Surgical management of AAST grades III-V XXXX by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience.

@entity1 @entity1143 @entity548 @entity649 @entity772 @entity551 @entity2611 @entity1317 @entity99 @entity204 @entity130
BACKGROUND: Severe @entity99 in @entity130 @entity1 still accounts for significant morbidity and mortality. Operative techniques in liver @entity130 are some of the most challenging. They include the @entity2611 , from damage control to liver resection. MATERIAL AND METHOD: This is a retrospective study of 121 @entity130 @entity1 with @entity99 American Association for Surgery of @entity130 (AAST) grade III-V who have undergone surgery. Indications for surgery include refractory @entity551 not responding to resuscitation due to uncontrolled @entity548 from liver @entity130 ; massive hemoperitonem on Focused assessment by ultrasound for @entity130 (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe @entity99 and major @entity1317 with active @entity548 . RESULTS: Non-survivors have significantly higher AAST grade of @entity99 and higher Injury Severity Score (ISS) (p   =   0.000; p   =   0.0001). Non-survivors have significant @entity551 on arrival and lower Glasgow @entity772 Scale (GCS) on admission (p   =   0.000; p   =   0.0001). Definitive hepatic repair was performed in 62(51.2  %) @entity1 . Damage Control, liver packing and planned re-laparotomy after 48  h were used in 59(48.8  %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24  h between survivors and non-survivors (p   =   0.001). Overall mortality rate was 33.1  %. Regarding complications non-survivors had significantly prolonged @entity548 and higher rate of @entity649 ( @entity649 ) (p   =   0.0001; p   =   0.0001), while survivors had significantly higher rate of @entity1143 (p   =   0.0001). CONCLUSION: All efforts in the treatment of severe @entity99 should be directed to the rapid and effective control of @entity548 , because uncontrollable @entity548 is the cause of @entity204 and it requires massive blood transfusion, all of which contributes to the late fatal complication.
