Mesh wrap in severe pediatric liver trauma.
OBJECTIVE
This study reviews the authors' experience in treating severe pediatric liver injuries with absorbable mesh wrapping. The authors found this relatively new therapeutic method very useful in selected cases, although its use is not very common in children. The authors analyze the indication describe some technical aspects, and discuss the advantages and the pitfalls of the method.


METHODS
In a 10-year period between 1990 and 2000, 181 children were admitted to Hillel-Yaffe Medical Center with blunt hepatic trauma. A total of 132 children were treated conservatively, and 49 (27%) were operated on. The operated group included 35 cases of isolated liver injuries and 14 cases of additional intraabdominal injuries. Thirty-four children were operated on between 1990 and 1995 (36% of 96 children), whereas between 1995 and 2000, 15 children were operated on (17% of 85 children), including 4 children aged 18 months to 15 years with massive liver bleeding who were treated with mesh wrap technique. The retrospective analysis of these 4 cases indicates a progressive policy in the recognition of cases suitable for mesh wrapping and gallbladder conservation.


RESULTS
The perihepatic mesh wrap technique controlled the bleeding in all children. In 3 of them the right lobe was wrapped, and, in 1 case, total liver wrapping was performed. Hepatic enzymes and bilirubin levels were elevated in the first 3 to 7 days and declined gradually to normal levels. The perihepatic mesh was not an obstacle to a transcutaneous drainage of an intrahepatic biloma. All 4 children returned to normal physical activities.


CONCLUSIONS
Liver mesh wrap is a simple, effective, and rapid way to obtain hemostasis and to conserve parenchyma in severe traumatized liver. The decision to wrap the liver should be done early to prevent acidosis and hypothermia. Cholecystectomy is not an integral part of the procedure in children. The morbidity is low, and most of the complications can be treated nonsurgically.
Division of Pediatric Surgery, Hillel-Yaffe Medical Center Affiliated with the Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
Miguel
M
Iuchtman
Ricardo
R
Alfici
Ahud
A
Sternberg
Zvi
Z
Steiner
Menachem
M
Litmanovich
Noah
N
Lieberman
Gabriel
G
Bartal
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D022125:Lacerations / Q000601:surgery*; D008099:Liver / Q000293:injuries*; D008297:Male; D012421:Rupture / Q000601:surgery; D013526:Surgical Mesh; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*