Blunt and penetrating liver trauma: surgical strategies

From our own experience with 104 patients with liver trauma treated by laparotomy we confirmed the present trends in treating blunt liver trauma, i.e. conservative therapy of minor lesions under closed observation with imaging procedures (US and CT-scan); minor local measures in superficial liver injuries when laparotomy is performed for other reasons; generous use of the Pringle maneuver in primary hemostasis; temporary or final treatment by perihepatic packing in all parenchymal fractures with predominant venous bleeding; direct suture or ligation of arterial bleeding; liver resection only for the debridement of destroyed tissue. With primary packing the patient can be transferred to an experienced center. The overall mortality is more dependent on combined lesions from polytrauma. The early and efficient hemostasis of liver trauma may, however, stabilize the border-line patient and give him a better chance. This is underlined by the experience, that isolated liver injuries have a much better prognosis except central lesions of the retrohepatic vena cava and large central hepatic veins.