Operative Management of Adult Blunt Hepatic Trauma

Over the past 2 decades, treatment of blunt hepatic injuries has changed dramatically. A shift away from operative management has occurred with a resultant decline in mortality.³ Richardson et al. attributed improved survival to less patients with major venous injuries requiring operative intervention, improved outcomes with venous injuries, better results with packing, and control of arterial hemorrhage by angioembolization.⁴ A recent review of the National Trauma Database demonstrated that only 13.7% of hepatic injuries are now managed operatively.⁵ As the primary indication for operative intervention is hemodynamic instability, trauma surgeons are faced with managing exsanguinating hemorrhage from complex hepatic injuries. Table 1 summarizes some of the major milestones in operative strategies.^6–22 Attempts were made to include the original description for trauma. We acknowledge that not all important advances or contributing surgeons are included.