Damage Control Surgery for Liver Trauma

Abstract

The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the “lethal triad” (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place, along with permanent closure of the abdominal wall.