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Invited Critique
May 2012

Nonoperative Management of Major Liver Trauma—When Failure May Be a SuccessComment on “Successful Nonoperative Management of the Most Severe Blunt Liver Injuries”

Author Affiliations

Author Affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

Arch Surg. 2012;147(5):428. doi:10.1001/archsurg.2012.341

In the 1980s, nonoperative management (NOM) of liver injuries began to come of age. Stable liver injuries could be managed with a period of observation. I vividly recall a discussion in a publication where prominent trauma surgeons lamented deaths they had contributed to by operating on minimally bleeding hepatic lacerations in stable patients. All concluded that you should not poke a skunk.

Major liver trauma continues to be a lethal injury. In this issue of the Archives, the Research Consortium of New England Centers for Trauma group reviews the success of operative management and NOM in 393 patients with grade 4 or grade 5 blunt liver injury during a 10-year period.1 Important and practical lessons can be gleaned from this study.

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