Treatment of Liver Trauma: Operative or Conservative Management

Abstract

BackgroundThe liver is one of the most frequently damaged organs when abdominal trauma occurs. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 143 patients with liver injury treated in a single institution.MethodsA retrospective study of the patients admitted with the diagnosis of liver trauma was performed from 1992-2008. The patients were classified according to the intention to treatment: Group I, operative management; Group II, conservative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, transfusions, morbi-mortality, and hospital stay. We established two periods (1992-1999; 2000-2008) in order to compare diagnosis and management.ResultsA total of 143 patients were analyzed. Thirty-one percent correspond to severe injuries. Conservative treatment was followed in 60.8 % with surgery undertaken in 14.9 % of patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 38.2 %. Total mortality was 14 %. Morbidity (35.7-38.5 %) in the group of immediate surgery and failure of conservative management is similar, but not in mortality (28.6-15.4 %). In the second group (2000-2008) there are more patients with conservative treatment, with a low percentage of failure of this treatment and morbi-mortality.ConclusionsConservative treatment is an adequate treatment in a great number of patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centers with experienced surgeons.

Liver Trauma - Operative Management

“…A similar study from Spain [18] described 143 patients admitted between 1992 and 2008 and found that surgery was required in 38% with 15% of the SNOM group eventually requiring operation. Haemodynamic instability was the main indication for operation following failure of SNOM in 9 out of 11 patients.…”

“…The numbers involved were small and we would not advocate this approach for all unstable trauma cases. There is also emerging literature about the pitfalls of multiple scans delaying definitive treatment and the additional radiation exposure increasing the risk of carcinogenesis in trauma patients [18].…”

Management modalities of isolated liver injury in blunt abdominal trauma

“…In another study Bernardo et al (n=143) majority (83.6%) of patients were males. 12 The incidence of abdominal trauma in the male population is higher because in our country males are the leaders of the family and hence lead a more active life and undergo more outdoor activities. Similar demographic data have been reported in other studies with most injuries affecting males and being incurred due to blunt trauma.…”

“…Similar results have been published in other studies Bernardo et al and Croce et al with most injuries due to road traffic accidents. 12,24 Vehicular accidents occur more frequently because every year there is increase in number of vehicles on road, poor maintenance of road, general public and drivers not following the rules and regulations, nonuse of seat belts, helmets, airbags in vehicles and lack of motivation and education in general-assault due to hit or by animal also is significant mode of trauma in rural parts of the country were run over or goring by a bullock is quite common.…”

“…[9][10] Initially skeptical but now NOM is standard of care with aim of obtaining a reduction in morbidity and mortality. 11,12 Surgery is also limited to limited debridement, selective vascular ligation and perihepatic packing. 13,14 The objective is to achieve a reduction in morbidity, mortality and complication rate.…”