Penetrating Liver Injuries

Abstract

Injuries to the liver are common. In the past, virtually, all penetrating injuries to the liver were managed by laparotomy, direct surgical exploration of the injured liver and repair. However, stable patients with isolated liver injuries, particularly those with low grade injuries, are now able to be managed non-operatively. Operative management can be as simple as packing, suture repair, and/or application of topical hemostatics. More complicated repairs such as resectional debridement, finger fracture with direct ligation of bleeding vessels, and major non-anatomic liver resections are sometimes needed to obtain hemostasis in major liver injuries. Damage control surgical techniques seem ideally suited for major liver injuries. Hemostasis is obtained with packing and whatever other techniques are necessary. This is used as a bridge to angiographic embolization, which can be followed by unpacking and other operative therapy as needed when the patient is more stable. Minimally invasive techniques, such as laparoscopy, do not have a major role in the management of penetrating liver injuries, though that may be expanded as time goes on. Newer adjuncts for hemostasis, such as higher quality topical hemostatic bandages, as well as other innovative therapies, may soon become available. Hepatic failure is infrequent, even with major liver injury, but extracorporeal techniques can be used in the few cases where profound hepatic failure does occur.