Mesh wrapping for severe hepatic injury: a beneficial option in the trauma surgeon's armamentarium

Ryan Kennedy; Sidney B Brevard; Patrick Bosarge; Jon D Simmons; Mohammed A Frotan; Jeremy A Baker; Lynda Tuart; Cindy Pritchett; Richard P Gonzalez

doi:10.1016/j.amjsurg.2014.12.006

Mesh wrapping for severe hepatic injury: a beneficial option in the trauma surgeon's armamentarium

Am J Surg. 2015 Mar;209(3):515-20. doi: 10.1016/j.amjsurg.2014.12.006. Epub 2014 Dec 20.

Authors

Ryan Kennedy¹, Sidney B Brevard¹, Patrick Bosarge², Jon D Simmons¹, Mohammed A Frotan¹, Jeremy A Baker¹, Lynda Tuart¹, Cindy Pritchett¹, Richard P Gonzalez³

Affiliations

¹ Department of Surgery, University of South Alabama, Mobile, AL, USA.
² Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, USA.
³ Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. Electronic address: richard.gonzalez@lumc.edu.

PMID: 25770395
DOI: 10.1016/j.amjsurg.2014.12.006

Abstract

Background: The purpose of this study was to assess the efficacy of absorbable mesh wrapping (MW) versus perihepatic packing (HP) for severe hepatic injury.

Methods: From January 2001 to December 2012, data were collected for MW patients with hepatic injury. Patients who underwent HP were matched with MW patients by injury mechanism, liver injury grade, Injury Severity Score, and age.

Results: Twenty-six MW and twenty-six HP patients were matched. Eighteen blunt and 8 penetrating injuries were present in each group. There were 9 (35%) mortalities in the MW group and 16 (62%) in the HP groups (P = .03). Average transfusions were 12.0 and 24.5 (P = .03) packed red blood cells in the MW and HP groups, respectively. Average laparotomies per survivors were 1.3 for the MW and 3.1 for the HP groups (P = .01). Average length of stay for survivors was 19 and 47 (P = .04) days in the MW and HP groups, respectively.

Conclusion: MW for hepatic injuries can significantly decrease mortality, transfusions, laparotomies, and length of stay.

Keywords: Absorbable; Hepatorrhaphy; Injury; Liver; Mesh; Repair; Wrap.

MeSH terms

Abdominal Injuries / diagnosis
Abdominal Injuries / mortality
Abdominal Injuries / surgery*
Absorbable Implants
Adolescent
Adult
Clinical Competence*
Equipment Design
Female
Follow-Up Studies
Humans
Laparotomy / methods*
Liver / injuries*
Liver / surgery
Male
Middle Aged
Retrospective Studies
Surgical Mesh*
Survival Rate / trends
Trauma Centers
Trauma Severity Indices
Treatment Outcome
United States / epidemiology
Wounds, Nonpenetrating / diagnosis
Wounds, Nonpenetrating / mortality
Wounds, Nonpenetrating / surgery*
Wounds, Penetrating / diagnosis
Wounds, Penetrating / mortality
Wounds, Penetrating / surgery*
Young Adult