Spleen and liver injuries: when to operate?

Area of Science:

• Trauma surgery
• Surgical critical care
• Emergency medicine

Background:

• Nonoperative management (NOM) is the preferred approach for most liver and spleen injuries.
• Despite NOM's acceptance, specific indications and timing for operative intervention remain debated.
• Evidence for optimal treatment strategies for solid organ injuries is limited.

Purpose of the Study:

• To review recent literature on indications and timing for operative treatment of liver and spleen injuries.
• To assess the current evidence supporting surgical intervention versus NOM.
• To identify gaps in knowledge regarding solid organ injury management.

Main Methods:

• Literature review of recent publications (last 12-24 months) on liver and spleen injuries.
• Analysis of evidence quality, focusing on study design and level of evidence.
• Assessment of the role of angiographic embolization in managing these injuries.

Main Results:

• Publication rates have decreased, reflecting NOM's established role.
• Most studies are retrospective or observational, lacking high-level evidence like randomized controlled trials (RCTs).
• The utility of angiographic embolization as an adjunct treatment is still under investigation.

Conclusions:

• Immediate exploratory laparotomy is indicated for hemodynamically unstable patients with ongoing bleeding from liver or spleen injuries.
• Further RCTs are essential to define the role of angiographic embolization and optimize patient selection for NOM versus surgical intervention.