Is a conservative approach justified in penetrating liver injury?

Abstract

Objective. To establish the mortality and morbidity associated with major penetrating liver injuries and to describe the nature and treatment of complications related to these injuries. We postulated that there had been a trend toward less radical initial surgery, as well as an increased utilization of modern imaging techniques in both diagnosing and treating postoperative complications following penetrating liver trauma. Design. A retrospective survey of medical records and radiology files. Setting. A university trauma center in an urban setting. Patients. Of the 188 patients admitted to our trauma center with penetrating liver trauma between April 1988 and December 1991, 36 had major liver trauma (grades 3 through 5) and are described in this report. Main Outcome 4easures. The mortality rate, type of operative treatment, and the nature and treatment of complications for each grade of major liver injury. Results. The mortality rate from major liver injuries was 17%. Surgical techniques employed primarily consisted of the use of hemostatic agents and cautery, simple suturing, direct vessel ligation, and packing. Fifty-two percent of the survivors had major complications related to the liver injury itself, but only two required operative therapy. The remaining patients were successfully treated with interventional radiologic techniques. Conclusions. The morbidity and mortality following major penetrating liver injuries remain significant. The majority of hepatobiliary complications can be successfully managed without further surgery but require the combined efforts of the surgeon and interventional radiologist.