COMPREHENSIVE EVALUATION OF LOCAL HEMOSTATIC AGENTS IN LIVER TRAUMA
Abstract
Liver trauma ranks among the most severe and life-threatening abdominal injuries, accounting for a significant proportion of emergency surgical cases. Mortality rates in severe forms may reach 20–30%, particularly when associated with combined injuries, massive blood loss, and hemorrhagic shock. Over the past decades, advances in surgical tactics have shifted the focus from extensive liver resections toward organ-preserving approaches, supported by the development and implementation of modern local hemostatic agents. However, despite the availability of numerous topical hemostatics, the choice of an optimal agent remains a critical and unresolved issue. This decision must consider not only the hemostatic efficacy and technical convenience of the material but also the morphological characteristics of the injury, the dynamics of tissue repair, and the potential for biliary complications. Morphological consequences of certain widely used agents—particularly those based on oxidized cellulose or collagen—may include coagulation necrosis, intense inflammatory infiltration, bile extravasation, and the development of coarse subcapsular fibrosis, leading to deformation of the liver capsule and impairment of its microarchitecture.