[Operations for liver injury 1968-93. A review from the Reykjavik City Hospital.]

The purpose of the study was to disclose the operative experience with liver injuries at the Reykjavik City Hospital for the years 1968-1993 and compare the results to those reported by others.

Journals for all patients undergoing an operation for liver injury during the period were studied. Age and sex, cause of injury, condition on arrival at the hospital, additional injuries, length of the operation, number of transfusions, hospital stay, indications for surgery, type of surgery, complications and mortality were all noted. The abbreviated injury severity scale (AIS-90) was used to classify the liver injuries. The injury severity score (ISS) was calculated for each patient.

There were 41 patients, 28 males and 13 females. The median age was 20 years (5-78) and one fourth were children under 10 years. Blunt trauma caused 84% of the injuries and traffic accident the most common cause. Seventeen patients (42.5%) were in shock (systolic BP under 90) on arrival and 12 (29%) were still in shock at the beginning of the operation. Each patient had on the average 2.22 additional injuries inside or outside the abdomen. The number of transfusions required, hospital stay and operative time were extremely variable the median being 1.4 liters, 100 minutes and 15 days respectively. The most common indication for laparatomy was shock or fluid in the abdomen as shown by ultrasound and signs of peritoneal irritation. The liver was bleeding at the time of surgery in 51.3% of cases. Bleeding could in most instances be controlled with sutures. Three patients underwent a major hepatic resection and all survived. One of the three had an associated vena cava injury. There were 20 major complications of which abdominal sepsis and renal failure were the most common. Seven patients died (17%) but only one of liver bleeding on the operating table. Others died from brain injury, chest injury or multiple organ failure. Seventy one per cent had minor or moderate injury to the liver (class I or II) while 29% had major or massive injury (class III or VI). Twenty three patients (56%) had injury severity score (ISS) under 16. One of these 23 patients died, an elderly man with cirrhosis and incurable carcinoma of the liver. Other patients who died had ISS of 41 or higher. In this series are only patients who underwent an operation. In recent years there has been a growing tendency to treat liver injury without operation. From 1988-93 seven of 15 patients with liver injury were treated without operation.

Most of the results in this study are similar to those reported by others. The mortality is low when compared to authors who mostly have closed injuries in their series as we do. No patient with normal liver before the accident died unless he had ISS of 41 or higher. This fact along with the low mortality seem to indicate that treatment was of high standard.