Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago.

BACKGROUND: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.

Acute Compartment Syndrome exists and can lead to irreversible outcomes if not treated in time.

ACS is a potentially lethal condition caused by any event that produces an increase in IAP, inducing systemic collapse, tissue hypoperfusion and organ dysfunction. Thus, ACS is not exclusively a problem of the traumatic and surgical patient population.Iatrogenic ACS predisposes patients to multiple organ failure if no urgent action is taken.

Acute Compartment Syndrome exists and can lead to irreversible outcomes if not treated in time / A Síndrome Compartimental Aguda existe e pode conduzir a desfechos irreversíveis se não tratada a tempo

ABSTRACT ACS is a potentially lethal condition caused by any event that produces an increase in IAP, inducing systemic collapse, tissue hypoperfusion and organ dysfunction. Thus, ACS is not exclusively a problem of the traumatic and surgical patient population.Iatrogenic ACS predisposes patients to multiple organ failure if no urgent action is taken.

RESUMO A SCA é uma condição potencialmente letal causada por qualquer evento que produza aumento da PIA induzindo colapso sistêmico, hipoperfusão tecidual e disfunção orgânica. Assim, a SCA não é um problema exclusivamente da população de pacientes traumáticos e cirúrgicos. A SCA iatrogénica predispõe os pacientes à falência de múltiplos órgãos se nenhuma ação urgente for tomada.

Topical hemostatic agents in surgery: review and prospects. / Agentes hemostáticos tópicos em cirurgia: revisão e perspectivas.

Hemostasis plays a critical and fundamental role in all surgical procedures. Its management has several key points that start with good operative technique and adequate anesthetic support. Certain situations, such as severe bleeding resulting from penetrating trauma, do not depend exclusively on the control of the surgical team and require the support of new solutions that decrease or control bleeding. Since ancient times, a hallmark of medicine has been to act in the control of hemorrhage, and more recently, in the facilitation of hemostasis by the application of topical agents by either manual compression or modern agents. In the last decade, the number of different topical hemostatic agents has grown dramatically. For the modern surgeon to choose the right agent at the right time, it is essential that he/she understands the mechanisms of action, the effectiveness and the possible adverse effects related to each agent. Thus, the great variety of topical hemostatics, coupled with the absence of a review article in the national literature on this topic, stimulated us to elaborate this manuscript. Here we report a detailed review of the topical hemostatic agents most commonly used in surgical specialties.

A hemostasia tem papel crítico e importância fundamental em todos os procedimentos cirúrgicos. Seu manejo possui diversos pontos chaves, que se iniciam por boa técnica operatória e adequado suporte anestésico. Determinadas situações, como hemorragias graves resultantes de trauma penetrante, por exemplo, não dependem exclusivamente do controle da equipe cirúrgica e necessitam do apoio de novas soluções que diminuam ou controlem a hemorragia. Desde os tempos antigos, um marco da medicina é atuar no controle da hemorragia e, mais recentemente, na facilitação da hemostasia pela aplicação de agentes tópicos, seja por compressão manual ou agentes modernos. Na última década, o número de diferentes agentes hemostáticos tópicos cresceu drasticamente. Para que o cirurgião moderno escolha o agente correto no momento correto, é essencial que conheça o mecanismo de ação, entenda a eficácia e os possíveis efeitos adversos relacionados a cada agente. Assim, a grande variedade de hemostáticos tópicos, somada à ausência de um artigo de revisão na literatura nacional sobre este tópico, nos estimulou a elaborar este manuscrito. Aqui relatamos uma revisão detalhada sobre os agentes hemostáticos tópicos mais comumente utilizados nas especialidades cirúrgicas.

In-person and telemedicine course models for disaster preparedness: a comparative analysis.

OBJECTIVE: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. METHODS: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. RESULTS: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). CONCLUSION: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

Agentes hemostáticos tópicos em cirurgia: revisão e perspectivas / Topical hemostatic agents in surgery: review and prospects

RESUMO A hemostasia tem papel crítico e importância fundamental em todos os procedimentos cirúrgicos. Seu manejo possui diversos pontos chaves, que se iniciam por boa técnica operatória e adequado suporte anestésico. Determinadas situações, como hemorragias graves resultantes de trauma penetrante, por exemplo, não dependem exclusivamente do controle da equipe cirúrgica e necessitam do apoio de novas soluções que diminuam ou controlem a hemorragia. Desde os tempos antigos, um marco da medicina é atuar no controle da hemorragia e, mais recentemente, na facilitação da hemostasia pela aplicação de agentes tópicos, seja por compressão manual ou agentes modernos. Na última década, o número de diferentes agentes hemostáticos tópicos cresceu drasticamente. Para que o cirurgião moderno escolha o agente correto no momento correto, é essencial que conheça o mecanismo de ação, entenda a eficácia e os possíveis efeitos adversos relacionados a cada agente. Assim, a grande variedade de hemostáticos tópicos, somada à ausência de um artigo de revisão na literatura nacional sobre este tópico, nos estimulou a elaborar este manuscrito. Aqui relatamos uma revisão detalhada sobre os agentes hemostáticos tópicos mais comumente utilizados nas especialidades cirúrgicas.

