ANATOMIC RESECTION FOR SEVERE LIVER TRAUMA

Background. Most publications during the past decade have condemned th e use of anatomic resection for liver trauma and advocated a conservat ive surgical approach when operative intervention was required. This p olicy has been supported by the high mortality rate reported by most a uthorities. The purpose of this study was to assess the results of ana tomic hepatic resection for liver trauma in an institution in which th e hepatobiliary surgeons are responsible for the management of severe liver injuries. Methods. During the period 1983 to 1996, 287 patients with liver injuries were admitted to the hospital and 37 patients with severe liver. trauma underwent anatomic resection. Demographic, clini cal, operative, and postoperative data were collected and analyzed. Th e resections performed included right hemihepatectomy (n = 27), left h emihepatectomy (n = 1), left lateral segment resection (n = 5), and se gmental resection (n = 4). Results. There were three postoperative dea ths after right hemihepatectomy (11.1%) and an overall mortality rate of 8.1%. There were no intraoperative deaths. Postoperative complicati ons occurred in 22 patients (60%) and were most frequent in patients w ith concomitant injuries to other systems. Liver-related morbidity occ urred in seven patients (19%). The median postoperative stay was 20 da ys. Conclusions. Anatomic hepatic resection for trauma is associated w ith low mortality and liver-related morbidity rates when performed by experienced hepatobiliary surgeons, and its rot in the management of s evere hepatic trauma should be reevaluated.