Background Conservative management nowadays takes the upper hand for liver trauma management in hemodynamically stable patients. Aim To evaluate the outcomes of an operative and conservative management of patients with blunt liver injury over a 10-year period. Patients and methods A retrospective study was conducted in the period from June 2010 to June 2020. It included 327 patients admitted with blunt liver trauma in the surgical trauma unit, Zagazig University hospital. The patients were classified according to the way of management: group I, conservative management, and group II, operative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, morbid-mortality, and hospital stay. Results Blunt liver trauma represented 33.89% of all blunt abdominal trauma cases in our emergency department. Our study included 327 patients. More than 50% of our patients were young males. Minor liver injuries (grades I–III) were detected in 256 (78.29%) patients, and major liver injuries (grade IV and V) were detected in 71 (21.71%) patients. Conservative management was done in 228 (69.72%) patients and operative management in 99 (30.27%). Mortality rate was 7.64% (25 patients). Conclusions Conservative management is a safe approach for stable hemodynamic patients and surgery the choice for hemodynamic unstable patients. Conservative management patients should be under close monitoring. Failure of conservative treatment did not show a higher incidence of morbidity or mortality. Keywords: blunt liver trauma, conservative management, liver injury grades, operative management