Operative management of liver trauma. A 10-year experience in Riyadh, Saudi Arabia.

Objective: To analyze our experience and the outcome of operative management of liver trauma, and to suggest ways to improve the management of such patients.

Methods: This retrospective study was conducted on patients admitted with liver trauma to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 1997 and December 2006. Only patients who underwent operative management were included in this study.

Results: Sixty-four out of 138 patients with liver injury were treated surgically. Most of the patients were young (mean 29.4 years), and male (84%). Fifty-six patients sustained blunt trauma. Eight patients had grade I, 17 had grade II, 21 had grade III, 12 had grade IV, and 6 patients had grade V liver injuries. Hepatorrhaphy (n=28) was the most common surgical technique used followed by peri-hepatic packing (n=12), simple hemostatic measures (n=9), and non-anatomical hepatic resections (n=8). Laparotomy was non-therapeutic in 7 patients (11%). Liver injury related morbidity was 19%, and mortality was 11%.

Conclusion: Hepatorrhaphy was the most common surgical modality employed to control bleeding. Peri-hepatic packing was used in unstable patients. In 25% of patients, bleeding had either stopped from the injured liver or needed only simple hemostatic measures.