A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury

• Published in: The surgeon (Edinburgh) Vol. 18; no. 3; pp. 165 - 177
• Main Author: Saqib, Yosuf
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-06-2020
• Subjects: Angioembolization; Hemodynamic stability; High-grade liver trauma; Non-operative management; Operative management; Angioembolization; Non-operative management; Operative management; High-grade liver trauma; Hemodynamic stability
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2019.07.001

The liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma.
PubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates.
The electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11).
Non-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.