Munawar Jamil, Tariq Hassan Choudry, Tahir Minhaas, Tahir Idrees, Humera Sobia.
Surgical management of liver trauma.
J Surg Pak Jan ;16(3):109-13.

Objective To compare the results of operative management of hepatic trauma treated with suture hepatorraphy alone and with suture hepatorraphy in combination with hepatotomy (resectional debridement with individual vessel suture ligation) spongston, and omental packing. Study design Cross-sectional comparative study. Place & Duration of study The study was conducted at Bahawal Victoria Hospital Quaid-e-Azam Medical College Bahawalpur, from Jaunary 2007 to December 2010. Methodology A total of fifty patients were divided into two groups. Group A comprising 25 patients (50%), was treated with suture hepatorraphy alone while the Group B was treated with suture hepatorraphy in combination with hepatotomy, omental packing and spongston. Results Of the 50 patients of liver trauma mean age was 28.14 years (SD ± 12.12y) and 94% were males. Sixty percent injuries were blunt in nature and 40% penetrating. Of penetrating trauma 75% were firearm injuries and 25% stab wounds. Right lobe was the site of injury in 56% of patients. Severity of injury was grade I in 14%, grade II in 40% , grade III in 36% and grade IV in 10% .Postoperative complications were sepsis in 24% , bile leak in 16% and recurrent hemorrhage in 24% of group A patients, whereas, in group B patients the sepsis was 8% , bile leak 8% and recurrent hemorrhage 4%. Mean hospital stay in group A was 26.44 days (SD ± 13.56) while in group B it was 20.20 days (SD ±11.06). In group A patients, the survival rate was 96% while it was 100% in group B. Conclusions Once decided for Surgical management for blunt and penetrating liver trauma, suture hepatorraphy in combination with hepatotomy, omental packing and use of spongston for hemostasis had marginally better survival rate, reduced hospital stay and significantly fewer postoperative complications as compared to simple suture hepatorraphy.

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