Blunt liver trauma: from non-operative management to transplantation. Systematic review and meta-analysis. Part I: primary control point - mortality

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Abstract

Introduction. The high incidence of blunt liver injuries, general and postoperative mortality necessitate a search for optimal treatment options of the condition.

Аim. To conduct a systematic literature review and meta-analysis and compare various treatment options for patients with blunt liver injury.

Methods. A systematic search for non–randomized studies was conducted from 01 October 2015, a systematic search for randomized studies was conducted without time limits, until February 29, 2024.

Results. There is a clear trend towards non-surgical management of hemodynamically stable or stabilized patients, and in case of hemodynamic instability, the use of liver tamponade followed by angioembolization.

Conclusion. A larger number of well-planned randomized clinical trials are required to concretize the surgical approach to patients with liver injury.

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About the authors

Vasiliy V Aleksandrov

Volgograd State Medical University

Author for correspondence.
Email: 79178304989@yandex.ru

Ph.D., Docent, associate Professor of the Department of Hospital surgery

Russian Federation, Volgograd

Sergey S. Maskin

Volgograd State Medical University

Email: maskins@bk.ru

M.D., Professor, head of the Department of Hospital surgery

Russian Federation, Volgograd

Viktor V. Matyukhin

Volgograd State Medical University

Email: victor.matyukhin@gmail.com

Ph.D., Docent, associate Professor of the Department of Hospital surgery

Russian Federation, Volgograd

Alexander Ya. Korovin

Kuban State Medical University

Email: kuman52@mail.ru

M.D., Professor, Professor of the Department of Faculty and Hospital Surgery

Russian Federation, Krasnodar

Sergey M. Sigaev

Volgograd State Medical University

Email: sersigaeff@yandex.ru

Applicant of the Department of Hospital surgery

Russian Federation, Volgograd

Dmitriy S. Biriulev

FSBEI HE VolgSMU MOH Russia

Email: Kotovo111083@yandex.ru

Applicant of the Department of Hospital surgery

Russian Federation, Volgograd

Azad Rachid

Volgograd State Medical University

Email: azad92rasheed@gmail.com

Applicant of the Department of Hospital surgery

Russian Federation, Volgograd

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Supplementary files

Supplementary Files
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2. Fig. 1. Stages of selection of the evidence base.

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3. Fig. 2. Forest graph showing the results of comparing non–surgical treatment with surgical mortality in hemodynamically stable/stabilized patients with blunt liver trauma.

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4. Fig. 3. Funnel-graph for assessing the systematic error of publications compared with mortality in hemodynamically stable/stabilized patients with blunt liver trauma during nonoperative and surgical treatment.

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5. Fig. 4. Forest–graph showing the results of comparing nonoperative treatment in combination with angioembolization with surgical mortality in hemodynamically stable/stabilized patients with blunt liver trauma (calculation of odds ratio).

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6. Fig. 5. Forest–graph showing the results of comparing nonoperative treatment in combination with angioembolization with surgical mortality in hemodynamically stable/stabilized patients with blunt liver trauma (calculation of relative risk).

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7. Fig. 6. Funnel-graph for assessing the systematic error of publications compared with mortality in hemodynamically stable/stabilized patients with blunt liver trauma during nonoperative combined with angioembolization and surgical treatment.

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8. Fig. 7. Forest–graph showing the results of comparing nonoperative treatment with nonoperative treatment in combination with angioembolization by mortality in hemodynamically stable/stabilized patients with blunt liver trauma (calculation of odds ratio).

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9. Fig. 8. Forest–graph showing the results of comparing surgical treatment in hemodynamically stable/stabilized patients with surgical treatment in hemodynamically unstable patients with blunt liver trauma by mortality (calculation of odds ratio).

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10. Fig. 9. Forest–graph showing the results of comparing surgical treatment in hemodynamically stable/stabilized patients with surgical treatment in hemodynamically unstable patients with blunt liver trauma by mortality (calculation of relative risk).

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11. Fig. 10. Forest–graph showing the results of comparing non–surgical treatment with surgical mortality in hemodynamically unstable patients with blunt liver trauma.

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12. Fig. 11. Funnel-graph for evaluating the systematic error of publications in comparison of mortality in hemodynamically unstable patients with blunt liver trauma during nonoperative and surgical treatment.

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Copyright (c) 2025 Aleksandrov V.V., Maskin S.S., Matyukhin V.V., Korovin A.Y., Sigaev S.M., Biriulev D.S., Rachid A.

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