Abstract
BackgroundThe liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V).Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death.MethodsWe designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2).ResultsBoth pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP.ConclusionsWe establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.
Highlights
The liver is the most injured organ following abdominal trauma
Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths [1, 4, 5]
Intraoperative and postoperative parameters In the perihepatic packing (PHP) group, one of the pigs did not survive the first 24 h. Both 2 pigs in the VacBagPack device (VBP) group and the remaining one in the PHP group went through the full 72-h period and were successfully reoperated
Summary
A major liver injury is the leading cause of death in patients with abdominal trauma, the treatment of which still poses a challenge to surgeons [1,2,3]. Packing and reoperation account for the increased survival in severe liver trauma in the last decades [2, 6]. This once revolutionary approach stands as part of the recommended management for severe liver injuries (grades IV–V) [2, 7]. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V). An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death
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