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

Baldoni, Franco; Saverio, Salomone Di; Antonacci, Nicola; Coniglio, Carlo; Giugni, Aimone; Montanari, N; Biscardi, Andrea; Villani, Silvia; Gordini, Giovanni; Tugnoli, Gregorio

doi:10.1016/j.amjsurg.2010.05.015

Cited by 25 publications

(12 citation statements)

References 22 publications

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“…A precise perihepatic packing technique starting with a Pringle manoeuvre and complete liver mobilization, with systematized placement of packs. Strategies for haemorrhage control are more efficient when DCS is associated with appropriate additional strategies such as an effective fluid resuscitation/transfusion protocols, a carefully selected angioembolization and an accurate ICU critical care [ 13 , 19 , 27 ]. According to the Asensio results, improvements in outcome can be achieved using damage control strategy to control hepatic bleeding in patients with severe liver injuries and compromised physiological stage [ 6 ].…”

Section: Discussonmentioning

confidence: 99%

“…Over half of patients surviving grade III–V liver injuries will be at risk for the development of complications [ 29 ]. Liver-related complications occur in approximately 20–45 % of patients and include hemorrhage, hemobilia, arteriovenous fistula, pseudo-aneurysm, biloma, bile leak and abscess formation [ 5 , 10 , 27 , 29 ]. MSCT and ultrasaund was used in diagnosing specific post- traumatic postoperative complications such as hepatic or perihepatic abscesses or bilomas.…”

Section: Discussonmentioning

confidence: 99%

“…MSCT and ultrasaund was used in diagnosing specific post- traumatic postoperative complications such as hepatic or perihepatic abscesses or bilomas. Postoperative prolonged hemorrhage can be associated with coagulopathy [ 5 , 10 , 27 , 29 ]. While blood transfusion is necessary because of massive bleeding in trauma, it carries many complications [ 29 , 30 ].…”

Section: Discussonmentioning

confidence: 99%

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Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience

et al. 2015

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BackgroundSevere liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection.Material and methodThis is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III–V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding.ResultsNon-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p = 0.000; p = 0.0001). Definitive hepatic repair was performed in 62(51.2 %) patient. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59(48.8 %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Overall mortality rate was 33.1 %. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001).ConclusionAll efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.

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Section: Discussonmentioning

confidence: 99%

Section: Discussonmentioning

confidence: 99%

Section: Discussonmentioning

confidence: 99%

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Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience

et al. 2015

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“…In fact, Suen et al found that hepatic angioembolization decreased the mortality rate caused by liver injury [15]. Angioembolization is now considered an important component for the control of bleeding in trauma patients, with a multidisciplinary approach after DCS improving clinical outcomes of patients with high-grade liver injury [25,26]. We identified a higher rate of angioembolization among patients who underwent re-laparotomy within ≤ 48 h after perihepatic packing in the present study; however, a lack of precise indications for angioembolization after DCS being performed at the discretion of individual surgeons existed.…”

Section: Discussionmentioning

confidence: 99%

Early re-laparotomy for patients with high-grade liver injury after damage-control surgery and perihepatic packing

et al. 2020

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“…In these situations, blood flow rapidly transports external agents away, preventing their delivery and delaying initiation of clotting at compromised vessels. Instead, superficial clots form at wound surfaces, which are susceptible to rupture during patient transport and resuscitation, causing rebleeding [6–8], which is correlated with poor clinical outcomes [9, 10]. Some intravenously administered coagulants, such as TXA and recombinant factor VIIa, are often effective, whereas many other coagulants carry major risks of thrombosis when their action cannot be adequately localized after injection [11–14].…”

Section: Main Textmentioning

confidence: 99%

Halting hemorrhage with self-propelling particles and local drug delivery

Baylis

Chan

Kastrup

2016

Thrombosis Research

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Approaches to locally deliver drugs to specific regions of the body are being developed for many clinical applications, including treating hemorrhage. Increasing the concentration of therapeutic coagulants in areas where clots are forming and growing can be achieved by applying them directly to the injury, such as with catheters or external delivery devices, or by systemically administering therapeutics that target molecular signals of vascular damage. Treating severe hemorrhage by external measures is challenging because blood flow pushes hemostatic agents outward, reducing their efficacy. This review explains that self-propelling particles may be used for delivering therapeutics, such as coagulation factors, small molecules, or other chemical or biological agents, deep into wounds during hemorrhage. A recent example of self-propelling particles is highlighted, where propulsion enhanced the efficacy of a formulation of thrombin and tranexamic acid in treating bleeding in two murine models of hemorrhage and a porcine model of fatal, non-compressible hemorrhage. Many agents exist which modulate clotting, and novel approaches that facilitate their safe delivery to sites of vascular injury could reduce the enormous number of deaths from hemorrhage that occur globally.

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

Cited by 25 publications

References 22 publications

Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience

Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience

Early re-laparotomy for patients with high-grade liver injury after damage-control surgery and perihepatic packing

Halting hemorrhage with self-propelling particles and local drug delivery

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