Packing for control of hemorrhage in major liver trauma

Abstract

Background: Packing for complex liver injuries has been associated with an increased risk of abdominal sepsis and bile leaks. The aim of the present study was to determine the optimum timing of pack removal and to assess whether the total duration of packing increases the incidence of these complications.

Methods: The study was based on a retrospective review of all patients requiring liver packing over an 8-year period in a level 1 trauma center.

Results: Ninety-three (17%) of 534 liver injuries identified at laparotomy required perihepatic packing. Penetrating and blunt trauma occurred in 72 (77%) and 21 (23%), respectively. The mean total duration of packing was 2.4 days (range: 0.5-6.0 days). There was no association between the total duration of packing and the development of liver-related complications (P = 0.284) or septic complications (P = 0.155). Early removal of packs at 24 h was associated with a higher rate of re-bleeding than removal of packs at 48 h (P = 0.006).

Conclusions: The total duration of liver packing does not result in an increase in septic complications or bile leaks. The first re-look laparotomy should only be performed after 48 h. An early re-look at 24 h is associated with re-bleeding and does not lead to early removal of liver packs.