Authors
Chubaryan K.A.2, Zhernosenco A.O.1, Groshilin V.S.3, Mrykhin G.A.3, Sogoyan E.Y.4
1 Pirogov National Medical and Surgical Center, Moscow
2 Rostov-on-Don City Emergency Hospital, Rostov-on-Don
3 Rostov State Medical University, Rostov-on-Don
4 Samara State Medical University, Samara
Abstract
Rationale: The search for new ways to stop bleeding in severe liver injuries is an urgent task of modern surgery, due to the technical complexity of known hemostasis methods, the high frequency of postoperative complications and the need for relaparotomies.
Objective: To improve the results of treatment of patients with severe traumatic liver injuries.
Methods: A randomized controlled clinical trial was conducted, including 70 patients with severe traumatic liver injuries. In the main group (n = 35), the original “Method of hemostasis in severe traumatic liver injuries” was used (patent Russian Federation 2792914). The control group (n = 35) uses traditional surgical techniques of hemostasis.
Results: The groups were comparable in terms of the main demographic indicators, the degree of liver damage, and the combination of injuries. In the main group, complications were biliary — 31.4%, inflammatory, requiring relaparotomy — 5.7%, liver failure — 11.4%, there were no recurrence of bleeding, relaparotomy — 2 was performed. In the control group, complications were biliary — 40.0%, inflammatory, requiring relaparotomy — 28.6%, liver failure — 31.4%, recurrent bleeding — 8.6%, relaparotomy — 19.
Conclusion: The original method of hemostasis allows to improve the results of treatment of patients with severe liver injuries, by reducing the frequency of postoperative complications and the need for relaparotomies. The effectiveness of the technique is based on the absence of direct contact of gauze tampons with the liver, which prevents them from sticking to the wound surface, impregnation with biological fluids and, accordingly, secondary infection.
Keywords: severe traumatic liver injury, hemostasis method, perihepatic packing.
References
1. Coccolini F. et al. WSES classification and guidelines for liver trauma/ World Journal of Emergency Surgery. 2016; 11(1). doi: 10.1186/s13017-016-0105-2.
2. CHalyk R.YU. Klinicheskoe obosnovanie vybora hirurgicheskoj taktiki pri povrezhdeniyah pecheni. [avtoreferat dissertacion] Saratov; 2009. (In Russ.)
3. Ermolov A.S. Abdominal’naya travma: rukovodstvo dlya vrachej. M.: Vidar-M, 2010. 495 р. (In Russ.)
4. Afendulov SA, Begezhanov BA. Oshibki i rezul’taty lecheniya travm pecheni. Annaly hirurgicheskoj gepatologii. 1998; 3: 176. (In Russ.)
5. Vladimirova ES, Valetova VV. Vremennyj gemostaz u postradavshih s tyazheloj travmoj pecheni i ego vliyanie na pokazateli vital’nyh funkcij. Medicinskij alfavit. 2016; 3(20): 14-19. (In Russ.)
6. Asensio JA, et al. Approach to the management of complex hepatic injuries. The Journal of Trauma: Injury, Infection, and Critical Care. 2000; 48(1): 66. doi: 10.1097/00005373-200001000-00011.
7. Smolyar AN. Zakrytaya travma zhivota. Povrezhdeniya pecheni. CHast’ 1. Hirurgiya. ZHurnal im. N.I. Pirogova. 2015; 12: 5-13. (In Russ.)
8. Maskin SS, et al. Zakrytye povrezhdeniya pecheni: algoritm dejstvij hirurga v usloviyah travmocentra I urovnya. Politravma. 2020; 2: 84-91. (In Russ.)
9. Rahbari NN, et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011; 149(5): 713-724. doi: 10.1016/j.surg.2010.10.001.
