[Closed injuries of the liver. A series of 70 surgical cases (1983-1988)].

Analysis of a series of 70 cases of closed trauma to the liver seen between 1983 and 1988, confirms the gravity of these lesions even when good transport and reception facilities exist for injured patients. The combined efforts of resuscitation and surgery fail for two reasons: the severity of actual hepatic disruption and the existence of extra-hepatic injury in patients with multiple trauma. The major threat comes from the hemorrhagic syndrome which is responsible for almost half the deaths. The dogma advising emergency surgical intervention still remains, if only to evaluate the exact degree of liver trauma and to deal with coexisting intra-abdominal lesions. The surgical intervention should be adapted to the hepatic lesion without attempting complicated technical procedures. In the absence of coagulopathy, resection should be reserved for massive lesions. Most often direct hemostasis and parenchymal suture are sufficient. This should always be attempted if it appears reasonable. In more severe situations, especially if a coagulopathy exists, packing is a wise and logical procedure. Surgical abstention should especially be reserved for cases of unruptured central or sub-capsular hematoma, in a stable hemodynamic situation, under strict surveillance in a specialised surgical department. In contrast to the high initial mortality (40%), the subsequent course is generally favorable and without specific sequelae even after major disruption or hepatic resection. The use of an appropriate therapeutic strategy will reward the surgeon with a cure in 6 out of 10 cases of closed hepatic trauma.