Surgical therapy for liver ruptures

The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3-88) presenting from January 1979 to August 1996 is r eviewed. There were 165 cases of blunt trauma and 13 cases of penetrating i njury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The overall mortality was 32 % (57 patients). The mortality for true hepatic injury was 15.7%. None of the patients with penetrating injuries died. Mortality was inflenced by the ty pe of liver injury and the number of associated injuries. The postoperative complication rate was 55 %. The most-frequent postoperative complications related to the hepatic injury were intrahepatic or subcapsular hematoma (12 .9 %) and postoperative bleeding (9.6 %). Intraabdominal abscess formation was seen in 2.8 %. Operative therapy for liver injuries depends on the grad e of the injury. The majority of liver injuries can be managed by simple te chniques, including electrocautery and application of hemostatic agents. In complex injuries hepatotomy, direct vessel ligation, and debridement of ne crotic tissue is the method of choice (Pachter's procedure). In non-control led bleeding, perihepatic picking is a standard method.