ORIGINAL ARTICLES   

Minerva Chirurgica 2015 February;70(1):7-15

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Management of grade III-IV blunt liver traumas: a comparative, observational study

Bonariol L. ¹, Massani M. ¹, Caratozzolo E. ¹, Ruffolo C. ¹, Recordare A. ¹, Scarpa M. ², Stecca T. ^{1, 3}, Cegolon L. ^{4, 5}, Bassi N. ^{1, 3} ✉

¹ II Department of Surgery (IV Unit), Regional Hospital “Ca’ Foncello”, Treviso, Italy; ² Surgical Oncology Unit, Veneto Institute of Oncology (IOV‑IRCCS), Padua, Italy; ³ Department of Surgery, Oncology and Gastroenterology (DISCOG), Padua University, Padua, Italy; ⁴ Imperial College London, School of Public Health, St. Mary’s Campus, London, UK; ⁵ Department of Molecular Medicine, Padua University, Padua, Italy

AIM: The aim of the present study was to assess the impact of angiographic embolization in view of expanding indications for the conservative management of grade III-IV liver injuries.
METHODS: Fifty adult patients with grade III-IV hepatic trauma were admitted to our Hepato-Biliary-Pancreatic Surgery and Level II Regional Trauma Center from 1993 to 2010 and retrospectively analyzed. Injury severity, management strategies and outcomes of patients admitted between 1993 and 2005 were analyzed and compared with those admitted between 2005 and 2010. Univariable and multivariable logistic models were fitted to investigate the differences between the two time windows studied, in particular with regard to morbidity, mortality, treatment and outcomes, the use of non-operative management and of angiographic embolization.
RESULTS: At univariable analysis the majority of the patients treated after 2005 were more likely to have undergone arterial embolization, and less likely to have incurred morbidity, conversion to surgery, or to be admitted to the Intensive Care Unit after initial treatment (baseline category). At multivariable analysis the patients treated before 2005 were more likely to be older than 25 years to receive angiographic embolization and less likely to undergo conversion to surgery after failure of non-operative management.
CONCLUSION: The criteria for the conservative treatment of blunt liver trauma is presently often based on hemodynamic stability in injured patients, but its successful management should, instead, be based also on early CT recognition of arterial bleeding and prompt use of angiographic embolization to control it.