Operative Versus Nonoperative Management of Penetrating Liver Injuries: A Systematic Review and Meta-analysis.

INTRODUCTION: While the conservative management of blunt liver injuries is well established in the medical literature, with reported success rates ranging from 82% to 100% in hemodynamically stable patients, its application to penetrating injuries remains controversial due to perceived risks. This study aims to assess the potential outcomes of non-operative management (NOM) in selected patients with penetrating liver injuries compared to operative management (OM). METHODS: A systematic review and meta-analysis of observational studies comparing NOM and OM in patients with penetrating liver injuries was conducted using the Medline, Scopus, and Cochrane databases, in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Six observational studies comprising 4,407 patients were included. NOM was associated with lower mortality (RR 0.40; 95% CI 0.31-0.53; I2=0%; p<0.01) and complication rates (RR 0.83; 95% CI 0.75-0.91; I2=0%; p<0.01). No statistically significant difference was observed in liver complications (RR 0.25; 95% CI 0.01-12.47; I2=0%; p=0.10), blood transfusion (RR 0.73; 95% CI 0.0-1741.82; I2=84%; p=0.73), and hospital length of stay (RR -0.44; 95% CI -6.76-5.87; I2=0%; p=0.83). CONCLUSION: Non-operative management of penetrating liver injuries, when compared to operative management, may be considered a possible alternative for selected patients.