This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Selective non‐operative management of liver gunshot injuries. BJS 2005; 92: 890-895.
Published: 25th May 2005
Authors: J. A. O. Omoshoro‐Jones, A. J. Nicol, P. H. Navsaria, R. Zellweger, J. E. J. Krige, D. H. Kahn et al.
Background
In contrast to non‐surgical treatment of blunt liver trauma, non‐operative management (NOM) of liver gunshot injuries (LGSIs) is not widely accepted. This prospective study evaluated an experience of NOM of gunshot wounds to the liver.
Method
All patients presenting with LGSIs who were haemodynamically stable with no evidence of peritonism underwent a protocol of NOM.
Results
Thirty‐three patients (mean age 25 (range 13–50) years) were enrolled over a 36‐month period. Fourteen had grade III injuries according to the American Association for the Surgery of Trauma (AAST) classification, whereas 11 and eight patients sustained major (AAST IV/V) and minor (AAST I/II) injuries respectively. NOM was successful in 31 of 33 patients. Two patients required delayed laparotomy for indications unrelated to the hepatic trauma. One patient died from necrotizing fasciitis, which appeared unrelated to the liver injury.
Conclusion
This study demonstrated that, regardless of the grade of liver trauma, NOM is safe and effective in appropriately selected patients with LGSI treated in centres with suitable facilities. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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