Control of Hemorrhage in Liver Trauma

Abstract

Background: Control of hemorrhage in major liver trauma constitutes an ongoing surgical challenge even in nowadays, as surgeons often face difficult situations in its management. The goal of this study was to analyze our experience in the control of hemorrhage in major liver trauma. Materials and methods: Our study was performed prospectively covering a period of time from January 2009 till December 2012. 173 patients with liver trauma were included in our study. Results: Temporary haemostasis maneuvers in the setting of urgent laparotomy consisted of: bimanual compression 13 patients (15.3%), Pringle maneuver 23 patients (27%), perihepatic packing 10 patients (11,8%), Foley catheter balloon tamponade 2 patients (2.4%), intrahepatic tamponade in penetrating trauma 4 patients (4.7%). Definitive haemostasis methods used in urgent laparotomy were: electro-coagulation of the liver injury 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic liver resection 1 patient (1.2%), nonanatomic/atypical liver resection 7 patients (8.2%), right hepatic artery ligation 1 patient (1.2%). Surgical techniques in preplanned laparotomies consisted of: left hepatectomy 1 patient (16.6%), right hepatectomy 1 patient (16,6%), nonanatomic/atypical liver resections 4 patients (66.7%). The success of treatment was significantly related to the grade of liver injury (z= 5.2912, p=<0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), amount of blood transfusion received (p=0.03207), and age (p=0.04944). Overall mortality rate was 13%. Conclusion: Perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma from our experience.