Application of modified packing in the combination treatment of extensive traumatic liver injuries

Introduction. Traumatic liver injuries are a significant challenge in modern emergency surgery. Developing new methods for surgical hemostasis of traumatic liver injuries is an extremely relevant task in urgent surgery.

Objective. Development and testing of surgical hemostasis for traumatic liver injuries using a modified packing technique.

Materials and methods. A new method of surgical hemostasis for traumatic liver injuries was developed using cadaveric material. The clinical trial included 27 patients with severe traumatic liver injuries (AAST Grade IV). Patients were divided into the main (n = 14) and control (n = 13) groups. Patients in the main group were treated using a new method of surgical hemostasis for traumatic liver injuries, involving tamponade of the liver wounds with Surgitamp hemostatic gauze impregnated with Molselect G-50 granular sorbent, followed by modified liver packing with strips of polypropylene mesh implant. In the control group, surgical hemostasis was performed by tamponading the liver wound with hemostatic sponges followed by suturing. The effectiveness of the proposed method was evaluated based on the following parameters: definitive hemostasis, number of recurrent hemorrhages, number of reсurrent operations, mortality, hospital stay duration, intensive care unit stay duration. Statistical analysis of the study results was performed using the Statistica 10 software.

Results. The application of modified packing in the combination treatment of patients with severe traumatic liver injuries increased the reliability of definitive hemostasis from 46.2% to 92.8% (p = 0.0391), reduced the number of re-bleeding episodes and re-operations from 38.4% to 7.1% (p = 0.0391), and decreased the mortality rate from 38.4% to 14.2% (p > 0.05).

Conclusions. The application of the new combined method of surgical hemostasis improved the treatment outcomes for patients with severe traumatic liver injuries by increasing the reliability of definitive hemostasis, reducing re-bleeding and re-operations, and lowering mortality.

1. García IC, Villalba JS, Iovino D, Franchi C, Iori V, Pettinato G, et al. Liver Trauma: Until When We Have to Delay Surgery? A Review. Life. 2022;12(5):694. https://doi.org/10.3390/life12050694

2. Corvino F, Giurazza F, Marra P, Ierardi AM, Corvino A, Basile A, et al. Damage Control Interventional Radiology in Liver Trauma: A Comprehensive Review. Journal of Personalized Medicine. 2024;14(4):365. https://doi.org/10.3390/jpm14040365

3. Vorontsov AK, Parkhisenko YuA, Cherednikov EF, Barannikov SV, Chernykh AV, Bezaltynnykh AA, et al. Experimental justification for the use of a new method of surgical hemostasis of extensive traumatic liver injuries. Volgograd Scientific Medical Journal. 2023;20(2):45–50 (In Russ.). EDN: HSJMKR

4. Evtikhov AV, Lyubivy ED, Kim VL. Clinical observations of severe traumatic liver injuries. Pirogov Russian Journal of Surgery. 2020;7:89–92 (In Russ.). https://doi.org/10.17116/hirurgia202007189

5. Aleksandrov VV, Maskin SS, Alimov MN, Biryulev DS, Matyukhin VV, Rashid A, et al. Closed liver injury. A systematic review. Russian Sklifosovsky Journal “Emergency Medical Care”. 2025;14(1):141–54 (In Russ.). https://doi.org/10.23934/2223-9022-2025-14-1-141-154

6. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World Journal of Emergency Surgery. 2020;15(1):24. https://doi.org/10.1186/s13017-020-00302-7

7. Benz D, Balogh ZJ. Damage control surgery: current state and future directions. Current Opinion in Critical Care. 2017;23(6):491–7. https://doi.org/10.1097/mcc.0000000000000465

8. Ordoñez CA, Parra MW, Millán M, Caicedo Y, Guzman-Rodriguez M, Padilla N, et al. Damage Control in Penetrating Liver Trauma: Fear of the Unknown. Colombia Médica. 2020;51(4):e4134365.

