**7. Surgical treatment**

Despite the trend of nonoperative treatment and continued advances in the areas of trauma and critical care, uncontrolled bleeding from major liver injury is still the leading cause of death and continues to frustrate trauma surgeons [12]. Therefore, it is crucial for the surgeon to know when surgery is needed. The two most important criteria for indicating immediate operative treatment to a patient with a hepatic injury are the presence of hemodynamic instability and the existence of peritoneal irritation, regardless of the grade of injury or the volume of hemoperitoneum.

There are several surgical techniques that could be applied depending upon the complexity of the lesion including simple manual compression, Pringle's maneuver (clamping of the hepatoduodenal ligament), hepatorrhaphy, hepatectomy, hepatic artery ligation, and liver resection. Finally, in the direst of circumstances and under specific indications, even a liver transplant can be considered [6]. Regarding the incidence of the surgical techniques employed, hepatorrhaphy is generally the most used procedure in most cases, and the least used are epiplonplasty and left hepatectomy, according to a recently published study, as shown in **Table 2** [6].

#### *Trauma and Emergency Surgery - The Role of Damage Control Surgery*


#### **Table 2.**

*Surgical techniques used to treat liver injuries in patients with liver trauma.*
