title: [Surgical treatment of blunt liver trauma, indications for surgery and results].
abstract: BACKGROUND
  The liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management.
  
  
  METHODS
  We performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications.
  
  
  RESULTS
  During the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management.
  
  
  CONCLUSIONS
  The need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.
authors.affiliation: Hospital Universitario San Vicente Fundación, Universidad de Antioquía, Medellín, Colombia; Universidad de Antioquía, Medellín, Colombia. Electronic address: cmorales@medicina.udea.edu.co.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Morales Uribe
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: Carolina Arenas
authors.initials: CA
authors.lastname: López
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: Juan Camilo Correa
authors.initials: JC
authors.lastname: Cote
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: Sebastián Tobón
authors.initials: ST
authors.lastname: Franco
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Saldarriaga
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: Jackson
authors.initials: J
authors.lastname: Mosquera
authors.affiliation: Universidad de Antioquía, Medellín, Colombia.
authors.forename: María I
authors.initials: MI
authors.lastname: Villegas Lanau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D055815:Young Adult
keywords: Blunt trauma; Liver trauma; Non-operative management; Operative management; Tratamiento no operatorio; Tratamiento operatorio; Traumatismo cerrado; Traumatismo hepático