Outcomes and safety of selective non-operative management of penetrating liver injuries: A prospective study.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41881752.
- Also identified by DOI 10.1016/j.injury.2026.113179.
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Abstract
Highly selective nonoperative management (SNOM) of penetrating liver injuries is increasingly implemented, however, still underutilized. This ambivalence is derived from the anxiety that hollow viscus injury may be missed, especially after gunshot wounds (GSWs). As a result, exploratory laparotomy is routinely performed in patients with penetrating abdominal trauma (PAT), frequently resulting in both negative and non-therapeutic laparotomies. The aim of this study was to assess the safety of nonoperative management (NOM) of penetrating liver injuries. A prospective study including patients with penetrating liver injuries admitted to a high-volume level I trauma centre was conducted over a 52 - month period (April 2015 - July 2019). Patients suitable for SNOM included: 1) penetrating injury to the right upper quadrant or right thoracoabdominal area 2) absence of peritonism 3) hemodynamic stability 4) GCS > 13 and no spinal cord injury 5) evidence of liver injury and absence of hollow viscus organ injury on CT scanning. Patients presenting with peritonism, hemodynamic instability, evisceration, or unreliable physical examination underwent immediate laparotomy. Primary outcome was failure of NOM and mortality. Overall, 243 patients had liver injury and met inclusion criteria. Immediate laparotomy (IL) and SNOM groups included 168 (68 %) and 75 (32 %) patients, respectively. The rate of GSW was higher in the IL subgroup (83 vs. 68 %). Also, the median ISS score (20 vs 18) and the median HLOS (10 vs 6 days) were higher in the IL group. Only three patients required delayed laparotomy resulting in successful nonoperative management rate of 96 %. The highly SNOM of patients with penetrating liver injuries is safe and associated with low morbidity and mortality. The continuous evolution in imaging and increased application of adjunctive minimally invasive therapies further encourage the applicability of SNOM.