# Preoperative Transcatheter Arterial Embolization and Modified Hepatorrhaphy for Severe Liver Trauma: An Emerging Damage-Control Strategy

## TL;DR

A new damage-control strategy for severe liver trauma combines preoperative embolization with a modified surgical technique to avoid risks of traditional methods.

## Contribution

Integrating preoperative TAE with hepatorrhaphy and using an absorbable hemostat as an alternative to non-absorbable pledgets.

## Key findings

- Preoperative TAE allowed successful hepatorrhaphy without perihepatic packing in a trauma case.
- An absorbable hemostatic agent was safely used instead of non-absorbable pledgets.
- The patient had an uneventful recovery with no need for further interventions.

## Abstract

The efficacy of hepatorrhaphy in managing severe hepatic trauma remains uncertain. Although perihepatic packing (PHP) is widely employed, it is associated with risks such as infection and abdominal compartment syndrome. These concerns underscore the need for safer and more effective damage-control strategies. We report the case of a 16-year-old female patient who sustained blunt abdominal trauma following a motorcycle collision and presented with hemodynamic instability due to severe hepatic and renal injuries. Preoperative transcatheter arterial embolization (TAE) enabled hepatorrhaphy without the need for PHP. An absorbable oxidized regenerated cellulose hemostat (Surgicel NU-KNIT, Ethicon, Raritan, NJ) was used in place of conventional non-absorbable pledgets. A right nephrectomy was concurrently performed due to extensive hilar avulsion. The postoperative course was uneventful, and no further interventions were required. This case highlights two potential innovations: the integration of preoperative TAE with hepatorrhaphy and the use of an absorbable hemostatic agent. These approaches may enhance hemostatic efficacy and reduce reliance on PHP in selected trauma cases.