Study about Control of Hemorrhage in Liver Trauma

Background: Control of hemorrhage in major liver trauma remains a surgical challenge even today, as surgeons frequently face difficult situations in its management. In minor liver injuries, hemorrhage control is obtained initially through packing of the bleeding site.

The purpose of this study was to analyze our experience in the control of hemorrhage in major liver trauma.

Materials and Methods: Our study was conducted prospectively and lasted from January 2009 to December 2012.

Our study included 173 patients with liver trauma.

Results: Temporary haemostasis manoeuvres used in the setting of an urgent laparotomy included bimanual compression in 13 patients (15.3%), Pringle manoeuvre in 23 patients (27%), perihepatic packing in 10 patients (11.8%), Foley catheter balloon tamponade in 2 patients (2.4%), and intrahepatic tamponade in 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%).

In preplanned laparotomies, surgical techniques included: left hepatectomy in one patient (16.6%), right hepatectomy in one patient (16.6%), and nonanatomic/atypical liver resections in four 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: In our experience, perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma.