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Minerva Chirurgica 2020 April;75(2):92-103

DOI: 10.23736/S0026-4733.20.08193-6


lingua: Inglese

Surgical treatment for severe liver injuries: a single-center experience

Bianca MITRICOF 1, Vladislav BRASOVEANU 1, 2, Doina HREHORET 2, Alexandru BARCU 2, Nausica PICU 2, Elena FLUTUR 2, Dana TOMESCU 3, Gabriela DROC 3, Ioana LUPESCU 4, Irinel POPESCU 1, 2, Florin BOTEA 1, 2

1 Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania; 2 Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania; 3 Center of Anesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania; 4 Center of Diagnostic and Interventional Radiology, Fundeni Clinical Institute, Bucharest, Romania

BACKGROUND: The liver is one of the most frequently injured organs in abdominal trauma. The advancements in diagnosis and interventional therapy shifted the management of liver trauma towards a non-operative management (NOM). Nevertheless, in severe liver injuries (LI), surgical treatment often involving liver resection (LR) and rarely liver transplantation (LT) remains the main option. The present paper analyses a single center experience in a referral HPB center on a series of patients with high-grade liver trauma.
METHODS: Forty-five patients with severe LI, that benefitted from NOM (6 pts), LRs (38 pts), and LT (1 pt) performed in our center between June 2000 and June 2019, were included in a combined prospective and retrospective study. The median age of the patients was 29 years (median 33, range 10-76), and the male/female ratio of 33/12. Almost all cases had blunt trauma, except 2 with stab wound (4.4%).
RESULTS: LIs classified according to the American Association for the Surgery of Trauma (AAST) system were 13.3% (grade III), 44.2% (grade IV), and 42.2% (grade V); none were grade I, II or VI. The rate of major LR was 56.4% (22 LRs). The median operative time was 200 minutes (mean 236; range 150-420). The median blood loss was 750 ml (mean 940; range 500-6500). Overall and major complication rates were 100% (45 pts) and 33.3% (15 pts), respectively. Overall mortality rate was 15.6% (7 pts).
CONCLUSIONS: Severe liver trauma, often involving complex liver resections, should be managed in a referral HPB center, thus obtaining the best results in terms of morbidity and mortality.

KEY WORDS: Liver; Wounds and injuries; Hepatectomy

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