Complex therapy for hepatic trauma

To investigate the optimal surgical management of patients with hepatic trauma.

A retrospective analysis of 197 patients treated for hepatic trauma in the two hospitals from January 1980 to January 2001.

Qilu and Dodoma Hospital in China and Tanzania respectively. PATIENT INTERVENTIONS: Two patients died before surgery, seven patients were treated conservatively, while 188 patients underwent various surgical interventions under the principles of damage control surgery including initial laparotomy, resuscitation phase and definitive surgery.

The overall mortality was 15.3% (30/197). The leading cause of death was the triad of coagulopathy, hypothermia and metabolic acidosis.

Patients with major exanguinating injuries will not survive complex procedures such as formal hepatic resection or complex procedures such as formal hepatic resection or pancreaticoduodenectomy. The operating team must undergo a radical shift in their "surgical ideology" if the patient is to survive such devastating injuries. The central principle of damage control surgery is that patients died of the triad of coagulopathy, hypothermia and metabolic acidosis. Damage control surgery can be thought of in three distinct phases: initial truncated laparotomy, resuscitation phase and definitive operation.