Blunt liver trauma: experience of the Botkin hospital

OBJECTIVE: To improve treatment outcomes in patients with blunt liver injuries using modern protocols and minimally invasive technologies in a multi-field hospital. MATERIAL AND METHODS: Treatment outcomes were analyzed in 93 patients with blunt traumatic liver injury between 2019 and 2024. There were 74 (79.6%) men and 19 (20.4%) women. Mean age was 42.8±11.3 years; 87 (93.5%) patients were delivered by ambulance, and 6 (6.5%) ones have gone by themselves. Of these, 36 (38.7%) patients presented within the first hour after injury, 49 (52.7%) - within 6 hours, 8 (8.6%) - later. Fifty-four (58.1%) victims had car accident as a cause of injury, 27 (29.0%) ones had falls and 12 (12.9%) had other domestic accidents. Concomitant injuries were observed in 61 (65.6%) victims. Isolated liver damage occurred in 32 (34.4%) patients. Damage to the liver and ≥ 2 organs in multiple and combined trauma was detected in 42 (68.9%) victims. The WSES grade IV in isolated and combined liver injury was observed in 53.1% and 72.1%, respectively. Traumatic brain injury, chest injury and skeletal trauma were the most common (36.6%) concomitant injuries. RESULTS: Nonoperative management (NOM) for blunt liver injury was applied in 26 (28.0%) patients. Of these, 12 (12.9%) ones underwent only conservative treatment. Successful angioembolization was performed in 17 (94.4%) patients. Laparoscopy was used in 18 (19.4%) patients. Tamponade for hemostasis within the "damage control surgery" concept was used in 35 (37.6%) patients. The incidence of specific and non-specific complications was 10.4% and 25.1%, respectively. Postoperative mortality in blunt isolated liver injury was 6.8%, in combined injury - 14.8%. Overall postoperative mortality - 11.8%. CONCLUSION: Routing patients to multidisciplinary hospitals, evidence based care protocols, minimally invasive endovascular and hybrid technologies, and damage control surgery are the main points for improving the outcomes for patients with blunt liver injuries.