Surgical treatment of liver and biliary tree trauma

Abstract

Most liver injuries are managed nonoperatively. However, patients who require surgical management of liver and biliary tree injuries may be severely physiologically compromised and may suffer severe morbidity and mortality. Knowledge of hepatic and biliary anatomy is critical to plan appropriate operative management. Once in the operating room, the surgeon must have an organized approach to hemorrhage control. Damage control should always be considered as a bailout strategy, but in some cases unrelenting hemorrhage may require more aggressive techniques. Drainage of the biliary system can always be used at the initial operation, but the ability to reconstruct the biliary tree must be in the skillset of the trauma surgeon. There are a number of common complications of liver and biliary surgery that must be managed.