Spleen and liver injuries: when to operate?

Although nonoperative management (NOM) is the safest option in most patients with liver and splenic injuries or splenic injuries, some cases still need operative intervention. The aim of this review is to address the most recent literature and the evidence it provides for indications and timing of operative treatment for liver and spleen injuries. There seems to be a decrease in publication rate on these topics over the last years, parallel to the acceptance of NOM as the 'gold standard', with little added to the existing body of evidence over the last 12-24 months. Most published studies are retrospective descriptions or comparisons with historical controls, some observational studies, but no randomized control trials (RCTs).There is a striking lack of high-level evidence for the optimal treatment of solid organ injuries. The role of angiographic embolization as an adjunct to the treatment of liver and spleen injuries is still a matter of discussion. Unstable patients with suspected ongoing bleeding from liver and spleen injuries or spleen injuries with inadequate effect of resuscitation should undergo immediate explorative laparotomy.More RCTs are needed to further determine the role of angiographic embolization and who can be safely be treated nonoperatively and who needs surgical intervention.