47361 Management of liver hemorrhage; exploration of hepatic wound, extensive debridement, coagulation and/or suture, with or without packing of liver

Name of the Procedure:

Management of Liver Hemorrhage; Exploration of Hepatic Wound, Extensive Debridement, Coagulation and/or Suture, with or without Packing of Liver

Summary

This is a surgical procedure to control bleeding in the liver that involves exploring the wound, cleaning it extensively (debridement), and stopping the bleeding through coagulation or suturing the liver tissue. Sometimes, the surgeon may need to pack the liver to control the bleeding.

Purpose

This procedure addresses severe bleeding within the liver, which can occur due to trauma or surgical complications. The goal is to stop the bleeding, remove damaged tissue, and promote healing. Without intervention, uncontrolled liver hemorrhage can be life-threatening.

Indications

• Severe liver bleeding due to trauma (e.g., car accidents, falls).
• Complications from previous liver surgery.
• Diagnosis of a liver injury via imaging studies (CT scan, MRI).
• Symptoms like severe abdominal pain, swelling, or signs of internal bleeding (low blood pressure, rapid heart rate).

Preparation

• Fasting for at least 8 hours before the procedure.
• Temporary discontinuation of certain medications, especially blood thinners.
• Pre-operative imaging (CT scan, MRI) to assess the extent of liver damage.
• Blood tests to evaluate liver function and blood clotting.

Procedure Description

1. Administration of general anesthesia.
2. An incision is made in the abdomen to access the liver.
3. Exploration of the liver to identify the source of bleeding.
4. Extensive debridement to remove dead or damaged tissue.
5. Bleeding is controlled using techniques like coagulation (cauterization) or suturing (stitching) of liver tissue.
6. If necessary, the liver is packed with medical gauze to control bleeding temporarily.
7. The incision is closed, and the patient is moved to recovery.

Duration

The procedure typically takes 2 to 4 hours, depending on the extent of the injury and the complexity of the operation.

Setting

The procedure is performed in a hospital operating room.

Personnel

• General or trauma surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs
• Blood clots
• Adverse reactions to anesthesia
• Long-term complications such as bile leaks or liver dysfunction

Benefits

• Control of life-threatening bleeding
• Removal of damaged tissue to prevent infection
• Promotion of effective liver healing
• Improved survival and recovery outcomes

Recovery

• Hospital stay of several days to monitor liver function and recovery.
• Pain management with prescribed medications.
• Instructions for wound care and activity modifications.
• Follow-up appointments with imaging and blood tests to ensure proper healing.
• Gradual return to normal activities over several weeks.

Alternatives

• Angiographic embolization: a less invasive procedure to block the bleeding vessels using radiology.
• Non-surgical management: observation and supportive care if bleeding is not severe.
• Each alternative comes with its own set of risks and benefits, often chosen based on the patient's overall condition, extent of injury, and available resources.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-operatively, they might experience pain and discomfort at the incision site, manageable with pain medications. Over the recovery period, the patient might experience some fatigue and will need to follow specific instructions about diet and physical activities to ensure proper healing.