Blunt Liver Injury: from Non-Operative Management to Transplantation. Systematic Review and Meta-Analysis. Part II: Secondary Control Points

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Abstract

Introduction. High incidence of blunt liver injuries, a large number of postoperative complications dictate the need to find optimal treatment options for patients’ management.

The aim of the study was to conduct a systematic review of the literature and meta-analysis to compare various treatment options for patients with blunt liver injury.

Methods. A systematic search for non-randomized studies was conducted from October 1, 2015, a systematic search for randomized studies were conducted without time restrictions, up to February 29, 2024.

Results. There is a clear trend towards non-operative management of hemodynamically stable or stabilized patients, supplemented by angioembolization if necessary.

Conclusion. More adequately-designed randomized clinical trials are needed to specify the treatment approach for patients with liver injuries.

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About the authors

Vasily V. Alexandrov

Volgograd State Medical University

Author for correspondence.
Email: 79178304989@yandex.ru

Ph.D., Associate Professor at 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

Victor V. Matyukhin

Volgograd State Medical University

Email: victor.matyukhin@gmail.com

Ph.D., Associate Professor at the Department of Hospital Surgery

Russian Federation, Volgograd

Alexander Ya. Korovin

Kuban State Medical University

Email: kuman52@mail.ru

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

Russian Federation, Krasnodar

Sergey M. Sigaev

Volgograd State Medical University

Email: sersigaeff@yandex.ru

Applicant at the Department of Hospital Surgery

Russian Federation, Volgograd

Dmitry S. Biryulev

Volgograd State Medical University

Email: Kotovo111083@yandex.ru

Applicant at the Department of Hospital Surgery

Russian Federation, Volgograd

Azad Rasheed

Volgograd State Medical University

Email: azad92rasheed@gmail.com

Applicant at the Department of Hospital Surgery

Russian Federation, Volgograd

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Supplementary files

Supplementary Files
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1. JATS XML
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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 complications in hemodynamically stable/stabilized patients with blunt liver trauma (calculation of odds ratio).

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4. Fig. 3. Forest-graph showing the results of comparing non-surgical treatment with surgical complications in hemodynamically stable/stabilized patients with blunt liver trauma (calculation of relative risk).

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5. Fig. 4. Funnel-graph for evaluating the systematic error of publications compared to the number of complications in hemodynamically stable/stabilized patients with blunt liver trauma during nonoperative and surgical treatment.

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

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7. Fig. 6. Forest-graph showing the results of comparing nonoperative treatment with nonoperative treatment in combination with angioembolization in terms of effectiveness (refusal to switch to laparotomy) in hemodynamically stable/ stabilized patients with blunt liver trauma (calculation of the odds ratio).

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8. Fig. 7. Forest-graph showing the results of comparing nonoperative treatment with nonoperative treatment in combination with angioembolization according to the average duration of hospital stay in hemodynamically stable/stabilized patients with blunt liver trauma.

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9. Fig. 8. Forest-graph showing the results of comparing non–surgical treatment with surgical treatment according to the average duration of hospital stay in hemodynamically stable/stabilized patients with blunt liver trauma.

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10. Fig. 9. Forest-graph showing the results of comparing nonoperative treatment in combination with angioembolization with surgical treatment according to the average duration of hospital stay in hemodynamically stable/stabilized patients with blunt liver trauma.

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11. Fig. 10. Funnel-graph for assessing the systematic error of publications in comparison of nonoperative treatment in combination with angioembolization with surgical treatment for the average duration of hospital stay in hemodynamically stable/stabilized patients with blunt liver trauma.

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Copyright (c) 2025 Alexandrov V.V., Maskin S.S., Matyukhin V.V., Korovin A.Y., Sigaev S.M., Biryulev D.S., Rasheed A.

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