Peri-Hepatic Liver Packing

in Liver Trauma
Feliciano et al (1986)  liver
packing  control of bleeding
 To date, become standard
approach for the control of
damage in liver injuries in
unstable patients
Despite the advantages 
there are some difficulties
encountered when the
surgeon removes the packing
Adhesive bands between the
liver damage area and the
pad  removal of the pad in
the second operation 
disruption of the liver tissue
and rebleeding
 Peri-Hepatic Liver Packing
• Hepatic packing for tamponade will be placed directly on the injured
liver, on the area of repair, or on the lobe overlying a retrohepatic
hematoma
• Packing to injured lobe directly or sites of hepatic sutures  tendency
for the packs to dry out if bleeding is rapidly controlled  injured liver
at the time of pack removal  bleeding may recur when the packs
and adherent clot are removed  insert some type of plastic barrier
between the injured or repaired liver and the packs  first described
by William S. Halsted in the early 1900s
Peri-Hepatic Liver Packing (2)
• Liver packing need for a reoperation for removal  reoperation for
removal of the packs and inspection of the hematoma is planned
within 24–72 h

• Insertion of perihepatic packing will elevate intraabdominal pressure

and may cause an abdominal compartment syndrome

• Other complications : intra-abdominal fluid collections, hematomas,

and abscesses