Surgical treatment of liver trauma (analysis of 244 patients)

BACKGROUND/AIMS: The liver is the most common injured intraabdominal organ after trauma. This retrospective study was designed to analyze the results of the surgical treatment of 244 cases of liver trauma operated between 1973 and 2001. METHODOLOGY: Two hundred and seventeen of the cases were male and 27 were female. Mean age of the patients was 29.6. Blunt injuries were responsible for liver trauma in 53.6% of the patients. According to the American Association for the Surgery of Trauma classification we evaluated the patients to two groups. The first one was Group A, minor hepatic injuries, which consisted of grade I, grade II and grade III injuries, and the second one was Group B, major hepatic injuries, which consisted of grade IV, grade V and grade VI injuries. There were 238 cases in Group A and 6 cases in Group B. Primary suturing of the hepatic rupture was performed in 187 of 238 cases in group A. Liver injuries of the other 50 cases did not require suturing so that we drained the suprahepatic and infrahepatic spaces during laparotomy. The remaining case in group A had resectional debridement and hemostasis. On the other hand we performed regular or irregular hepatic resection in all group B patients. RESULTS: Overall mortality rate was 16.3%. The mortality rate was higher in group B than group A (66.6% and 15.1%, respectively). The mortality rate was also higher in the blunt abdominal trauma cases than penetrating injuries (25.9% and 5.3% consecutively). CONCLUSIONS: We concluded that the injury grade and the type of trauma influence the mortality rate. Careful clinical assessment and close radiological monitoring of the patients with minor hepatic injuries, may prevent unnecessary laparotomies.