J. Sabat1, T. Tan2, B. Hoang2, P. Hsu2, Q. Chu3 1Banner University Medical Center/ University of Arizona,Tucson, AZ, USA 2University Of Arizona,Tucson, AZ, USA 3Louisiana State University Health Sciences Center,New Orleans, LA, USA
Introduction:
Portal vein injury is uncommon, and the optimal treatment is controversial. We compared the outcomes of ligation versus repair of portal injury utilizing the National Trauma Database (NTDB).
Methods:
All adult patients who suffered from portal injury were identified from NTDB (2002-2014) by International Classification of Diseases (ICD), Ninth Revision Diagnosis codes. Patients were stratified by treatment modality into observation, ligation, and surgical repair using ICD procedure codes. Outcomes including hospital mortality, bowel resection, and length of stay (LOS) between ligation and surgical repair were compared by two-sample t-test or X2 test as appropriate. Multivariable analyses were performed with logistic regression.
Results:
Among 752 patients with portal vein injury, 345 patients (45.9%) were observed, 103 patients (13.7%) had ligation, and 304 (40.4%) underwent surgical repair. Over 95% was from penetrating trauma, and mortality was 49%. Age, gender, injury severity score (ISS), Glasgow Coma Scale (GCS), presenting blood pressure and heart rate were similar between groups that underwent ligation and surgical repair. The hospital mortality (59.2% vs. 47.7%, p=.08), bowel resection (1.9% vs. 1%, p=.55), and LOS (12.5 vs. 15 days, p=.08) were also comparable between ligation and repair in univariable analysis. In multivariable analysis, the hospital mortality was significantly lower for surgical repair compared to ligation (OR 0.63, 95% CI 0.40, 0.99, p=.04).
Conclusion:
Portal vein injury is caused by penetrating trauma and is associated with significant mortality and morbidity. Surgical repair is associated with significantly lower mortality than ligation of the portal vein and should be performed if feasible.