MAJOR LIVER RESECTION FOR PATIENTS WITH LIVER TRAUMA

Document Type : Original Article

Authors

1 Department of HBP Surgery, Menoufiya University, Egypt

2 Department of Anaesethia, National Liver Istitute, Menoufiya University, Egypt

Abstract

Introduction: The liver is the second most commonly injured organ in abdominal trauma, but liver damage is 
the most common cause of death after abdominal injury. In spite of there has been a paradigm shift in the 
management of patients who have stable hemodynamic with marked change toward a more conservative 
approach in the treatment of abdominal trauma has been noted during the last decades, urgent surgery 
continues to be the standard for hemodynamically compromised patients with hepatic trauma.
Aim of the work: to find out and assess the role of surgery and liver resection in the management of blunt 
liver trauma. 
Patients and Methods: this study included sixty five patients with liver trauma referred to the National Liver 
Institute (NLI), university of Menoufiya, Egypt, as a tertiary center in five years duration. The management 
option was based on hemodynamic status, radiological (ultrasound and CT) staging criteria. Analysis was 
done using SPSS 18. Statistical significance was set at P<0.05.
Results: The age of these patients ranged from 4 to 38 years, with a mean age of 20.4 years, and with male 
predominance (84%). Twenty seven (41.5%) patients were not previously explored and 5 (7.6%) were explored 
in NLI due to biliary peritonitis. Thirty eight (58.5%) were referred after primary exploration. Fourteen 
(21.5%) were managed conservatively and only 5 (7.6%) were opened for removal of packs after 48 hours. 
Twenty four (36.9%) were explored due to hemodynamic instability and CT criteria, 4 (6.1%) were managed 
by conservative surgery (repair of lacerations). Twenty (30.7%) patients needed major liver resection, 3 (4.6%) 
patients by left lateral segmentectomy, 2 (3%) patients by right posterior sector resection, and 15 (23%) 
patients underwent right hepatectomy with one (1.5%) perioperative mortality, one (1.5) postoperative portal 
vein thrombosis and 3 (4.6%) postoperative biliary complications. 
Conclusion: hemodynamic stable patients can be managed safely non-operatively, while urgent surgery 
continues to be the standard for hemodynamic compromised patients with hepatic trauma. Non operative
management doesn’t lead to longer hospital stay. Low grade injuries can be managed non-operatively with 
excellent results. 

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