The management of complex liver injuries

Although the majority of traumatic liver injuries are relatively minor and can be treated non-operatively, complex liver injuries remain a serious challenge to the trauma surgeon with peri-operative mortality in excess of 50%. There is only one series of complex liver injuries managed operatively. Ascensio et al. reported on 22 patients managed at Los Angeles County Hospital over six years [58]. They used a combination of packing, hepatectomy, resection and direct approach to hepatic vein. Over 70% had angiographic embolization and 60% were managed with damage control techniques. Survival was an impressive 86%. This study clearly demonstrates that a cooperative multi-disciplinary approach between surgeons and support personnel is necessary in order to maximize survival. Surgical principles are not different for complex liver injuries, but they must be ordered in a manner that utilizes them to their best advantage. Surgeons must know all options and be prepared to be definitive early on. As a last resource, liver transplantation should be considered a viable option for patients with potentially lethal hepatic injury.