Therapeutic perihepatic packing in complex liver trauma

Bornman, P. C.; Terblanche, J.

doi:10.1002/bjs.1800790114

Cited by 72 publications

(34 citation statements)

References 31 publications

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“…Packing of the liver facilitates the transfer of stabilized patients to trauma centers. Moreover, its effectiveness has been reported during definitive surgery, because it provides time for correction of coagulopathy and hypothermia [20,24,25]. After the reintroduction of packing, more articles have been published favoring nonresectional management of major hepatic trauma by means of perihepatic packing [10,12,[24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Estourgie¹,

Werken²,

Leenen

2002

European Journal of Trauma

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Background: This study evaluates the management and treatment of liver trauma with emphasis on the efficacy of gauze packing. Material and Methods: 92 patients, diagnosed with liver trauma between 01/1992 and 01/2000, were evaluated retrospectively. For clinical management reasons, a distinction was made between hemodynamically stable and unstable patients. Results: 42 patients were clinically diagnosed as hemodynamically stable and had an average Injury Severity Score (ISS) of 24. 15 of them underwent abdominal surgery. In ten of these patients additional liver treatment was performed. The mortality among the 42 patients was two, both non-liver-related (sepsis and neurologic injury). 50 patients were considered to be hemodynamically unstable and had an average ISS of 35. All patients needed abdominal surgery. The mortality was 22 out of 50, of which seven were liver-related.In 38 of all 92 patients only gauze packing was used as initial therapy. In twelve patients the bleeding was controlled by the first tamponade, and ten patients needed a second tamponade after an average of 2 days. Additional surgery was performed in nine patients, and seven patients died shortly after the first laparotomy. The mortality was 16, of which nine were directly liverrelated. Conclusion: Gauze packing as the initial treatment of liver trauma is considered a safe and quick method for controlling ongoing hemorrhage. Nevertheless, severe liver trauma goes with a high mortality rate.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Estourgie¹,

Werken²,

Leenen

2002

European Journal of Trauma

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“…17 This technique of packing the prostate has been demonstrated to be an effective method of controlling bleeding even in adverse circumstances with the absence of any direct long-term complications. Alternative methods of haemostasis include selective embolisation of the iliac vessels under radiological control 18 and open ligation of one or both iliac arteries.…”

mentioning

confidence: 99%

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Lynch

Sriprasad

Thompson³

2010

Ann R Coll Surg Engl

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Ann R Coll Surg Engl 2010; 92: 555-558 555There are several techniques of transurethral prostatic surgery including the traditional transurethral resection of the prostate (TURP) and newer techniques including holmium laser enucleation of the prostate (HoLEP), Green-light laser photoselective vaporisation of the prostate (PVP) and the Gyrus bipolar system. The number of TURPs is falling 1 and there is no doubt that newer techniques are being accepted as established alternatives. Bleeding is one of the main complications after any modality of endoscopic prostatectomy, including TURP. The incidence of blood loss requiring transfusion is reported to be 0.4-7.1%, 2,3 with rates declining with evolving technology despite an increasingly aged population having prostatic surgery.The experience of surgeons dealing with troublesome bleeding is now, therefore, much less. The conservative, resuscitative and endoscopic measures to deal with bleeding are well established and understood. However, there are occasions when this is not sufficient to stop what may be life-threatening haemorrhage and many surgeons may now be unfamiliar with the surgical technique of packing the prostatic cavity to arrest bleeding when other measures have failed. In this paper, we have reviewed all TURP and PVP procedures over a 3-year period and identified those patients who required surgical intervention postoperatively to arrest continuing haemorrhage and in particular describe open packing of the prostate. Patients and MethodsWe retrospectively reviewed a 3-year period where 437 TURPs and 590 PVPs were performed for lower urinary tract symptoms (LUTS) and for urinary retention in our institution. Of patients who underwent TURP, 19 needed a cystoscopy in the immediate postoperative period for persistent bleeding despite conservative measures such as catheter traction and manual bladder washouts. Two patients who , is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent ble...

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“…Liver packing was initially described by Feliciano et al (4) for the control of bleeding, and to date, it is the standard approach for the control of damage in liver injuries in unstable patients. Although this technique has many advantages (12,13), there are some difficulties encountered when the surgeon removes the packing. Adhesive bands between the liver damage area and the pad develop during the interoperation period, and the removal of the pad in the second operation can cause some disruption of the liver tissue and rebleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Adhesive bands between the liver damage area and the pad develop during the interoperation period, and the removal of the pad in the second operation can cause some disruption of the liver tissue and rebleeding. In some cases, rebleeding is so severe that it requires parenchymal repair with sutures (5,13,14). In this study, we used a new method for liver packing to decrease liver injury and rebleeding during the second operation.…”

Section: Discussionmentioning

confidence: 99%

Simple and Safe Packing Method for High-Grade Liver Injuries

Hosseinpour¹,

Asgarzadeh²,

Mohammadzadeh³

et al. 2012

Arch Trauma Res

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Because of both its ease of use and potential for rapid hemorrhage control, OpSite sheet three-layer pack is introduced for decreasing the complication of pack removal in liver trauma. Background:Injury to the liver is a commonly encountered problem in trauma cases and is a frequent cause of morbidity and mortality. Because gauze packing is easy to use and has the potential for rapid hemorrhage control, it is the most commonly used method for patients with severe liver injuries, particularly those with coagulopathy. Objectives: In this study, OpSite sheets were used to make three-layer packs for decreasing the complication associated with removing gauze packing. Patients and Methods: Twenty male patients with grade IV or V liver injuries that required laparotomy were enrolled in the study. Ten patients were treated using conventional packing, while the other 10 were treated using the three-layer pack. In the case group, the liver was mobilized as much as possible. The three-layer pack was then placed at the site of liver damage and extended onto the liver surface, and the other pads were placed on top of this pad. After 72 h, reoperation was performed, the packs were removed, and the packs causing injury were recorded. Additionally, if rebleeding due to the adhesive bands of the pack was observed, the blood was suctioned and bleeding volume was measured. Data were analyzed using the Mann-Whitney test. Results: Patients in the case and control groups were similar in age and admission vital signs. During the second operation, the bleeding volumes measured in the case and control groups were 66 ± 27.01 mL and 152 ± 85.4 mL, respectively. There was some padinduced damage after the removal of the pad in the control group. Conclusions: Our study has provided a simple and safe packing method for high-grade liver injuries.

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Therapeutic perihepatic packing in complex liver trauma

Cited by 72 publications

References 31 publications

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Simple and Safe Packing Method for High-Grade Liver Injuries

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