Abstract
The use of damage control techniques, including interventional radiology techniques, liver packing, and planned reoperation, has contributed to current management of complex liver injury. The training of trauma surgeons must include a familiarity with all such techniques and formal training in hepatobiliary surgery or liver transplantation. Appropriate decision-making for formal resections in patients who have been stabilized and then require subsequent surgical care is based on a mandatory evaluation of massive lobar or multilobar damage and intra- or retrohepatic venous injuries with hemorrhage that have been temporally controlled by packing or other measures during surgical management at initial admission. Stabilization with damage control techniques and the transfer, after the acute period, of the patient to a transplant center is the gold standard for centers that lack the surgical and medical expertise of transplant referral centers. Technical skills in advanced hepatobiliary surgery, patient hemodynamic and resuscitation, diagnostic evaluations, operative indications by grade of injury, selection criteria for surgical management, and criteria for the choice of operation are mandatory for indicating formal liver resection as initial or delayed management of patients with complex liver trauma.
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Abbreviations
- AAST- OIS:
-
American Association for the Surgery of Trauma-Organ Injury Scale
- ISMETT:
-
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (Mediterranean Institute for Transplantation and Advanced Specialized Therapies)
- CT:
-
Computed tomography
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
- IVC:
-
Inferior vena cava
- OLT:
-
Orthotopic liver transplantation
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Gruttadauria, S., Pagano, D., Spada, M. (2015). Liver Resection and Transplantation for Trauma by Transplant Surgeons. In: Ivatury, R. (eds) Operative Techniques for Severe Liver Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1200-1_14
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