Abstract

Background: Liver trauma remains a major challenge in emergency surgery due to the organ’s rich vascularization, large surface area, and proximity to vital structures. Historically managed operatively, hepatic injuries are increasingly treated non-operatively (NOM) in hemodynamically stable patients, owing to advances in imaging, interventional radiology, and intensive care. This study summarizes a three-year experience at the University Hospital of Trauma in Tirana, Albania’s national referral center, focusing on management strategies and outcomes.

Materials and Methods: A retrospective analysis was conducted of all patients with liver trauma admitted between 2020 and 2023. Data included demographics, mechanism of injury, hemodynamic status, AAST and WSES grades, associated injuries, treatment modality, complications, and outcomes. Stable patients underwent NOM with close monitoring, while unstable patients or those with ongoing hemorrhage received operative or interventional management. Comparative analyses evaluated hospital stay, transfusion requirements, complications, and mortality. Statistical methods included Pearson’s correlation, Kaplan–Meier survival analysis, and multivariate logistic regression.

Results: A total of 186 patients were included. NOM was applied in 130 patients (70%), and operative management was used in 56 (30%). High-grade injuries (AAST III–V) accounted for 61% of cases. NOM achieved a success rate of 91%, with failure in 12 patients (9%), primarily due to ongoing hemorrhage, bile leak, or abscess formation. These results align with contemporary series reporting NOM success rates exceeding 85%. Predictors of adverse outcomes included hemodynamic instability, high-grade injury (IV–V), and multi-organ trauma.

Conclusions: NOM is safe and effective for most hepatic injuries in hemodynamically stable patients. Optimal outcomes depend on a multidisciplinary trauma system that integrates surgeons, radiologists, anesthesiologists, and intensivists. Continued protocol standardization and investment in trauma care infrastructure are essential to further progress.

Keywords: liver trauma; blunt abdominal trauma; penetrating abdominal trauma; trauma surgery; liver injury classification; non-operative management; operative management.