Surgical management of liver trauma.

Trauma surgeons must be familiar with the different alternatives that are available in managing hepatic injuries. Although most injuries of the liver can be managed by straightforward operative techniques, the severe injury requires immediate recognition and expedient application of surgical skills for a successful outcome. These guidelines are intended to counter the two major causes of death associated with liver trauma: operative hemorrhage and postoperative sepsis. Operative technique must be impeccable. Operative judgment must be based on the specific entities involved. The correct operative maneuvers must be made before hypovolemic and ischemic insults have irreversibly affected organ function or before a profound coagulopathy has developed. It is imperative that the surgeon and anesthesiologist work as a team when confronted with a patient who has a major liver injury.