Perihepatic Packing of Major Liver Injuries
Complications and Mortality
Daniel M. Caruso, MD;
Felix D. Battistella, MD;
John T. Owings, MD;
Steven L. Lee, MD;
Rodney C. Samaco
Arch Surg. 1999;134:958-963.
Hypothesis Perihepatic packs used to control hemorrhage after liver injury increase the risk of complications and this risk increases the longer packs are left in place.
Design Retrospective case series.
Setting University level I trauma center.
Patients Consecutive patients with hepatic injury.
Main Outcome Measures Liver-related complications (biliary leak and abscess), rebleeding, and mortality.
Results One hundred twenty-nine of 804 patients with liver injuries were treated with perihepatic packing. Of the 69 who survived more than 24 hours, 75% lived to hospital discharge. Mortality rates were 14% and 30% in patients with and without liver complications, respectively (P=.23). Liver complication rates were similar (P=.83) when packs were removed within 36 hours (early [33%]) or between 36 and 72 hours (late [29%]) after they were placed; the rebleeding rate was greater in the early group (21% vs 4%; P<.001).
Conclusions Liver complications associated with perihepatic packing did not affect survival. Removing liver packs 36 to 72 hours after placement reduced the risk of rebleeding without increasing the risk of liver-related complications.
From the Department of Surgery, University of California, Davis, Health System, Sacramento.
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