9. Chubaryan KA, Groshilin YuV, Lukash VS. Possibilities of improving thе results of surgical treatment of patients with severe liver injuries. Polytrauma. 2024;3:19–27 (In Russ.). https://doi.org/10.24412/1819-1495-2024-3-19-27

10. Brooks A, Reilly JJ, Hope C, Navarro A, Naess PA, Gaarder C. Evolution of non-operative management of liver trauma. Trauma Surgery and Acute Care Open. 2020;5(1):e000551. https://doi.org/10.1136/tsaco-2020-000551

11. Iacobellis F, Di Serafino M, Caruso M, Dell’Aversano Orabona G, Rinaldo C, Grimaldi D, et al. Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT. Diagnostics. 2023;13(7):1347. https://doi.org/10.3390/diagnostics13071347

12. Aleksandrov VV, Maskin SS, Ermolaeva NK, Matyukhin VV. Conservative management of patients with closed trauma of parenchymal organs of the abdominal cavity and retroperitoneal space, with retroperitoneal hemorrhages — indications, methodology and feasibility. Russian Sklifosovsky Journal “Emergency Medical Care”. 2021;3:540–7 (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-3-540-548

13. Gavrishchuk YaV, Manukovsky VA, Tulupov AN, Demko AE, Kolchanov EA, Savello VE, et al. Diagnostics and treatment of liver injuries in blunt abdominal trauma using minimally invasive technologies. Grekov’s Bulletin of Surgery. 2022;181(3):28–36 (In Russ.). https://doi.org/10.24884/0042-4625-2022-181-3-28-36

14. Podoluzhny VI, Radionov IA, Pelts VA, Startsev AB, Krasnov KA, Shatalin VA. Traumatic liver injury. Polytrauma. 2023;1:34–8 (In Russ.). https://doi.org/10.24412/1819-1495-2023-1-34-38

15. Lipatov VA, Lazarenko SV, Severinov DA, Denisov AA, Chupakhin EG, Aniskina EN. Comparative analysis of the effectiveness of new samples of local hemostatic agents. Extreme Medicine. 2023;25(4):131–6 (In Russ.). https://doi.org/10.47183/mes.2023.063

16. Barannikov SV, Cherednikov EF, Polubkova GV, Banin IN, Bolkhovitinov AE, Berezhnoy SI, et al. Use of alginate polymer polysaccharide hemostatic hydrogel in ongoing arterial bleeding from a peptic ulcer of a gastroenteroanastomosis (clinical case). Extreme Medicine. 2025;27(2):235–42 (In Russ.). https://doi.org/10.47183/mes.2025-243

17. Gavrishchuk YaV, Manukovsky VA, Tulupov AN, Demko AE, Kolchanov EA, Kisilev M, et al. Treatment of a victim with closed liver injury using interventional methods. Bulletin of Experimental and Clinical Surgery. 2023;16(4):316–20 (In Russ.). https://doi.org/10.18499/2070-478X-2023-16-4-316-320

18. Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. Journal of the American College of Surgeons. 2008;207(5):646–55. https://doi.org/10.1016/j.jamcollsurg.2008.06.342

19. Vorontsov AK, Parkhisenko YuA, Cherednikov EF, Barannikov SV, Bezaltynnykh AA, Chernykh AV. Hemostatic Gauze Surgitamp and Granular Sorbent Molselect G-50 Application in the Treatment of Simulated Bleeding Liver Wounds. Journal of Experimental and Clinical Surgery. 2023;1(16):52–9 (In Russ.). https://doi.org/10.18499/2070-478X-2023-16-1-52-59

20. Vorontsov AK, Parkhisenko YuA, Vorontsov KE, Bezaltynnykh AA. A method of surgical treatment for patients with severe liver injuries. Patent of Russian Federation № 2674874 С1; 2018 (In Russ.). EDN: ZECXBR