Operative management of hepatic injuries

Seventy-seven cases of hepatic trauma diagnosed during exploratory laparotomy were retrospectively studied. Blunt trauma comprised the majority of cases. Seventy-five per cent of cases had associated injuries and 58 per cent were in shock on arrival. The mortality rate was 19 per cent. Exsanguination and associated head injuries were the major causes of death. Aggressive resuscitation and immediate exploratory laparotomy are not overemphasized if survival is expected. During operation, suture ligature of the bleeding points or hepatorrhaphy stopped the bleeding in most circumstances. Hepatic artery ligation was seldom performed. Omental packing of the liver wounds was an effective procedure. Anatomical hepatic resections were performed with a relatively high mortality rate. Debridement of devitalized liver tissue should be done routinely to prevent postoperative infection. Perihepatic packing was a useful procedure when termination of the operation was considered necessary in order to prevent the development of hypothermia, acidosis and coagulopathy.