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Related Experiment Videos

Hepatic trauma: contemporary management.

Donald D Trunkey1

  • 1Department of Surgery, Oregon Health and Science University, L223, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA. trunkeyd@ohsu.edu

The Surgical Clinics of North America
|April 6, 2004
PubMed
Summary

The incidence of liver injuries has not increased; apparent rises are due to improved diagnostics and population changes. Current nonoperative management for severe liver injuries has unacceptable complication rates.

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Area of Science:

  • Trauma surgery
  • Surgical critical care
  • Hepatobiliary surgery

Background:

  • The perceived increase in liver injury incidence may be influenced by diagnostic advancements and population growth.
  • Severe liver injuries are increasingly concentrated in specialized trauma centers across 35 states.
  • There is a noted shift towards blunt trauma as the predominant mechanism of injury compared to penetrating trauma.

Purpose of the Study:

  • To critically evaluate the current trends and management strategies for severe liver injuries.
  • To question the rising enthusiasm for nonoperative management of severe liver injuries.
  • To highlight the unacceptable complication rates associated with current nonoperative approaches.

Main Methods:

  • Review of literature concerning liver injury incidence and management.

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  • Analysis of trends in blunt versus penetrating liver trauma.
  • Critical assessment of nonoperative versus operative management outcomes.

    • Main Results:

    • Evidence does not strongly support an increased incidence of liver injuries.
    • Diagnostic modalities, population increases, and trauma center concentration contribute to the perception of increased incidence.
    • Nonoperative management of severe liver injuries is associated with unacceptably high complication rates.

    Conclusions:

    • The apparent increase in liver injuries is likely multifactorial, not a true rise in incidence.
    • Operative management strategies, when comprehensive, offer viable alternatives to nonoperative approaches.
    • Further research and refinement of management protocols are needed to reduce complications in severe liver injuries.