Role of Damage Control Surgery in Severe Liver Trauma: A Systematic Review of Mortality, Morbidity, and ICU Stay

TL;DR

This review examines how damage control surgery improves survival and reduces ICU stays in patients with severe liver injuries.

Contribution

The study systematically evaluates DCS effectiveness in severe liver trauma, highlighting optimal timing for re-laparotomy.

Findings

Damage control surgery improves short-term survival in critically unstable patients with severe liver trauma.

Early re-laparotomy within 24-48 hours reduces ICU stay and postoperative complications.

Mortality remains high due to initial physiological instability and associated injuries.

Abstract

This systematic review evaluates the role of damage control surgery (DCS) in managing severe hepatic trauma (AAST grade III-V), focusing on mortality, morbidity, and ICU stay. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified six studies with a combined sample size of 1,497 patients, analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. DCS comprising perihepatic packing, temporary abdominal closure, and staged re-laparotomy was shown to improve short-term survival by rapidly controlling hemorrhage and stabilizing physiology in critically unstable patients. Evidence indicated that early re-laparotomy (within 24-48 hours) reduced ICU stay and postoperative complications compared with delayed re-exploration. Despite improved outcomes, mortality remained influenced by initial physiological instability and associated injuries. Most studies presented a moderate risk of bias due to retrospective designs and heterogeneity in protocols. Overall, DCS remains a cornerstone in the management of severe liver trauma, and future multicenter prospective studies are needed to refine operative timing, standardize protocols, and optimize patient outcomes.

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