Name of the Procedure:

Management of Liver Hemorrhage and Re-exploration of Hepatic Wound for Removal of Packing (also known as hepatic packing removal and re-exploration surgery)

Summary

This procedure involves the surgical removal of packing material previously placed in the liver to control bleeding. The surgeon re-enters the hepatic wound to ensure the bleeding is controlled before removing the packing.

Purpose

The main goal is to manage liver hemorrhage, ensuring that bleeding is controlled and managed effectively. Removing the packing helps prevent infection and other complications while maintaining the liver's functional integrity.

Indications

• Persistent or recurrent bleeding from a liver injury
• Previous hepatic packing due to severe liver trauma or surgery
• Symptoms of infection or complication from the packing
• Hemodynamic instability despite initial management

Preparation

• Patients are generally required to fast (no food or drink) for at least 8 hours before the surgery.
• Preoperative blood tests, imaging studies (such as CT scans), and physical exams to assess the liver and overall health.
• Adjustments or discontinuation of certain medications (e.g., blood thinners) may be necessary.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: The surgeon reopens the previous incision made during the initial liver surgery.
3. Exploration: The site is carefully examined to assess bleeding and the condition of the liver.
4. Removal of Packing: The packing materials placed during the initial procedure are carefully removed.
5. Hemostasis: The surgeon ensures there is no active bleeding, employing techniques such as cauterization or applying surgical clips.
6. Closure: The wound is sutured closed, and dressings are applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the case.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon (typically a trauma or general surgeon)
• Anesthesiologist
• Surgical nurses
• Surgical assistants

Risks and Complications

• Infection at the surgical site
• Recurrent bleeding
• Damage to surrounding organs or structures
• Anesthesia-related complications (e.g., respiratory issues)
• Blood clots

Benefits

• Effective control and management of liver bleeding
• Prevention of further complications, such as infection or significant blood loss
• Promotes healing and recovery of the liver

Recovery

• Patients may stay in the hospital for monitoring for several days post-surgery.
• Pain management with medications.
• Slowly resume eating and physical activity as tolerated.
• Follow-up appointments to monitor healing and liver function.

Alternatives

• Non-surgical management (e.g., conservative observation)
• Interventional radiology techniques, such as embolization
• Each alternative has its own risks and benefits, which depend on the severity and specific circumstances of the bleeding.

Patient Experience

• Patients will be under general anesthesia during the procedure and will not feel pain.
• Postoperative pain is managed with pain relief medications.
• Some discomfort, swelling, and bruising at the incision site.
• Patients may need assistance with daily activities during the initial recovery period.
• Full recovery can vary but generally takes several weeks to months, depending on the patient’s overall health and the extent of the initial injury.