title: Surgical management of complex liver trauma: a single liver transplant center experience.
abstract: Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of  patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to V according to the American Association for the Surgery of  Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was  26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity  was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant  centers.
authors.affiliation: Department of Abdominal and Transplantation Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy, Palermo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Li Petri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Echeverri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Francesco
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006498:Hepatectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*