Use of Sengstaken-Blakemore Intrahepatic Balloon: An Alternative for Liver-Penetrating Injuries

• Published in: World journal of surgery 2012-09, Vol.36 (9), p.2119-2124
• Main Authors: Fraga, Gustavo Pereira, Zago, Thiago Messias, Pereira, Bruno Monteiro, Calderan, Thiago Rodrigues Araujo, Silveira, Henrique Jose Virgili
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - surgery; Abdominal Surgery; Adolescent; Adult; Balloon Occlusion - instrumentation; Balloon Occlusion - methods; Biliary Fistula; Cardiac Surgery; Female; General Surgery; Hemorrhage - etiology; Hemorrhage - surgery; Hepatic Injury; Humans; Injury Severity Score; Liver - injuries; Liver Trauma; Male; Medicine; Medicine & Public Health; Registries; Retrospective Studies; Revise Trauma Score; Surgery; Thoracic Surgery; Vascular Surgery; Wounds, Penetrating - etiology; Wounds, Penetrating - surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1625-x

Background Severe lesions in the liver are associated with a high mortality rate. Alternative surgical techniques such as the use of an intrahepatic balloon may be effective and reduce mortality in severe hepatic lesions. This study aimed to demonstrate the experience of a university hospital in the use of the Sengstaken-Blakemore balloon in patients with transfixing penetrating hepatic injury as an alternative way to treat these challenging injuries. Methods A retrospective study based on the trauma registry of a university hospital was performed. All patients admitted with hepatic penetrating injuries and treated with the Sengstaken-Blakemore balloon within the period 1990–2010 were reviewed. Results Forty-six patients with transfixing hepatic injuries were treated with the Sengstaken-Blakemore balloon in the study period. The most frequent cause of injury was gunshot wound (87 % of the patients). The mean trauma scores on admission were Revised Trauma Score (RTS) = 7.12 ± 1.46, Injury Severity Score (ISS) = 22.4 ± 9.7, and Abdominal Trauma Index (ATI) = 19.5 ± 11. According to the severity of the hepatic trauma, 71.8 % of patients had grade III, 23.9 % grade IV, and 4.3 % grade V injuries. Associated abdominal injuries were found in 89.1 % of the patients. The most frequent liver-related complications were hepatic abscess postoperative bleeding (8.6 %), biliary fistula (8.6 %), (4.3 %), and biliary peritonitis (2.1 %). Surgical reintervention was necessary in 14 patients (31.1 %). From those 14, only 3 had the balloon removed. The overall morbidity and mortality rates were 56.5 % and 23.9 % (11 patients), respectively. Conclusion The knowledge of alternative surgical techniques is essential in improving survival in patients with severe penetrating hepatic injuries. The use of intrahepatic balloon is a viable surgical strategy.