Nonoperative Management of Liver Trauma: Results of the Consensus of SBAIT (Brazilian Trauma Society)

Hepatic trauma is one of the most complex challenges faced by surgeons, particularly in developing countries.Nonoperative management (NOM) has emerged as the standard approach for hemodynamically stable patients, supported by technological advances such as computed tomography (CT) and selective angiographic embolization.Studies report success rates exceeding 80-90% when clinical criteria are rigorously followed.However, implementation in Brazil faces significant challenges due to disparities in hospital resources, such as the lack of 24-hour angiography and limited access to high-quality CT.The consensus developed by trauma surgeons who are members of the Brazilian Trauma Society (SBAIT) addresses NOM criteria, emphasizing hemodynamic stability, the absence of significant active bleeding, and intensive care unit (ICU) monitoring.The consensus outlines the role of arteriography and embolization in specific cases and proposes guidelines for the use of videolaparoscopy in patients with persistent pain, perihepatic collections, or bilomas, highlighting the importance of experienced teams and appropriate equipment.Additionally, it addresses venous thromboembolism (VTE) prophylaxis, emphasizing the safe use of low-molecular-weight heparin after hemodynamic stabilization.Return to physical activities and outpatient follow-up should follow specific guidelines, particularly for patients with major trauma.Conclusion: This initiative reflects SBAIT's commitment to adapting global best practices to local realities, promoting equity in the care of patients with hepatic trauma.