Refinement in the technique of perihepatic packing: a safe and effective surgical hemostasis and multidisciplinary approach can improve the outcome in severe liver trauma.

Abstract

BACKGROUND:

since 2005, we refined the technique of perihepatic packing including complete mobilization of the right lobe and packing around the posterior paracaval surface, lateral right side, and anterior and posteroinferior surfaces.

METHODS:

two groups of patients with grade IV/V liver trauma underwent perihepatic packing before and after 2005. The study group included 12 patients treated with the new technique. The control group included 23 patients treated with the old technique.

RESULTS:

all 13 patients except one who died within 24 hours were treated with the old technique. The overall survival rate was 75% in the patients treated with the new technique (vs 30.4%, P < .02); the liver-related mortality was 8.3% versus 34.8% (P = not significant). The mean survival time in the intensive care unit was longer in the latest group (39.4 vs 22.3 days, P = not significant). The incidence of rebleeding requiring repacking was 16.7% in the patients who underwent new packing versus 45.5% in the patient who were treated with the old technique (P = not significant). The overall (81.8% vs 100%, P = not significant) and liver-related morbidity rate (18.2% vs 41.7%, P = not significant) and the incidence of abdominal sepsis (9.1% vs 41.7%, P = not significant) decreased.

CONCLUSIONS:

our refined technique of perihepatic packing seems to be safe and effective.

• Authors: Franco Baldoni, Salomone Di Saverio, Nicola Antonacci, Carlo Coniglio, Aimone Giugni, Nicola Montanari, Andrea Biscardi, Silvia Villani, Giovanni Gordini, Gregorio Tugnoli
• Journal: American journal of surgery (Am J Surg) Vol. 201 Issue 1 Pg. e5-e14 (Jan 2011) ISSN: 1879-1883 [Electronic] United States
• PMID: 21167358 (Publication Type: Journal Article)
• Copyright: 2011 Elsevier Inc. All rights reserved.

Topics

• Abdominal Injuries (surgery)
• Adult
• Bandages
• Endotamponade (methods)
• Female
• Hemostasis, Surgical (methods)
• Humans
• Liver (injuries, surgery)
• Male
• Treatment Outcome
• Young Adult