ABSTRACT
Surgery of the liver, whether emergent or elective, can involve significant blood loss, and delayed complications such as hepatic failure can be life threatening. A multimodality approach to the management of hepatic-related complications is essential and calls for close cooperation between the disciplines of surgery, gastroenterology, critical care, and radiology. Total hepatic vascular isolation techniques may rarely be necessary, and have been used with or without either atriocaval shunting or extracorporeal veno-venous bypass. The venous drainage can be best approached by dissection along the bare area of the liver to the retrohepatic cava for the right hepatic vein, and along the left triangular ligament and the falciform ligament for the left and middle hepatic veins. The hepatic vein can be divided and oversewn with nonabsorbable sutures, or, alternatively can be ligated and divided with an endovascular stapling device. Patients who can be stabilized after blunt trauma typically undergo computed tomographic scanning of the abdomen.
