The role of hepatic resection in the management of blunt liver trauma.

Forty-two (14%) of 306 patients with liver injuries presenting to Westmead Hospital over a 10-year period required hepatic resection as their definitive treatment. Two types of resection were performed: Resectional debridement utilized the plane of injury as the line of resection while anatomical resection utilized anatomical planes. Resectional debridement was used in 35 patients. In 29, the major technical problem was bleeding and 21 of these patients had associated hepatic vein injuries. In 5, the major problem was devitalized parenchyma, and, in 1, it was an intrahepatic bile duct injury. Anatomical resection was performed in 7 patients: 3 with bleeding, 2 with devitalized parenchyma, and 2 with intrahepatic bile duct injuries. Overall, 15 patients died (36%). The most common cause of death was bleeding in 9 of the 15 patients. Survivors spent a median of 32 days in hospital (range: 11-162 days) and sustained a median of 2 complications (range: 0-6). The most common complications were respiratory infection and/or failure, coagulopathy, and sepsis. Resection successfully addressed bleeding, devitalized parenchyma, and intrahepatic bile duct injuries with an acceptable mortality in critically ill patients who would otherwise have died.