Treatment of major hepatic necrosis: Lobectomy versus serial debridement

Danielle N. Dabbs, Deborah M. Stein, Benjamin Philosophe, Thomas M. Scalea

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Major hepatic necrosis (MHN) is a common complication after angioembolization (AE) for severe liver injuries. We compared the outcomes of two treatment modalities. Methods: Patients with MHN were retrospectively reviewed from January 2002 to October 2007. Demographics, Injury Severity Scale score, length of stay, admission Glasgow Coma Scale Score, mortality, transfusion requirements, intra-abdominal complications, admission physiologic variables, and the number and type of abdominal procedures (operative or nonoperative) were collected. These patients were then divided into two groups-those treated with hepatic lobectomy (HL) and those treated with multiple procedures including serial operative debridements and/or percutaneous drainage (Ir/Or). Results: Thirty patients (41%) with MHN were identified from 71 patients who had AE. Sixteen patients with MHN underwent HL and 14 patients underwent multiple IR/OR procedures. The two groups were similar at baseline, except that the HL group had a higher Injury Severity Scale score. Outcomes between the two groups were similar. There was a significantly higher complication rate and increased number of procedures in the IR/OR group. There were no deaths in patients who had early HL (<5 days). There was one death in the later lobectomy group. Conclusion: MHN is a common complication after AE. This complication can be safely managed with a series of operative debridements in conjunction with interventional procedures or with HL. Lobectomy is associated with a lower complication rate and a fewer number of procedures. Early lobectomy may be better than a delayed procedure.

Original languageEnglish (US)
Pages (from-to)562-567
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number3
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

Keywords

  • Hepatic angioembolization
  • Hepatic necrosis
  • High-grade liver injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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