Which Is the Last Stage before Packing in Elective Liver Surgery?

Excerpt

We read with great interest the article by Allard et al. [1] regarding their experience with liver packing during elective surgery. Through their wide experience with liver surgery, involving more than 100 liver transplants (LT) and 200 liver resections (LR) per year, the authors report seven cases in which liver packing was performed because of uncontrollable bleeding during LT (four cases) or LR (three cases). The main message of this work is that bleeding of the transection plane from venous origin, in particular when it is secondary to partial outflow obstruction, could present a challenging situation for the liver surgeon. This could happen, for instance, in cases of reduced graft LT with interruption of hepatic vein tributaries, or during complex LR when a hepatic vein is interrupted downstream. The authors focus on the difficulties in bleeding control when coagulation disorders become predominant, with resulting hypothermia, acidosis, and hemodynamic instability so that liver packing for 24–60 h could become an efficient procedure to stop bleeding. …