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Treatment of Major Hepatic Necrosis: Lobectomy Versus Serial Debridement

Dabbs, Danielle N. DO; Stein, Deborah M. MD, MPH; Philosophe, Benjamin MD, PhD; Scalea, Thomas M. MD

The Journal of Trauma: Injury, Infection, and Critical Care: September 2010 - Volume 69 - Issue 3 - p 562-567
doi: 10.1097/TA.0b013e3181ebf591
Original Article

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.

From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland.

Submitted for publication March 29, 2010.

Accepted for publication June 8, 2010.

Presented as a poster at the 67th Annual Meeting of the American Association for the Surgery of Trauma, September 24–27, 2008, Maui, Hawaii.

Address for reprints: Deborah M. Stein, MD, MPH, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201; email: dstein@umm.edu.

© 2010 Lippincott Williams & Wilkins, Inc.