Nonresectional management of major hepatic trauma. An evolving concept

Over a 6 year period, 319 acute liver injuries were identified at laparotomy. Fifty-three patients (17 percent) sustained major hepatic trauma that necessitated complex operative techniques: lobectomy in 21, segmentectomy in 6, selective hepatic artery ligation in 3, and temporary packing in 7. Throughout the study period, there has been a progressive shift to nonresectional therapy. Lobectomy for parenchymal injuries has continued to have a prohibitive mortality rate of 64 percent, whereas alternative procedures, such as hepatotomy, selective hepatic artery ligation, and packing, have had lower mortality rates from hemorrhage without an increase in delayed death from sepsis. Hepatotomy has also proved useful to gain access to retrohepatic vena caval tears. Our present experience supports the national trend of surgical restraint in the operative treatment of complex liver trauma and suggests that hepatic lobectomy is rarely justified.