14 Non operative vs operative management of blunt hepatic injury: A Retrospective Study
Journal Title: Indian journal of applied basic medical sciences - Year 2018, Vol 20, Issue 31
Abstract
The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and non operative management. Currently, a non operative management constitutes the treatment of choice in patients with hemodynamic stability.The objective of this study is to examine the outcomes of blunt hepatic trauma, and compare surgical and nonsurgical treatment on patients admitted with hemodynamic stability and with no obvious indications of laparotomy. Methods: A retrospective study of the patients presented with blunt liver trauma was performed from 2016-2017.Variables analyzed included demographic data, cause of injury, grade of injury, associated injuries, vitals, haemoglobin values,number of blood transfusion, mode of treatment and complications. Clinical parameters, GCS were recorded in all the patients. ultrasonography and CT scan were also done. Patients with unstable hemodynamics who responded to fluid challenge and with stable hemodynamics were included in conservative management of liver trauma.Results: A total of 55 patients were analyzed. 5 patients had sustained severe injuries. Mean pulse rate in conservative group was 92 beats/min.Mean blood pressure in conservative group was 110/70 mmHg . Conservative treatment was followed in 50 patients with surgery undertaken in 6 of the patients from this group due to failure of conservative treatment. Mean duration of hospital stay in conservative and operative groups are respectively 17 and 19 days. P value is significant (0.04).Conclusions: A non-operative approach results in lower complications, a lesser need for blood transfusions and a lower mortality rate. Failure of conservative treatment did not show a higher incidence of complications or mortality.
Authors and Affiliations
Dr Kalpit Suthar
Keywords
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