War liver injuries.

AIM To provide a retrospective analysis of our results and experience in primary surgical treatment of subjects with war liver injuries. METHODS From July 1991 to December 1999, 204 subjects with war liver injuries were treated. A total of 82.8% of the injured were with the liver injuries combined with the injuries of other organs. In 93.7%, the injuries were caused by fragments of explosive devices or bullets of various calibers. In 140 (68.6%) of the injured there were minor lesions (grade I to II), treated with simple repair or drainage. There were complex injuries of the liver (grade III-V) in 64 (31.4%) of the injured Those injuries required complex repair (hepatorrhaphy, hepatotomy, resection debridement, resection, packing alone). The technique ofperihepatic packing and planned reoperation had a crucial and life-saving role when severe bleeding was present. Routine peritoneal drainage was applied in all of the injured. Primary management of 74.0% of the injured was performed in war hospitals. RESULTS After primary treatment, 72 (35.3%) of the injured were with postoperative complications. Reoperation was done in 66 injured. Total mortality rate in 204 injured was 18.1%. All the deceased had significant combined injuries. Mortality rates due to the liver injury of the grade III, IV and V were 16.6%, 70.0% and 83.3%, respectively. CONCLUSION Complex liver injuries caused very high mortality rate and the management of the injured was delicate under war circumstances (if the injured reached the hospital alive). Our experience under war circumstances and with war surgeons of limited knowledge of the liver surgery and war surgery, confirmed that it was necessary to apply compressive abdominal packing alone or in combination with other techniques for hemostasis in the treatment of liver injuries grade III-V, resuscitation and rapid transportation to specialized hospitals.