Blunt hepatic injury: Minimal intervention is the policy of treatment

Background: Many publications recommend nonoperative treatment for stable b lunt hepatic injury patients. Unstable hemodynamic status is the only indic ation for surgery. When operation is indicated, controversies exist regardi ng which operative procedure will be more beneficial to the patients, The p urposes of this study are to compare the results of operative and nonoperat ive management of patients with blunt hepatic injuries and to identify the optimal surgical approach when surgery is indicated. Methods: Different prospective protocols of treating adult blunt hepatic in juries were conducted. From 1992 to 1993 (group I), urgent surgery would be performed in the presence of hemoperitoneum, The policy shifted to aggress ive nonoperative approach between 1996 and 1997 (group II). The patients fr om each period were divided into three subgroups. Group A included the pati ents who received nonoperative treatment in either period, Group B consiste d of the patients who received surgery in the first period and nonoperative management in the second period. Group C included the patients who were op erated on in either group. Comparisons were made between matched groups. Results: Groups IA and IIA patients had minor injuries and could be success fully treated nonoperatively, The results of groups IB and HB were similar concerning hospital stay, morbidity, and mortality. Transfusion requirement s of group IIB patients were significantly higher (2.2 vs. 1.1 units, p = 0 .01) than those of group IB, However, 25 (58%) celiotomies of group IB pati ents were nontherapeutic, When surgery was indicated, group IC patients had significantly higher liver-related mortality (14 of 49 vs. 3 of 55, p = 0. 002), Anatomic resection was performed more frequently in that period. Conclusion: Nonoperative treatment significantly decreased the rate of nont herapeutic laparotomy but carried the risks of higher transfusion requireme nts and delaying operation. When surgery was indicated, the policy of minim al intervention positively affected the patients' outcomes. The goal of sur gery should be hemorrhage control rather than resection of the injured live r tissues.