Perihepatic Packing in The Management of Liver Trauma

141 show that surgery is still the best treatment in many instances in terms of quality of the results, cost and rapid rehabilitation compared to non surgical methods such as interventional radiology or "operative" endoscopy. (1981) Les traumatismes operatoires de la voie biliaire principale. Monographie de l'Association Franaise de Chirurgie (AFC). Masson 2. Hepp, J. (1985) Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions: the French connection. (1978) The use of silastic trans-hepatic stents in benign and malignant biliary strictures. Perihepatic packing was used in 25 of 197 (12.7%) patients presenting with liver trauma to Westmead Hospital over an 8 year period. Packing was used either to provide temporary haemostasis prior to transfer or as part of a definitive treatment plant at this hospital. Thirteen patients were packed prior to transfer. Only two were unstable on arrival, one of whom died. They were compared with 18 'comparison' patients with liver injuries of similar severity. In this group 10 were unstable on arrival (P=0.027), nine of whom died (P=0.015). Packing was used as part of a definitive treatment plan at Westmead on 17 occasions. Four patients were coagulo-pathic and five had also been packed prior to arrival. Eight of this group died. Packing is a convenient and safe way of controlling major hepatic haemorrhage prior to transfer to a tertiary referral centre. It may also be part of a definitive treatment plan to control hepatic bleeding especially as many patients arrive with a coagulopathy or develop a coagulopathy during the course of surgery to control bleeding. Packing will control haemorrhage until the coagulopathy has been corrected .