term follow-up of patients having blunt solid organ injuries? A single center study

Damage Control Surgery for Liver Trauma

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