We have improved and developed surgical procedures for abdominal trauma based on reported operations. In patients with severe hepatic trauma who had an increase of hemoperitoneum on repeat US or CT, we performed hepatectomy in order for resection of devitalized liver parenchyma and reliable hemostasis. Two of seventeen patients with hepatectomy died from hemorrhage of liver injuries. Ten patients who had injury to the main pancreatic duct underwent pancreatic duct repair rather than Letton & Wilson operation. Pancreatic fistulas occurred in three patients, who later recovered with conservative therapy. As additional operative procedures for duodenal injuries, we performed diverticulization on 20 patients and pyloric exclusion without gastrojejunostomy on 4 patients, of whom one patient had duodenal fistula. Eighteen patients suspected of bowel injuries without free air on CT and exhibiting peritoneal signs underwent laparoscopic examination under general anesthesia. There were no delayed laparotomies and one nontherapeutic laparotomy.
We introduce the process of establishment and present status of the first local government-directed major trauma center in our country in the City of Yokohama. First, the retrospective population based study revealed the number of preventable trauma deaths in the city. We focused on hemorrhagic shock with torso injury as the main target to treat at the trauma center. The city designated two major trauma centers and added the function of "trauma care for serious injury" to 2 of 8 existing tertiary emergency and critical care centers. Yokohama City Medical Control Council introduced a prehospital medical protocol. The two centers replaced their hybrid operating room and resuscitation room with a CT scan, respectively. The unexpected trauma survivor rate increased after the establishment in the single center study. Regional trauma care systems should aim to save lives and function to reduce post-trauma disabilities. In the future, the definition of "trauma center" should be clarified, and further effort will be necessary for the nationwide establishment of an inclusive trauma care system based on local emergency medical service plans with continuous quality improvement to avoid preventable death as well as disabilities.
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