Nonoperative Management of Blunt Hepatic Injuries

Sherman, Harold F.; Savage, Beverley A.; Jones, Larry M.; Barrette, Roger R.; Latenser, B.A.; Varcelotti, Jorge R.; McAuley, Clyde E.; Jones, R. T.; Myers, Andy

doi:10.1097/00005373-199410000-00015

Cited by 110 publications

(57 citation statements)

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“…This is comparable to the 11% seen in NONOP1 17 and the 9% reported by Boone et al, 14 but it is more than the 3% to 4% in other recent reports 15,16,18 (see Table 9). This discrepancy may be accounted for by the greater percentage of patients managed nonoperatively: 85% in the current report versus 50% to 61% in the other reports 15,16,18 (see Table 9). We believe that this relatively small increase in the incidence of failure is acceptable in light of the much larger percentage of patients with blunt hepatic injury who benefit from nonoperative management.…”

Section: Failure Of Nonoperative Managementsupporting

confidence: 80%

Blunt Hepatic Injury: A Paradigm Shift From Operative to Nonoperative Management in the 1990s

et al. 2000

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ObjectiveTo analyze the outcome of hemodynamically stable patients with blunt hepatic injury managed nonoperatively, and to examine the impact of this approach on the outcome of all patients with blunt hepatic injury. Summary Background DataUntil recently, operative management has been the standard for liver injury. A prospective trial from the authors' institution had shown that nonoperative management could safely be applied to hemodynamically stable patients with blunt hepatic injury. The present study reviewed the authors' institutional experience with blunt hepatic trauma since that trial and compared the results with prior institutional experience. MethodsSix hundred sixty-one patients with blunt hepatic trauma during the 5-year period ending December 1998 were reviewed (NONOP2). The outcomes were compared with two previous studies from this institution: operative 1985 to 1990 (OP) and nonoperative 1993 to 1994 (NONOP1). ResultsAll 168 OP patients were managed operatively. Twenty-four (18%) of 136 NONOP1 patients and 101 (15%) of the 661 NONOP2 patients required immediate exploration for hemodynamic instability. Forty-two (7%) patients failed nonoperative management; 20 were liver-related. Liver-related failures of nonoperative management were associated with highergrade injuries and with larger amounts of hemoperitoneum on computed tomography scanning. Twenty-four-hour transfusions, abdominal infections, and hospital length of stay were all significantly lower in the NONOP1 and NONOP2 groups versus the OP cohort. The liver-related death rate was constant at 4% in the three cohorts over the three time periods. ConclusionsAlthough urgent surgery continues to be the standard for hemodynamically compromised patients with blunt hepatic trauma, there has been a paradigm shift in the management of hemodynamically stable patients. Approximately 85% of all patients with blunt hepatic trauma are stable. In this group, nonoperative management significantly improves outcomes over operative management in terms of decreased abdominal infections, decreased transfusions, and decreased lengths of hospital stay.

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Section: Failure Of Nonoperative Managementsupporting

confidence: 80%

Blunt Hepatic Injury: A Paradigm Shift From Operative to Nonoperative Management in the 1990s

et al. 2000

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“…These data reinforce the finding of other studies and suggest that metabolic overload of RL induced by hepatectomy per se, indicated in a sensitive way by mitochondrial alterations found in the first hours after hepatectomy 11,12 , is probably a consequence of an imbalance between energy supply and demand of the remnant liver 13,14 .…”

Section: Discussionsupporting

confidence: 90%

Effect of laser on the remnant liver after the first 24 hours following 70% hepatectomy in rats

Barbosa¹,

Santana²,

Silva

et al. 2011

Acta Cir. Bras.

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PURPOSE:To evaluate the mitochondrial function of the remnant liver (RL) in the early phase of liver regeneration in rats after 70% partial hepatectomy (PH). METHODS: Sixty male Wistar rats (200-250g) submitted to 70% PH were divided into five groups according to the time of euthanasia and application or not of laser light: C = Control, time zero; 2 minutes, 4, 6 and 24 hours after PH. The dose of laser radiation was 22.5 J/cm 2 , wavelength of 660 nm (visible/red), in the remnant liver. We studied the respiration activated by ADP (state 3), basal mitochondrial respiration (state 4), respiratory control ratio (RCR) and mitochondrial membrane potential (MMP). RESULTS:The mitochondrial function of RL changed at 4 and 6 hours after PH, with a significant increase in state 3 and a concomitant increase in state 4 and with maintenance of RCR. MMP differed significantly between the groups biostimulated with laser radiation and the control group 4 hours after HP, with a substantial reduction in the non-laser groups. CONCLUSION: The laser light at the dose used in this study did not induce additional damage to the RL and seems to have delayed the hepatocellular metabolic overload of the remnant liver. Keywords: Laser. Liver. Hepatectomy. Mitochondria. Liver Regeneration. Rats. RESUMO OBJETIVO:Avaliar a função mitocondrial do fígado remanescente (FR) na fase precoce da regeneração hepática em ratos após hepatectomia parcial (HP) a 70%. MÉTODOS: Sessenta ratos machos Wistar (200 -250g) submetidos à HP a 70%, foram distribuídos em cinco grupos de acordo com o tempo de eutanásia e com aplicação ou não de luz laser: C= Controle,tempo zero; 2 minutos, 4, 6 e 24 horas após HP. O laser foi utilizado na dose 22.5 J/cm 2 , 660 nm, no FR.Estudou-se o estado 3 (respiração ativada por ADP), estado 4 (respiração mitocondrial basal), razão de controle respiratório,estado 3/estado 4 (RCR) e o potencial de membrana mitocondrial(PMM). RESULTADOS: A função mitocondrial do FR alterou-se no período de 4 e 6 horas após a HP com aumento significativo do estado 3 e aumento concomitante do estado 4, com manutenção da RCR. O PMM apresentou diferença significativa entre os grupos bioestimulados com laser e o controle a partir de 4 horas pós HP, com queda importante do grupo sem laser e tendência a equiparação dos valores após 24 horas. CONCLUSÃO: A luz laser, na dose utilizada no presente estudo, não induziu lesão adicional ao FR e parece ter retardado a sobrecarga hepatocelular do fígado remanescente. Descritores: Lasers. Fígado. Hepatectomia. Mitocôndria. Regeneração Hepática. Ratos. Effect of laser on the remnant liver after the first 24 hours following 70% hepatectomy in ratsActa Cirúrgica 5011 -471

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“…This high liverrelated morbidity is not observed in other series. 7,14,22 Among our patients undergoing NOMLI, only 1 (2%) was found on follow-up CT to have an intraparenchymal pseudoaneurysm; this patient underwent successful embolization. However, 23 (42%) of our 55 patients undergoing NOMLI (38% [18/47] of those in whom NOMLI succeeded and 62% [5/8] of those in whom NOMLI failed) developed a non-liver-related morbidity.…”

Section: Commentmentioning

confidence: 82%