title: Treatment of Liver Trauma: Operative or Conservative Management.
abstract: BACKGROUND
  The liver is one of the most frequently damaged organs when abdominal trauma occurs. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 143 patients with liver injury treated in a single institution.
  
  
  METHODS
  A retrospective study of the patients admitted with the diagnosis of liver trauma was performed from 1992-2008. The patients were classified according to the intention to treatment: Group I, operative management; Group II, conservative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, transfusions, morbi-mortality, and hospital stay. We established two periods (1992-1999; 2000-2008) in order to compare diagnosis and management.
  
  
  RESULTS
  A total of 143 patients were analyzed. Thirty-one percent correspond to severe injuries. Conservative treatment was followed in 60.8 % with surgery undertaken in 14.9 % of patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 38.2 %. Total mortality was 14 %. Morbidity (35.7-38.5 %) in the group of immediate surgery and failure of conservative management is similar, but not in mortality (28.6-15.4 %). In the second group (2000-2008) there are more patients with conservative treatment, with a low percentage of failure of this treatment and morbi-mortality.
  
  
  CONCLUSIONS
  Conservative treatment is an adequate treatment in a great number of patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centers with experienced surgeons.
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Carmen Garcia
authors.initials: CG
authors.lastname: Bernardo
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Bombuy
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Sanchez
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Loera
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Marti
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
authors.affiliation: Intensive Care Unit. Department of Anesthesiology. Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Elizabet
authors.initials: E
authors.lastname: Zavala
authors.affiliation: Department of Surgery. Hepatic Surgery and Liver Transplant Unit, IMDIM. CIBERHED,IDIBAPS, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Valdecasas
keywords: Conservative management; Liver trauma; Surgical treatment