title: Perihepatic Packing versus Primary Surgical Repair in Patients with Blunt Liver Trauma; an 8-year Experience.
abstract: OBJECTIVE
  To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.
  
  
  METHODS
  This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients' hospital medical records during the study period. The patients' outcome was compared between those who underwent perihepatic packing or primary surgical repair.
  
  
  RESULTS
  Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room  due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002).
  
  
  CONCLUSIONS
  We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more  than  1000 milliliters hemoperitoneum  and  more  than  1600 milliliters of intra-operative  estimated blood  loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Paydar
authors.affiliation: Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mahmoodi
authors.affiliation: Cardio-Vascular Health Institute, TriCity Medical Center, Oceanside, California, USA and Oklahoma State University, Oklahoma, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jamshidi
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Niakan
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Keshavarz
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Moeenvaziri
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Esmaeil
authors.initials: ME
authors.lastname: Ghorbaninejad
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Farrokhnia
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Forough
authors.initials: F
authors.lastname: Izadi Fard
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Jaafari
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Golshan
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Abbasi
authors.affiliation: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Bolandparvaz
authors.affiliation: Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Behnam
authors.initials: B
authors.lastname: Honarvar
keywords: Blunt; Liver; Packing; Repair; Perihepatic; Trauma