title: Refinement in the technique of perihepatic packing: a safe and effective surgical hemostasis and multidisciplinary approach can improve the outcome in severe liver trauma.
abstract: BACKGROUND
  since 2005, we refined the technique of perihepatic packing including complete mobilization of the right lobe and packing around the posterior paracaval surface, lateral right side, and anterior and posteroinferior surfaces.
  
  
  METHODS
  two groups of patients with grade IV/V liver trauma underwent perihepatic packing before and after 2005. The study group included 12 patients treated with the new technique. The control group included 23 patients treated with the old technique.
  
  
  RESULTS
  all 13 patients except one who died within 24 hours were treated with the old technique. The overall survival rate was 75% in the patients treated with the new technique (vs 30.4%, P < .02); the liver-related mortality was 8.3% versus 34.8% (P = not significant). The mean survival time in the intensive care unit was longer in the latest group (39.4 vs 22.3 days, P = not significant). The incidence of rebleeding requiring repacking was 16.7% in the patients who underwent new packing versus 45.5% in the patient who were treated with the old technique (P = not significant). The overall (81.8% vs 100%, P = not significant) and liver-related morbidity rate (18.2% vs 41.7%, P = not significant) and the incidence of abdominal sepsis (9.1% vs 41.7%, P = not significant) decreased.
  
  
  CONCLUSIONS
  our refined technique of perihepatic packing seems to be safe and effective.
authors.affiliation: Emergency and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Baldoni
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.forename: Nicola
authors.initials: N
authors.lastname: Antonacci
authors.forename: Carlo
authors.initials: C
authors.lastname: Coniglio
authors.forename: Aimone
authors.initials: A
authors.lastname: Giugni
authors.forename: Nicola
authors.initials: N
authors.lastname: Montanari
authors.forename: Andrea
authors.initials: A
authors.lastname: Biscardi
authors.forename: Silvia
authors.initials: S
authors.lastname: Villani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D001458:Bandages; D058450:Endotamponade / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult