Operative Management versus Conservative in Patients with Liver Trauma Injury

Abstract

Background: The liver is one of the most frequently damaged organs when abdominal trauma occurs. Currently, conservative management becomes the treatment of choice in hemodynamic stable patients. Aim: To evaluate the results of an operative and conservative management of liver injury patients. Patients and methods: From March 2011 to June 2015, 113 patients suffered from hepatic trauma were referred to Zagazig University hospital, trauma unit. The patients were classified according to the way of management: Group I, operative management; Group II, conservative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, morbidity, mortality, and hospital stay. Results: 113 patients had hepatic trauma. 39 (34.5%) patients were managed non- operatively. The commonest type of trauma was blunt and the main cause was motor vehicle in 59 (52.2%) patients. The second cause was stab injury with 33 (29.2%) patients. The least cause was gunshot injury in 21 (18.6%) patients. There was no significant difference in hospital stay between patients operated on and these managed non-operatively. There was no mortality in the patients managed conservatively. Conclusions: Conservative management is a safe approach for hemo-dynamically stable patients with liver trauma. Conservative management patients should be admitted to intensive care unit for at least 48-72 hours for close monitoring of vital signs repeated clinical examinations and follow up investigations as indicated. Failure of conservative treatment did not show a higher incidence of complications or mortality. Good results obtained from conservative management resulted from a highly cooperated trauma team including surgery, anethesia, intensive care, cardiothoracic and neurosurgery doctors.