Operative Management of Adult Blunt Hepatic Trauma

This is a recommended algorithm of the Western Trauma Association for the operative management of blunt hepatic injuries. Because there are few published prospective randomized trials, the recommendations are based on available published prospective, observational, and retrospective data and expert opinion of Western Trauma Association members. The algorithm (Figure) and accompanying text represent reasonable treatment strategies that could be followed at most trauma centers. We recognize that there will be variability in decision-making and institutional and patientspecific factors that may warrant deviation from the recommended algorithm. We encourage institutions to use this algorithm as a basis to develop institution-specific protocols. The algorithm contains letters that correspond to the text. Their purpose is to explain the critical factors affecting decisions and to guide the reader through the algorithm.¹  References to support each step are inserted as appropriate. No attempt is made to describe the proposed techniques, but rather to guide the reader through an organized approach to the bleeding patient with a complex hepatic injury requiring operative intervention. As experience with operative intervention is diminishing, familiarity with operative techniques is of paramount importance. Lucas and Ledgerwood2 recently reported that a fully trained surgical resident would perform some type of hemostatic technique to control liver bleeding only ^1.2 times by completion of their residency.