Role of Damage Control Surgery in Severe Liver Trauma: A Systematic Review of Mortality, Morbidity, and ICU Stay

This systematic review evaluates the role of damage control surgery (DCS) in managing severe hepatic trauma (AAST grade III-V), focusing on mortality, morbidity, and ICU stay. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified six studies with a combined sample size of 1,497 patients, analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. DCS comprising perihepatic packing, temporary abdominal closure, and staged re-laparotomy was shown to improve short-term survival by rapidly controlling hemorrhage and stabilizing physiology in critically unstable patients. Evidence indicated that early re-laparotomy (within 24-48 hours) reduced ICU stay and postoperative complications compared with delayed re-exploration. Despite improved outcomes, mortality remained influenced by initial physiological instability and associated injuries. Most studies presented a moderate risk of bias due to retrospective designs and heterogeneity in protocols. Overall, DCS remains a cornerstone in the management of severe liver trauma, and future multicenter prospective studies are needed to refine operative timing, standardize protocols, and optimize patient outcomes.