Surgical Management of Traumatic Liver Injury

PURPOSE: The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. Patients with liver injury can be treated by using nonoperative or operative management. The aim of this study was to study patients with traumatic liver injury who were treated by using operative management. METHODS: Ninety-eight patients with traumatic liver injury underwent surgical treatment from January 1995 to December 2004 at Soonchunhyang University Cheonan hospital. Medical records were reviewed retrospectively, and demographic, clinical, operative, and postoperative datas were collected and analyzed. RESULTS: Among the patients with operative management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 1.9:1. The most frequent injury mechanism was blunt trauma (85.7%). Abdominal computed tomography was the diagnostic modality used most frequently. Severe liver injury above Grade III was seen in 80.6% of all patients, and long bone fracture was the most common combined injury. Patients were managed by using various techniques, including simple closure, liver resection, and perihepatic packing. Pulmonary complications were the most common postoperative complications (35.7%). the overall mortality rate was 17.3%. Between the survival group and the expired group, the amount of transfusion for the expired group was statistically more than that for the survival group. CONCLUSION: Operative management is an effective treatment modality for hemodynamically unstable patients with severe traumatic liver injury. The amount of transfusion is a significant prognostic factor for survival.

Treatment and Prognostic Factors for Traumatic Liver Injury

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.

A Comparison of Safety between the Operative and Nonoperative Management of Traumatic Liver Injury

PURPOSE: The aim of this study was to evaluate the safety of the nonoperative management of traumatic liver injuries. METHODS: The medical records of 67 patients, with traumatic liver injury, between January 1998 and December 2001, were reviewed retrospectively, with respect to the cause of injury, combined injury, hemodynamic stability, amount of transfusion, liver injury grade, length of hospital stay and complications. RESULTS: Of the 67 patients, 30 were treated operatively (Group A), and 37 nonoperatively (Group B). The initial systolic blood pressure in Group A was significantly lower than that in Group B (81.33+/-23.00 vs 108.10+/-20.66 mmHg, P<0.001). The amount of transfusion for hemodynamic stability were 2.83 and 0.89 units (P<0.01), and the mean total transfusion requirement and injury grade were 10.30 and 1.29 units (P<0.001). 3.63+/-0.99 and 2.48+/-1.12 (P<0.001) for Groups A and B. The duration of intensive care unit stay in Group A was significantly shorter than that of Group B (6.70+/-6.12 vs. 3.13+/-4.00 days, P<0.01), but there was no difference in total length of hospital stay. The complication rates in Groups A and B were 63.3 and 21.8%, respectively (P<0.01), and the most common complications were respiratory problems, such as pleural effusion, pneumonia, atelectasis and pulmonary edema. Five patients in Group A died, 2 from hypovolemic shock, and one each from disseminated intravascular coagulation, multiple organ failure, and respiratory failure, but no patients in Group B died. CONCLUSION: Nonoperative management is safe for hemodynamically stable patients with traumatic liver injury, regardless of the injury severity, but close observation and frequent physical examinations must be adhered to.

Resectional Management of Traumatic Liver Injury

BACKGROUND: Patients with liver injury can be managed by various techniques, including simple closure, electrocautery, hemostatic agent application, temporary packing, perihepatic drainage, and hepatic resection. Two different types of hepatic resections can be employed in selected and advanced hepatic injury; resectional debridement and anatomical hepatic resection. The aim of this study was to consider the role of hepatic resection in the management of severe liver trauma and to define the roles of the different types of resections. METHODS: Two hundred two patients with traumatic liver injury underwent surgical treatment from July 1989 to June 1998 at the Department of Surgery, Soonchunhyang University Chunan Hospital. From them, the records of forty-six patients who received hepatic resections in the same period were collected. Demographic, clinical, operative, and postoperative data were collected and analyzed. RESULTS: Among the patients with resectional management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 3.1:1. The most frequent injury mechanism was blunt trauma (95.7%). There was one postoperative death among the 8 anatomical resections (12.5%) and nine postoperative deaths among the 38 resectional debridements (24.4%). The overall mortality rate was 21.7%. There were no intraoperative deaths. Postoperative complications occurred in 11 patients (23.9%). CONCLUSIONS: Hepatic resection can play a major role in the management of hepatic trauma. It can be indicated in cases of deep laceration in the liver involving major vascular structures or the bile duct, extensive devitalization of the hepatic parenchyma, and hepatic venous bleeding. In selected cases, an anatomical resection can be successful by making a clear line of resection through anatomical planes away from any damaged parenchyma.