Surgical restraint in the management of hepatic injury: a review of Charity Hospital Experience.

We have reviewed 546 cases of hepatic trauma treated from 1964 through 1976: 76 patients with blunt injury, 308 with gunshot wounds, and 162 with stab wounds. Hypovolemic shock was present in 22%. The overall mortality was 10%. Stab wounds had a negligible mortality of 0.6%, whereas 12% of patients with gunshots and 28% of patients with blunt trauma died. Management followed the general principles of control of hemorrhage and conservative debridement with avoidance of major procedures. Eighty-four per cent of patients required only drainage or suture and drainage. Only 8% had extensive debridement. An additional 5% (31 patients) underwent hepatic lobectomy. Hepatic artery ligation, as an isolated procedure, was not employed. Common bile duct cannulation was employed only six times. Mortality among patients treated by suture or drainage was 5.4%. When resection was required, a 52% mortality resulted. We conclude that the principles of conservative surgical treatment can give a satisfactory survival rate in most hepatic trauma.