High success with nonoperative management of blunt hepatic trauma

The liver is a sturdy organ

George C. Velmahos, Konstantinos Toutouzas, Randall Radin, Linda Chan, Peter M Rhee, Areti Tillou, Demetrios Demetriades, Scott Norwood, R. Stephen Smith, Anthony P. Borzotta, Claude H. Organ

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

Hypothesis: Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events. Design: Prospective observational study. Setting: High-volume academic level I trauma center. Patients: For 26 months, 78 consecutive unselected patients with liver injuries were followed up prospectively. In the absence of hemodynamic instability or signs of hollow visceral trauma, NOMLI was offered irrespective of the magnitude of the liver injury. Main Outcome Measure: Failure of NOMLI, defined as a laparotomy after an initial decision to treat the patient nonoperatively. Results: Of the 78 patients, 23 (29%) were operated on immediately, but only 12 (15%) for bleeding from the liver. All 12 patients required packing in addition to other maneuvers (hepatorrhaphy [n = 81, resection [n = 4], and liver isolation [n = 1]). Of the remaining 55 patients selected for NOMLI, the method failed in 8 for reasons unrelated to the liver injury: 2 underwent a splenectomy, 1 underwent a nephrectomy, 1 had a small-bowel repair, 1 underwent abdominal decompression for abdominal compartment syndrome, and 3 underwent a nontherapeutic laparotomy. The success rate of NOMLI was 85% (47 of 55 patients), but the liver-specific success rate was 100%. Compared with those in whom NOMLI was successful, patients in whom it failed had a higher Injury Severity Score and underwent more blood transfusions, but they had similar liver injury grades. In total, 66 (85%) of liver injuries did not bleed significantly. No adverse events were attributed to NOMLI. Conclusions: Nonoperative management of liver injuries is safe and effective regardless of the grade of liver injury. Failure of NOMLI is caused by associated abdominal injuries and not the liver. Fluid and blood requirements, the degree of injury severity, and the presence of other abdominal organ injuries may help predict failure.

Original languageEnglish (US)
Pages (from-to)475-481
Number of pages7
JournalArchives of Surgery
Volume138
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

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Liver
Wounds and Injuries
Abdominal Injuries
Laparotomy
Intra-Abdominal Hypertension
Lower Body Negative Pressure
Injury Severity Score
Trauma Centers
Splenectomy
Nephrectomy
Blood Transfusion
Observational Studies
Hemodynamics
Outcome Assessment (Health Care)
Prospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

High success with nonoperative management of blunt hepatic trauma : The liver is a sturdy organ. / Velmahos, George C.; Toutouzas, Konstantinos; Radin, Randall; Chan, Linda; Rhee, Peter M; Tillou, Areti; Demetriades, Demetrios; Norwood, Scott; Smith, R. Stephen; Borzotta, Anthony P.; Organ, Claude H.

In: Archives of Surgery, Vol. 138, No. 5, 01.05.2003, p. 475-481.

Research output: Contribution to journalArticle

Velmahos, GC, Toutouzas, K, Radin, R, Chan, L, Rhee, PM, Tillou, A, Demetriades, D, Norwood, S, Smith, RS, Borzotta, AP & Organ, CH 2003, 'High success with nonoperative management of blunt hepatic trauma: The liver is a sturdy organ', Archives of Surgery, vol. 138, no. 5, pp. 475-481. https://doi.org/10.1001/archsurg.138.5.475
Velmahos, George C. ; Toutouzas, Konstantinos ; Radin, Randall ; Chan, Linda ; Rhee, Peter M ; Tillou, Areti ; Demetriades, Demetrios ; Norwood, Scott ; Smith, R. Stephen ; Borzotta, Anthony P. ; Organ, Claude H. / High success with nonoperative management of blunt hepatic trauma : The liver is a sturdy organ. In: Archives of Surgery. 2003 ; Vol. 138, No. 5. pp. 475-481.
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abstract = "Hypothesis: Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events. Design: Prospective observational study. Setting: High-volume academic level I trauma center. Patients: For 26 months, 78 consecutive unselected patients with liver injuries were followed up prospectively. In the absence of hemodynamic instability or signs of hollow visceral trauma, NOMLI was offered irrespective of the magnitude of the liver injury. Main Outcome Measure: Failure of NOMLI, defined as a laparotomy after an initial decision to treat the patient nonoperatively. Results: Of the 78 patients, 23 (29{\%}) were operated on immediately, but only 12 (15{\%}) for bleeding from the liver. All 12 patients required packing in addition to other maneuvers (hepatorrhaphy [n = 81, resection [n = 4], and liver isolation [n = 1]). Of the remaining 55 patients selected for NOMLI, the method failed in 8 for reasons unrelated to the liver injury: 2 underwent a splenectomy, 1 underwent a nephrectomy, 1 had a small-bowel repair, 1 underwent abdominal decompression for abdominal compartment syndrome, and 3 underwent a nontherapeutic laparotomy. The success rate of NOMLI was 85{\%} (47 of 55 patients), but the liver-specific success rate was 100{\%}. Compared with those in whom NOMLI was successful, patients in whom it failed had a higher Injury Severity Score and underwent more blood transfusions, but they had similar liver injury grades. In total, 66 (85{\%}) of liver injuries did not bleed significantly. No adverse events were attributed to NOMLI. Conclusions: Nonoperative management of liver injuries is safe and effective regardless of the grade of liver injury. Failure of NOMLI is caused by associated abdominal injuries and not the liver. Fluid and blood requirements, the degree of injury severity, and the presence of other abdominal organ injuries may help predict failure.",
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AU - Demetriades, Demetrios

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AU - Organ, Claude H.

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