Operative and Nonoperative Management of Blunt Liver Injuries

Abstract

Purpose of Review The purpose of this review is to discuss the indications for operative and nonoperative management in patients with blunt liver injuries. Recent Findings Over the past several years, research has begun to show that nonoperative management in blunt liver injuries is feasible and has favorable outcomes over immediate operations in patients who are hemodynamically stable. This includes highgrade injuries who were previously taken to the operating room, in the absence of peritoneal signs or instability, for washout and packing. This trend in management is likely multifactorial and includes improved quality of critical care medicine, advances in imaging to accurately define the injury and trend changes, and other interventional techniques such as embolization, percutaneous drainage and endoscopy. The mainstay of treatment for hemodynamically unstable patients remains operative. Summary This article will provide current recommendations for operative and nonoperative management strategies in patients with blunt liver injuries, taking into account initial clinical picture and resources available.

Definitive Repair of Injuries to the Liver During Initial Trauma Laparotomy

“…2 For the minority of patients requiring emergent surgery, there remains a significant mortality and morbidity, with confounding recommendations as to the optimal surgical treatment in the acute setting. 3,4 Multiple operative techniques together with invasive procedures are used depending on the extent of the liver parenchymal injury, the biliary continuity, the hemodynamics of the patient, training/comfort/ability of the surgeon, and resources available. The surgical approaches range from damage control packing ± second/third looks, 5 selective vascular ligation, resection (anatomic or nonanatomic), balloon tamponade, primary repair, complex reconstruction, and hemostatic agents.…”