A 10-year experience with hepatic trauma in a Chinese level one trauma center

OBJECTIVES: To analyze strategies of operative management (OM) and non-operative management (NOM), mortality, and morbidity of hepatic trauma patients.

METHODS: We retrospectively reviewed 296 consecutive patients with hepatic trauma at the Department of Hepatobiliary Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, China a single level one trauma center between January 2003 and December 2012. Data on demographics, mechanism of trauma, American Association for the Surgery of Trauma grade, initial management, and outcome were collected for this study.

RESULTS: A total of 101 (34%) patients were of low-grade, while 195 (66%) were of high-grade. Hepatic trauma with associated injury of other organs was noted in 205 (69.3%) patients. The initial management was OM for 119 (40.2%) and NOM for 177 (59.8%), 12 patients later required laparotomy. Surgical intervention included perihepatic packing in 6, liver parenchyma suturing in 29, liver parenchyma suturing and hemostasis in 50, segmental resection in 19, and right hepatectomy in 2. The overall mortality rate was 9.1%, and the mortality rate of 8.4% was due to hepatic injuries.

CONCLUSION: All hemodynamically stable patients can be managed by NOM with excellent results, while high-grade hepatic injuries require OM due to hemodynamic instability, or concomitant injuries.