title: Liver packing during elective surgery: an option that can be considered.
abstract: BACKGROUND
  Packing is a life-saving procedure in patients undergoing emergency surgery for blunt hepatic trauma, especially when massive blood transfusions, acidosis, or hypothermia have resulted in coagulation disorders. The purpose of this study was to apply this concept to the setting of elective liver surgery.
  
  
  METHODS
  Elective packing was performed in 7 patients who had sustained prolonged bleeding mainly related to partial outflow obstruction during the course of liver resection (n = 3) or transplantation (n = 4). At the time of packing, conventional methods of hemostasis had failed and surgery had lasted for 490 (range, 380-695) minutes, blood loss was 5,700 (range, 2,100-13,700) ml, and all patients had coagulation disorders (prothrombin time PT <30%, platelets <45 g/l), hypothermia (body temperature 35.4 °C), acidosis (median blood pH 7.24; serum lactate 6.5 mmol/l) and required catecholamine support.
  
  
  RESULTS
  Unpacking was performed after a median of 37 (range, 26-60) hours. At that time, all patients were normothermic, with platelet counts >45 g/l, PT >30%, and restored acid-base balance. Active bleeding had stopped, and secondary fascia closure was feasible. With a minimum follow-up of 6 months, all patients are alive without sequel.
  
  
  CONCLUSIONS
  Packing is a safe and efficient means to control venous bleeding when conventional methods of hemostasis have failed, knowing that commonly the reason for failure of conventional method of hemostasis is partial outflow obstruction.
authors: Department of Hepato-Biliary Surgery, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris 7, 100 bld du Général Leclerc, 92118, Clichy, France.
authors: Marc Antoine
authors: MA
authors: Allard
authors: Federica
authors: F
authors: Dondero
authors: Daniel
authors: D
authors: Sommacale
authors: Safi
authors: S
authors: Dokmak
authors: Jacques
authors: J
authors: Belghiti
authors: Olivier
authors: O
authors: Farges
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