Affiliation:
1. Surgical Unit, Mater Hospital, Belfast, UK
Abstract
Abstract
Background and methods
Management of blunt or penetrating injuries to the liver remains a significant challenge. This review discusses the mechanisms of liver injury, grading system for severity, available diagnostic modalities and current management options. It is based on a Medline literature search and the authors' clinical experience.
Results
Unstable patients require immediate laparotomy, but selected patients who are haemo- dynamically stable may be managed without operation. The preferred operative techniques include resectional debridement, hepatotomy with direct suture ligation and perihepatic packing; anatomical resection, hepatic artery ligation and various bypass techniques have a limited, more defined role for selected injuries. Major complications include haemorrhage, sepsis and bile leak.
Conclusion
Enhanced resuscitation, anaesthesia and intensive care have contributed to a significant reduction in mortality rates from liver trauma. Optimum results are obtained with a specialist team that includes an experienced liver surgeon, anaesthetist, endoscopist and interventional hepatobiliary radiologist with expertise in managing postoperative complications.
Publisher
Oxford University Press (OUP)
Reference154 articles.
1. Surgery for liver trauma;Feliciano;Surg Clin North Am,1989
2. Blunt abdominal trauma. A five 5-year analysis of 870 patients requiring celiotomy;Cox;Ann Surg,1984
3. Fatal hepatic hemorrhage: an unresolved problem in the management of complex liver injuries;Beal;J Trauma,1990
4. Leberverletzungen nachstumpfem Bauchtrauma;Matsch;Unfallchirurgie,1982
5. Diagnostik und Therapie von Leberverletzungen beim polytraumatisierten Patienten;Schweizer;Helv Chir Acta,1989
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