Approach to the management of complex hepatic injuries

Juan A. Asensio, Demetrios Demetriades, Santiago Chahwan, Hugo Gomez, David Hanpeter, George Velmahos, James Murray, William Shoemaker, Thomas V. Berne

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Background: Complex hepatic injuries American Association for the Surgery of Trauma Organ Injury Scale grades IV and V incur high mortality rate ranging from 40 to 80%, respectively. The objective of this study is to assess the clinical experience with an aggressive approach to the management of these, the most complex of hepatic injuries. Methods: This is a retrospective 6-year study (1992-1997) at an American College of Surgeons urban Level I trauma center of patients sustaining complex hepatic injuries whose interventions included surgery, angiographic embolization, endoscopic retrograde cholangiopancreatography plus biliary stenting and percutaneous computed tomographic-guided drainage. The main outcome measure was survival. Results: A total of 22 patients sustaining complex hepatic injuries; mean age of 26 years (range, 10-52 years), mean Revised Trauma Scale score of 9.9, mean Injury Severity Score of 32 (range, 16-75), American Association for the Surgery of Trauma - Organ Injury Scale grade IV (13 cases); grade V (9 cases). Mean estimated blood loss was 4,600 mL; mean number of units of blood transfused was 15. The patients underwent the following interventions: surgery (n = 22), re-operated (n = 13) mean number of operations 1.6 (range, 1-4), extensive hepatotomy and hepatorrhaphy (n = 17), nonanatomic resection (n = 7), formal hepatectomy (n = 4), packing (n = 10), direct approach to hepatic veins (n = 3); angiographic embolization (n = 15); endoscopic retrograde cholangiopancreatography and stenting (n = 5); computed tomographic guided drainage (n = 6). Mean length of stay in the intensive care unit was 21 days (range, 2-134 days), mean hospital length of stay was 40 days (range, 2-147 days). Overall mortality rate was 14% (3 of 22 cases), hepatic mortality rate was 9% (2 of 22 cases), mortality rate by injury grade was 8% grade IV (1 of 13 cases) and 22% grade V (2 of 9 cases). Conclusion: In this select patient population, improvements in mortality rates can be achieved with an aggressive approach to the management of complex hepatic injuries, including surgery, early packing, angiographic embolization, endoscopic retrograde cholangiopancreatography and stenting of biliary leaks, and drainage of hepatic abscesses.

Original languageEnglish
Pages (from-to)66-69
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume48
Issue number1
StatePublished - Jan 2000
Externally publishedYes

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Liver
Wounds and Injuries
Endoscopic Retrograde Cholangiopancreatography
Mortality
Drainage
Length of Stay
Liver Abscess
Injury Severity Score
Hepatic Veins
Trauma Centers
Hepatectomy
Intensive Care Units
Outcome Assessment (Health Care)
Survival
Population

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Asensio, J. A., Demetriades, D., Chahwan, S., Gomez, H., Hanpeter, D., Velmahos, G., ... Berne, T. V. (2000). Approach to the management of complex hepatic injuries. Journal of Trauma - Injury, Infection and Critical Care, 48(1), 66-69.

Approach to the management of complex hepatic injuries. / Asensio, Juan A.; Demetriades, Demetrios; Chahwan, Santiago; Gomez, Hugo; Hanpeter, David; Velmahos, George; Murray, James; Shoemaker, William; Berne, Thomas V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 48, No. 1, 01.2000, p. 66-69.

Research output: Contribution to journalArticle

Asensio, JA, Demetriades, D, Chahwan, S, Gomez, H, Hanpeter, D, Velmahos, G, Murray, J, Shoemaker, W & Berne, TV 2000, 'Approach to the management of complex hepatic injuries', Journal of Trauma - Injury, Infection and Critical Care, vol. 48, no. 1, pp. 66-69.
Asensio JA, Demetriades D, Chahwan S, Gomez H, Hanpeter D, Velmahos G et al. Approach to the management of complex hepatic injuries. Journal of Trauma - Injury, Infection and Critical Care. 2000 Jan;48(1):66-69.
Asensio, Juan A. ; Demetriades, Demetrios ; Chahwan, Santiago ; Gomez, Hugo ; Hanpeter, David ; Velmahos, George ; Murray, James ; Shoemaker, William ; Berne, Thomas V. / Approach to the management of complex hepatic injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 48, No. 1. pp. 66-69.
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AU - Velmahos, George

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N2 - Background: Complex hepatic injuries American Association for the Surgery of Trauma Organ Injury Scale grades IV and V incur high mortality rate ranging from 40 to 80%, respectively. The objective of this study is to assess the clinical experience with an aggressive approach to the management of these, the most complex of hepatic injuries. Methods: This is a retrospective 6-year study (1992-1997) at an American College of Surgeons urban Level I trauma center of patients sustaining complex hepatic injuries whose interventions included surgery, angiographic embolization, endoscopic retrograde cholangiopancreatography plus biliary stenting and percutaneous computed tomographic-guided drainage. The main outcome measure was survival. Results: A total of 22 patients sustaining complex hepatic injuries; mean age of 26 years (range, 10-52 years), mean Revised Trauma Scale score of 9.9, mean Injury Severity Score of 32 (range, 16-75), American Association for the Surgery of Trauma - Organ Injury Scale grade IV (13 cases); grade V (9 cases). Mean estimated blood loss was 4,600 mL; mean number of units of blood transfused was 15. The patients underwent the following interventions: surgery (n = 22), re-operated (n = 13) mean number of operations 1.6 (range, 1-4), extensive hepatotomy and hepatorrhaphy (n = 17), nonanatomic resection (n = 7), formal hepatectomy (n = 4), packing (n = 10), direct approach to hepatic veins (n = 3); angiographic embolization (n = 15); endoscopic retrograde cholangiopancreatography and stenting (n = 5); computed tomographic guided drainage (n = 6). Mean length of stay in the intensive care unit was 21 days (range, 2-134 days), mean hospital length of stay was 40 days (range, 2-147 days). Overall mortality rate was 14% (3 of 22 cases), hepatic mortality rate was 9% (2 of 22 cases), mortality rate by injury grade was 8% grade IV (1 of 13 cases) and 22% grade V (2 of 9 cases). Conclusion: In this select patient population, improvements in mortality rates can be achieved with an aggressive approach to the management of complex hepatic injuries, including surgery, early packing, angiographic embolization, endoscopic retrograde cholangiopancreatography and stenting of biliary leaks, and drainage of hepatic abscesses.

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