ABSTRACT Hemostasis plays a critical and fundamental role in all surgical procedures. Its management has several key points that start with good operative technique and adequate anesthetic support. Certain situations, such as severe bleeding resulting from penetrating trauma, do not depend exclusively on the control of the surgical team and require the support of new solutions that decrease or control bleeding. Since ancient times, a hallmark of medicine has been to act in the control of hemorrhage, and more recently, in the facilitation of hemostasis by the application of topical agents by either manual compression or modern agents. In the last decade, the number of different topical hemostatic agents has grown dramatically. For the modern surgeon to choose the right agent at the right time, it is essential that he/she understands the mechanisms of action, the effectiveness and the possible adverse effects related to each agent. Thus, the great variety of topical hemostatics, coupled with the absence of a review article in the national literature on this topic, stimulated us to elaborate this manuscript. Here we report a detailed review of the topical hemostatic agents most commonly used in surgical specialties.

In-person and telemedicine course models for disaster preparedness: a comparative analysis / Modelo de curso presencial e via telemedicina para preparação em desastres: uma análise comparativa

ABSTRACT Objective: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. Methods: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. Results: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). Conclusion: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

RESUMO Objetivo: comparar o desempenho dos alunos nos cursos presenciais e via telemedicina para a capacitação e atuação necessária em desastres, se valendo da telemedicina como uma ferramenta efetiva de treinamento. Métodos: pesquisa online realizada após o término do curso de preparação em desastres, realizado presencialmente, bem como, por videoconferência. Comparou-se o desempenho dos alunos do curso presencial e via telemedicina. Resultados: na comparação dos resultados obtidos com os dados pré e pós-teste entre os alunos que cursaram via telemedicina e presencialmente, observou-se que nas duas modalidades do curso houve aumento do conhecimento (p<0,001). Constatou-se ainda que não houve diferenças estatisticamente significativas na avaliação posterior entre os cursos presenciais e via telemedicina (p=1,0), no entanto, houve diferença com significância no momento avaliativo pré-teste (p<0,001). Conclusão: as videoconferências podem ser utilizadas de forma efetiva para a capacitação de profissionais da área de saúde na gestão de desastres, sendo capaz de prover o conhecimento de forma adequada e ser ferramenta importante para alcance à distância em educação continuada.

WSES position paper on vascular emergency surgery.

Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).

Extrahepatic duct injury in blunt trauma: two case reports and a literature review.

Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.

Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography?

OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.

Is there a role for pyloric exclusion after severe duodenal trauma?

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.

Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography? / Trauma contuso de jejuno e íleo: o que mudou com a implementação da tomografia computadorizada multislice?

OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far. .

OBJETIVO: avaliar se o avanço tecnológico dos aparelhos de tomografia computadorizada (TC) melhorou a acurácia e rapidez no diagnóstico dessas lesões. MÉTODOS: pacientes com lesão de intestino delgado grau>I (AAST-OIS) por trauma contuso foram identificados e suas imagens de TC analisadas por especialista. Foram analisados achados clínicos e tomográficos agrupando os pacientes em antes e após o uso da TC multislice 64 canais, incorporada em nosso Serviço em abril de 2009. RESULTADOS: Dentre os 26 pacientes identificados entre 2005 e 2012, 16 realizaram TC. Acidente automobilístico (62,5%) foi o principal mecanismo de trauma. No período pré-multislice, cinco dentre 13 pacientes (38,5%) realizaram TC e no pós-multislice 11 de 13 (84,6%). No grupo pré-multislice todos os exames foram alterados, sendo os principais achados pneumoperitônio (60%), liquido livre (40%) e espessamento da parede intestinal (20%). No grupo pós-multislice apenas um exame foi considerado normal e os achados mais frequentes nos outros 10 casos foram: líquido livre (90,9%), espessamento da gordura do mesentério (72,7%) e pneumoperitônio (54,5%). Não foi observada mudança no intervalo de tempo entre a realização de TC e a laparotomia. A mortalidade em ambos os grupos foi semelhante (20% no pré-multislice e 18,2% no pós-multislice). CONCLUSÃO: O uso de tomografia multislice aumentou a sensibilidade do diagnóstico, porém sem alteração na evolução dos pacientes. .

Is there a role for pyloric exclusion after severe duodenal trauma? / Existe lugar para a exclusão pilórica no trauma duodenal grave?

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.

