Operative management in liver trauma

Aim: in accordance to the american association for surgery trauma (aast) grades of liver injuries selection of an appropriate surgical technique to control hemorrhage,minimize postoperative complications and mortality. study design: it is a descriptive study. place and duration: this study is carried out prospectively in mayo hospital lahore affiliated with king edward medical university and in kampala international university teaching hospital (kiu-th) ishaka,uganda. the study was conducted in 3 years time from 1st december 2010 to 1st december 2011 and then from 1st january 2012 to 1st january 2014. sample size: study was conducted on 30 patients of liver trauma. results: hepatorraphy alone was sufficient in 14 patients (46.66%),in 11 patients (36.66%) hepatorraphy was combined with perihepatic packing,2 patients (6.66%) were managed by perihepatic packing alone while 2 patient (6.66%) with advance liver trauma right hepatic artery was ligated.1 patient (3.33%) underwent left lobectomy. conclusion: in liver trauma both blunt and penetrating the major cause of mortality is bleeding and delay in treatment. the decision of operation depends on the hemodynamic status of the patient not on the grade of injury. hepatorraphy alone can be effective in grade i and ii liver injuries,while in advance liver injuries it was observed that suture hepatorraphy combined with peri hepatic packing,pringle's maneuver and specific hepatic artery ligation were effective in controlling hemorrhage.