CURRENT PLACE OF PERIHEPATIC ABSORBABLE M ESH BASED ON A SERIES OF 105 PATIENTS WITH LIVER TRAUMA

From October 1987 to June 1993, 105 patients with liver trauma includi ng 71 patients with multiple trauma were admitted to the emergency uni t of the Hopital Sud in Marseilles. Mean age was 32+/-15 years, rangin g from 16 to 77 years. 77 were male and 28 were female. 83 cases prese nted with closed trauma, and there were 11 by knife wounds and 11 gun shot injuries. 22 patients, including 10 with multiple trauma, were no t operated. Operation was decided immediately in 38 cases for hypovole mia for during the following six hours because of unstable blood press ure after four units of blood transfusion. The absorbable perihepatic mesh was used by 3 surgeons and 3 others used classical procedures (su tures, packing). Global mortality was 15%. The morbidity (31%) was not different from other reports but was significantly lower when using t he mesh (p=0.002). This technique can achieve rapid and lasting hemost asis and bilistasis without any increase of cholestasis or hepatic cyt olysis compared to conventional procedures, and without any alteration of laboratory parameters, as shown by specific laboratory tests and f ollow-up liver biopsies. The mesh also avoids compression of the adjac ent organs, compared to packing, thereby avoiding respiratory and rena l impairment and reoperation. It can be used in a septic context and i n combination with all kinds of radiologic follow-up and percutaneous aspiration and drainage.