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Review
Evolution of non-operative management of liver trauma
  1. Adam Brooks1,
  2. John-Joe Reilly1,
  3. Carla Hope2,
  4. Alex Navarro1,
  5. Paal Aksel Naess3,4,
  6. Christine Gaarder3,4
  1. 1East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
  3. 3Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway
  4. 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to John-Joe Reilly, East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; johnjoereilly{at}gmail.com

Abstract

The management of complex liver injury has changed during the last 30 years. Operative management has evolved into a non-operative management (NOM) approach, with surgery reserved for those who present in extremis or become hemodynamically unstable despite resuscitation. This NOM approach has been associated with improved survival rates in severe liver injury and has been the mainstay of treatment for the last 20 years. Patients that fail NOM and require emergency surgery are associated with increased morbidity and mortality. Better patient selection may have an impact not only on the rate of failure of NOM, but the mortality rate associated with it. The aim of this article is to review the evidence that helped shape the evolution of liver injury management during the last 30 years.

  • abdominal injuries
  • liver
  • shock
  • hemorrhagic
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000551

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    Footnotes

    • Contributors AB, JJR, and CH researched and wrote the article. AN, PAN and CG revised the article and reviewed it critically for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.