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Packing for control of hepatic hemorrhage
Insights
Perihepatic packing is a life-saving technique for severe hepatic injuries, particularly those from penetrating wounds. This method effectively manages nonmechanical bleeding and coagulopathies in critical trauma patients.
Area of Science:
- Trauma Surgery
- Hepatobiliary Surgery
- Surgical Critical Care
Background:
- Hepatic injuries pose significant management challenges.
- Perihepatic packing is a critical intervention for severe liver trauma.
- Understanding its indications and outcomes is vital for trauma surgeons.
Purpose of the Study:
- To evaluate the efficacy and outcomes of perihepatic packing in patients with severe hepatic injuries.
- To identify the primary indications for perihepatic packing.
- To assess complications and outcomes following perihepatic packing removal.
Main Methods:
- Retrospective analysis of 1,348 patients with hepatic injuries treated between July 1978 and July 1985.
- Identification of 66 patients who underwent perihepatic packing.
- Review of operative records, indications, packing removal, and postoperative complications.
Main Results:
- Perihepatic packing was required in 5.3% of hepatic injury patients, predominantly due to penetrating wounds (77.2%).
- Major indications included post-repair coagulopathies (85.5%) and extensive subcapsular hematomas (12.2%).
- Of 49 survivors, 57.1% had packing removed, with 18.4% experiencing postoperative complications like fluid collections or abscesses.
Conclusions:
- Perihepatic packing remains a crucial, life-saving adjunct for selected patients with severe hepatic injuries.
- It is effective in controlling nonmechanical bleeding and coagulopathies.
- Careful patient selection and management are essential for optimal outcomes.
Abstract:
From July 1978 to July 1985, 1,348 patients with hepatic injuries were treated. During this period, 66 patients (5.3% or 9.4 patients/year) required perihepatic packing. Penetrating wounds accounted for 77.2% of injuries requiring packing. Seventeen patients died in the operating room from massive hepatic and other intra-abdominal injuries and were excluded from further analysis. Perihepatic packing was inserted in 41 patients at a first operation and at a second or third operation in eight others. The major indications for packing were post-repair coagulopathies (85.5%) and extensive subcapsular hematomas or capsular avulsion (12.2%). Packing was removed from 28 surviving patients (28/49 = 57.1%) at an average of 3.7 days following insertion. Pack removal was accomplished by laparotomy in 24 patients (85.7%) and extraction through a hole in the body wall in four others. Ten postoperative intra-abdominal fluid collections, hematomas, or abscesses occurred in nine patients (9/49 = 18.4%) surviving the first operation. Perihepatic packing continues to be a life-saving adjunct in a highly selected group of patients with the most severe hepatic injuries and nonmechanical bleeding at the completion of repairs or extensive subcapsular hematomas.