Management of liver trauma: a 5-year experience.

Most liver injuries are minor (class I and II) which can be managed by simple techniques. Class III injuries are primarily treated by deep liver suture and hepatotomy and vessel ligation. Most class IV injuries are amenable to resectional debridement. Direct repair of class V juxtahepatic venous disruption may be facilitated by early caval shunt placement. Hepatic resetion should be avoided because of high morbidity and mortality. Perihepatic packing is an effective and safe adjunct after hepatic repair. Routine closed suction drainage is recommended for complex liver injuries. Postoperative hyperpyrexia is found more in blunt trauma and severe liver injuries but not related to the occurrence of sepsis. Hypoglycemia can be prevented by routinely administered 10 per cent dextrose solutions intraoperatively followed by total parenteral nutrition or enteral nutrition in the immediate postoperative period. The high mortality and morbidity of liver injury will remain a challenge to traumatic surgeons until these figures are acceptably low and this can be achieved by well regulated accident prevention measures.