Combined intra-abdominal pelvic packing during cytoreductive surgery in advanced epithelial ovarian cancer: a case series

Abstract

Uncontrollable hemorrhage during cytoreductive surgery for advanced carcinoma ovary is a major cause of peri-operative mortality. This case series presents a novel technique of "combined intra pelvic and intra-abdominal packing," a life saving approach for such situations. This case series describes the retrospectively analyzed outcome of 16 non-consecutive patients with advanced epithelial ovarian cancer who underwent this 'packing' procedure in view of diffuse oozing and deteriorating patient condition. Three to six povidone-iodine soaked roller gauges were used and removal was done through exit sites on abdomen, 48 h after packing at bedside in 14 cases. 43 patients of carcinoma ovary who underwent debulking surgery during the same period but did not need packing were analyzed to compare underlying patient- and disease-related factors and complication rates. Operative mortality due to excessive primary hemorrhage was avoided in 14 out of 16 packed patients (87.5%). There was no notable increase in morbidity in cases compared with controls. Post-operative complication rates were more or less acceptable. This method can achieve acceptable survival rates in patients with advanced ovarian malignancy having severe primary hemorrhage.