Blunt liver trauma: effectiveness and evolution of non-operative management (NOM) in 145 consecutive cases
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ORIGINAL ARTICLE
Blunt liver trauma: effectiveness and evolution of non‑operative management (NOM) in 145 consecutive cases Elena Schembari1 · Maria Sofia2 · Saverio Latteri3 · Antonio Pesce3 · Valentina Palumbo4 · Maurizio Mannino4 · Domenico Russello3 · Gaetano La Greca3 Received: 29 September 2019 / Accepted: 28 July 2020 © Italian Society of Surgery (SIC) 2020
Abstract In recent decades, haemodynamically stable patients with traumatic liver injuries have been managed conservatively. The primary aim of this study is to retrospectively analyse the outcomes of the authors’ approach to blunt hepatic trauma according to the degree of injury. The secondary aim is to analyse the changes in the decision-making process for blunt liver trauma management over the last 10 years. A total of 145 patients with blunt liver trauma managed by one trauma team were included in the study. Causes, sites and grades of injury, clinical conditions, ultrasonography and CT results, associated injuries, laboratory data, types of treatment (surgical or non-operative management/NOM), blood transfusions, complications, and lengths of hospitalization were recorded and analysed. A total of 85.5% of patients had extrahepatic injuries. The most frequently involved liver segments were VII (50.3%), VI (48.3%) and V (40.7%). The most common injury was grade III OIS (40.6%). Fifty-nine patients (40.7%) were treated surgically, with complications in 23.7% of patients, whereas 86 patients (59.3%) underwent NOM, with a complication rate of only 10.5%. The evolution over the last 10 years showed an overall increase in the NOM rate. This clinical experience confirmed that NOM was the most appropriate therapeutic choice for blunt liver trauma even in high-grade injuries and resulted in a 100% effectiveness rate with a 0% rate of conversion to surgical treatment. The relevant increase in the use of NOM did not influence the effectiveness or safety levels over the last 10 years; this was certainly related to the increasing experience of the team and the meticulous selection and monitoring of patients. Keywords Blunt liver trauma · Non-operative management · Outcomes
Introduction The liver is the most frequently injured abdominal organ, even if it is situated in a protected site [1]. The treatment of liver injuries has undergone paradigmatic shifts throughout history. It was first described in Greek and Roman mythology, but Hogarth Pringle’s description of the “Pringle manoeuvre” became notable in 1908 [2, 3]. The majority of * Elena Schembari [email protected] 1
General Surgery, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
2
General Surgery, Cannizzaro Hospital, Catania, Italy
3
Department of Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy
4
General Surgery, Cannizzaro Hospital, University of Catania, Catania, Italy
patients with hepatic trauma have traditionally been treated in the operating room with a variety of techniques, including pa
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