O trauma duodenal é incomum, mas possui alta morbimortalidade. As condições clínicas dos pacientes, gravidade das lesões, tempo de diagnóstico e lesões associadas influenciam na escolha do procedimento operatório. A maioria das lesões duodenais é tratada com reparo primário. Procedimentos adjuvantes para proteger a linha de sutura e evitar deiscência podem ser úteis em lesões complexas. Embora a exclusão pilórica (EP) seja utilizada em lesões duodenais graves, há controvérsia quanto a sua necessidade. A reunião "Telemedicina Baseada em Evidências - Cirurgia do Trauma e Emergência" (TBE-CiTE) revisou a literatura e selecionou três publicações relevantes sobre as indicações de EP no trauma duodenal. O primeiro estudo, retrospectivo, comparou 14 pacientes com ferimentos penetrantes duodenais grau > II, tratados com EP, com 15 pacientes semelhantes tratados com reparo primário; não houve diferença nos resultados. O segundo, também retrospectivo, comparou o reparo primário (34 casos) com EP (16 casos), em lesões duodenais contusas ou penetrantes grau > II. Os autores concluíram que a EP não é necessária para todos os pacientes, apesar de lesões duodenais graves. O terceiro estudo constituiu-se de revisão da literatura sobre os desafios do tratamento dos traumatismos duodenais. Na experiência do autor, a EP é útil nos casos de fístula de anastomoses gastrojejunais. Conclui-se que a escolha do procedimento operatório no tratamento das lesões duodenais deve ser individualizada. Não há evidência cientifica de boa qualidade para justificar o abandono da EP no tratamento das lesões duodenais graves com grande perda tecidual.

Telemedicina como ferramenta de ensino no cuidado ao paciente queimado / Telemedicine as a teaching tool in the care of burned patients

No contexto da saúde e educação médica, o cuidado ao paciente queimado ocupa uma pequena carga horária na formação. Objetivos: Avaliar os conhecimentos no cuidado do paciente queimado e validar o uso da telemedicina como instrumento de propagação destes conhecimentos. Materiais e Métodos: Aplicou-se dois questionários iguais com 10 questões, online, via SurveyMonkey, antes e após curso com 8 aulas de uma hora de duração cada, presencial ou via videoconferência. Ao final do curso uma prova online com 36 questões foi realizada. Resultados: Participaram do curso gratuito 215 pessoas, sendo 53% estudantes, 23% enfermeiros, 9% técnicos e 6% residentes. Desses, 39% já haviam participado do atendimento ao paciente queimado e 22% haviam realizado curso de formação. Dos 69 que concluíram o curso, 68,1% acompanharam presencialmente, enquanto 31,9% via telemedicina. No teste aplicado antes do curso a média foi de 56,6% de acertos e após o curso 84,8%. A nota final atribuída ao curso para aqueles que o concluíram foi de 8,6 (máxima de 10). Conclusão: A realização de palestras via telemedicinaé ferramenta útil na propagação dos conceitos no cuidado a saúde.

In the context of health care and medical education, burned patient’s care takes a small workload in training. Aims: To assess the knowledge in burn care and to validate the use of telemedicine as a tool to spread this knowledge. Materials and Methods: Two identical questionnaires were provided with 10 questions online via SurveyMonkey before and after an 8 lessons course with one hour each, live or through videoconference. At the end of the course an online test with 36 questions was conducted. Results: A total of 215 people attended the free-of-charge course. 53% students, 23% nurses, 9% technicians and 6% residents. Of these, 39% participated in some extent to the care of burned patients and 22% have attended training courses in the past. Of the 69 who completed the course, 68.1% attended in person, while 31.9% through telemedicine. In the test performed before the course, the average rate was 56.6 % correct and after the course 84.8 %. The final score of the course for those who have completed was 8.6 (out of 10). Conclusion: Lectures through telemedicine are a useful tool in spreading the concepts in health care.

Nonoperative management of splenic injury grade IV is safe using rigid protocol.

OBJECTIVE: To demonstrate the protocol and experience of our service in the nonoperative management (NOM) of grade IV blunt splenic injuries. METHODS: This is a retrospective study based on trauma registry of a university hospital between 1990-2010. Charts of all patients with splenic injury were reviewed and patients with grade IV lesions treated nonoperatively were included in the study. RESULTS: ninety-four patients with grade IV blunt splenic injury were admitted during this period. Twenty-six (27.6%) met the inclusion criteria for NOM. The average systolic blood pressure on admission was 113.07 ± 22.22 mmHg, RTS 7.66 ± 0.49 and ISS 18.34 ± 3.90. Ten patients (38.5%) required blood transfusion, with a mean of 1.92 ± 1.77 packed red cells per patient. Associated abdominal injuries were present in two patients (7.7%). NOM failed in two patients (7.7%), operated on due to worsening of abdominal pain and hypovolemic shock. No patient developed complications related to the spleen and there were no deaths in this series. Average length of hospital stay was 7.12 ± 1.98 days. CONCLUSION: Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.

Hepatic trauma: a 21-year experience.

OBJECTIVE: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. METHODS: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). RESULTS: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. CONCLUSION: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

Trauma hepático: uma experiência de 21 anos / Hepatic trauma: a 21-year experience

OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

OBJECTIVE: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. METHODS: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). RESULTS: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. CONCLUSION: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.