The records of 443 cases of liver trauma operated on at San Francisco General Hospital from 1976 to 1981 were reviewed. Forty-two percent of the injuries were due to blunt trauma, 32 percent to stabbings, and 26 percent to gunshot wounds. Seventy-two percent of the patients were treated by simple repair and only 8 percent of patients had to undergo major resection. Infections and pulmonary problems were the most common complications, and the overall morbidity was 38 percent. Associated injuries occurred in 84 percent of patients. Our overall mortality was 9 percent; mortality for blunt trauma was 14 percent, for gunshot wounds 8 percent, and for stab wounds 2.8 percent. Most deaths were intraoperative (58 percent), with the primary cause of death being exsanguination. Multiple organ failure accounted for most of the postoperative deaths. Our 5 years study and comparison with previous studies reaffirms our belief in a conservative approach to the traumatized patient with liver injury. Utilizing the aforementioned principles, we have managed to show a continual decrease in mortality in spite of treating a more severely traumatized group of patients. We believe that continued improvement in mortality and morbidity is possible through the prevention of trauma, adherence to our basic guidelines, and the implementation of new technological advances now on the horizon.