DAMAGED CONTROL SURGERY IN COMPLEX LIVER INJURIES

Abstract

The planned intra-abdominal packing for severe haemorrhage from complex liver injuries may be lifesaving, especially, in the presence of hypothermia, acidosis and coagulopaty. This study presents our experience with packing for the control of surgically uncorrectable haemorrhage and analyses the effect of several risk factors on survival. The investigated risk factors were Injury Severity Score, Revised Trauma Score, Glasgow Coma Score, presence of associated injury, referral from an other hospital, preoperative time and the number of blood transfusions. Seventeen liver trauma patients for whom packing was used to control haemorrhage were retrospectively reviewed. The overall mortality rate was 58% (10717). There were 40 complications in 14 patients. Preoperative time (161 vs. 249) and the number of transfusion (6.71 vs. 13.6) were significantly different (p<0.05) between the survivors and the non survivors. Damaged control surgery represents a modern trauma resuscitation in the operating room. Surgeons adaptation to this strategy, selection of the proper patient, early decision for packing and the decrease in preoperative time may reduce the overall mortality rate.