Modified perihepatic packing; a creative and beneficial method for management of high grade liver injury

ABSTRACT

To evaluate the efficacy of modified perihepatic packing [MPHP] in reducing the rate of re-bleeding rate after packing removal. This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A [control] included 14 and group B [experimental] comprised 16 rabbits. The animals in group A underwent standard perihepatic packing [SPHP] and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings. There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A [57.1% vs. 12.5%; p=0.019]. The mean bleeding volume was also significantly lower in group B compared to group A [76.88 +/- 22.12 vs. 98.93 +/- 33.8 mL; p<001]. Although the survival rate was higher in group A compared to group B [93.8% vs. 78.6%] but the difference was not statistically significant [p=0.315]. MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson's capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP