Non-operative management versus operative management in high-grade blunt hepatic injury

Cirocchi, Roberto; Trastulli, Stefano; Pressi, Eleonora; Farinella, Eriberto; Avenia, Stefano; Uribe, Carlos Hernándo Morales; Botero, Ana María; Barrera, L.

doi:10.1002/14651858.cd010989.pub2

“…Literature suggest most liver injuries of grade 1-3 are treated by NOM with 82-100% success [9,27,28]. However, studies comparing OM versus NOM in high grade liver injury are still evolving [29]. Our comparisons of the two cohorts showed poor outcomes in those undergoing OM.…”

Section: Discussionmentioning

confidence: 78%

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

Sinha

¹

,

Khajanchi²,

Prajapati³

et al. 2020

Preprint

1

0

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Background Low- and Middle-Income Countries (LMICs) contribute to 90% of injuries occurring in the world. Liver is the one of the commonest organ injured in abdominal trauma. This study aims to highlight the demographic and management profile of liver injury patients, presenting to four urban Indian university hospitals in India. Methods This is a retrospective registry-based study. Data of patients with liver injury either isolated or concomitant with other injuries was used using the ICD-10 code, S36.1 for liver injury. The severity of injury was graded based on the World Society of Emergency Surgery (WSES) grading for liver injuries. Results A total of 368 liver injury patients were analysed. 89% were males, with road traffic injuries being the commonest mechanism. As per World Society of Emergency Surgery (WSES) liver injury grade, there were 126 (33.7%) grade I, 87(23.6%) grade II, 67(18.2%) grade III & 88 (24.5%) grade IV injuries. The overall mortality was 16.6%. 262 patients (71.2%) were managed non-operatively (NOM) & 106 (38.8%) were operated. 90.1% of those managed non-operatively, survived. Conclusion In this multi-centre cohort of liver injury patients from urban university hospitals in India, the commonest profile of patient with a was a young male, with a blunt injury to the abdomen due to a road traffic accident. Success rate of non-operative management of liver injury is comparable to other countries.

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“…Selective NOM of blunt hepatic injury is associated with less mortality when compared to operative therapy [ 6 – 9 ]. The current literature supports NOM for all grades of blunt liver injury in hemodynamically stable adults, but inconsistency still exists in terms of the efficacy, patient selection, and management of high-grade injury [ 7 , 10 – 13 ]. Operative management is usually considered immediately for the hemodynamically unstable patients with extensive injuries or selectively to treat liver injury-associated complications [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Blunt liver trauma: a descriptive analysis from a level I trauma center

Afifi

¹

,

Abayazeed²,

El‐Menyar

³

et al. 2018

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BackgroundWe aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes.MethodsIt is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches.ResultsBlunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group.ConclusionsIn our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.

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“…Literature suggest most liver injuries of grade 1-3 are treated by NOM with 82-100% success [9,26,27]. However, studies comparing OM versus NOM in high grade liver injury are still evolving [28]. Our comparisons of the two cohorts showed poor outcomes in those undergoing OM.…”

Section: Discussionmentioning

confidence: 78%

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

Sinha

¹

,

Khajanchi²,

Prajapati³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Low- and Middle-Income Countries (LMICs) contribute to 90% of injuries occurring in the world. Liver is the one of the commonest organ injured in abdominal trauma. This study aims to highlight the demographic and management profile of liver injury patients, presenting to four urban Indian university hospitals in India. Methods This is a retrospective registry-based study. Data of patients with liver injury either isolated or concomitant with other injuries was used using the ICD-10 code, S36.1 for liver injury. The severity of injury was graded based on the World Society of Emergency Surgery (WSES) grading for liver injuries. Results A total of 368 liver injury patients were analysed. 89% were males, with road traffic injuries being the commonest mechanism. As per World Society of Emergency Surgery (WSES) liver injury grade, there were 126 (33.7%) grade I, 87(23.6%) grade II, 67(18.2%) grade III & 88 (24.5%) grade IV injuries. The overall mortality was 16.6%. 262 patients (71.2%) were managed non-operatively (NOM) & 106 (38.8%) were operated. 90.1% of those managed non-operatively, survived. Conclusion In this multi-centre cohort of liver injury patients from urban university hospitals in India, the commonest profile of patient with a was a young male, with a blunt injury to the abdomen due to a road traffic accident. Success rate of non-operative management of liver injury is comparable to other countries.

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Non-operative management versus operative management in high-grade blunt hepatic injury

Cited by 23 publications

References 36 publications

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

Blunt liver trauma: a descriptive analysis from a level I trauma center

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

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