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Operative Versus Nonoperative Management of Penetrating Liver Injuries: A Systematic Review and Meta-analysis
Sophia Massafelli Battistuta1, Luís Fernando Ferreira Cavalcante1, Giovanna Ristori Costa1
1- Faculdade de Ciências Médicas de São Paulo - São Paulo - SP - Brasil.
Revista Do Colegio Brasileiro De Cirurgioes
|August 6, 2026
Summary
Non-operative management (NOM) for penetrating liver injuries shows lower mortality and complication rates compared to operative management (OM). This approach may be a viable alternative for carefully selected patients with these injuries.
Area of Science:
- Trauma Surgery
- Surgical Outcomes Research
- Emergency Medicine
Background:
- Conservative management of blunt liver injuries is established, but its use in penetrating injuries is debated.
- This study addresses the controversy surrounding non-operative management (NOM) versus operative management (OM) for penetrating liver injuries.
Purpose of the Study:
- To compare the outcomes of non-operative management (NOM) versus operative management (OM) in patients with penetrating liver injuries.
- To assess the safety and efficacy of NOM for selected patients with penetrating liver trauma.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Searched Medline, Scopus, and Cochrane databases.
- Followed PRISMA and Cochrane Handbook guidelines.
Main Results:
- Included 6 studies with 4,407 patients.
- NOM was linked to significantly lower mortality (RR 0.40) and overall complication rates (RR 0.83).
- No significant differences in liver complications, blood transfusion needs, or hospital length of stay.
Conclusions:
- Non-operative management (NOM) is a potential alternative for selected patients with penetrating liver injuries.
- NOM demonstrates favorable outcomes regarding mortality and complications compared to operative management (OM).