The methods of hemostasis used for liver
injuries were evaluated prospectively in 637 patients treated at Detroit General Hospital during a 5-year period. Variables evaluated included severity of injury, presence or absence of
bleeding, and methods of hemostasis, The liver injury was either not
bleeding or was controlled by temporary pack compression during
laparotomy in 325 patients: none of these patients, including the 284 in whom no
hemostatic procedure was used, rebled postoperatively. Active
bleeding at
laparotomy was directly related to the severity of liver injury, and required some
hemostatic procedure in 312 patients. The methods of hemostasis were liver
sutures (244 patients), nonanatomic resection (30 patients), anatomic resection (21 patients), hepatic artery
ligation (nine patients), hepatotomy with intraparenchymal vascular control (five patients), and temporary internal pack with later re-operation (three patients). Rebleeding occurred in eight of the 243 patients who survived (seven after liver
sutures and one after nonanatomic resection) and four required re-operation for control of
bleeding. Sixty-nine patients with active
bleeding died. Death on the table in 38 patients was related primarily to uncontrolled
bleeding from liver and major vessel injury. Postoperative rebleeding from the liver occurred in 14 of 31 patients who died after surgery: following initial control by liver
sutures (seven patients); anatomic resection (four patients); and hepatic artery
ligation (three patients). There was no apparent relationship between any
hemostatic procedure and the subsequent appearance of the hepatic
ischemia or parahepatic
abscess. Based on this experience, the merits and detriments of individual
hemostatic procedures are presented.