Perihepatic packing of major liver injuries - Complications and mortality

Hypothesis: Perihepatic packs used to control hemorrhage after liver injury increase the risk of complications and this risk increases the longer packs are left in place. Design: Retrospective case series. Setting: University level I trauma center. Patients: Consecutive patients with hepatic injury. Main Outcome Measures: Liver-related complications (biliary leak and abscess), rebleeding, and mortality. Results: One hundred twenty-nine of 804 patients with liver injuries were treated with perihepatic packing. Of the 69 who survived more than 24 hours, 75% lived to hospital discharge. Mortality rates were 14% and 30% in patients with and without liver complications, respec tively (P=.23). Liver complication rates were similar (P=.83) when packs were removed within 36 hours (early [33%]) or between 36 and 72 hours (late [29%]) after they were placed; the rebleeding rate was greater in the early group (21% vs 4%; P<.001). Conclusions: Liver complications associated with perihepatic packing did not affect survival. Removing liver packs 36 to 72 hours after placement reduced the risk of rebleeding without increasing the risk of liver-related complications.