Abstract
Introduction
Uncontrollable hemorrhage during cytoreductive surgery for advanced carcinoma ovary is a major cause of peri-operative mortality. This case series presents a novel technique of “combined intra pelvic and intra-abdominal packing,” a life saving approach for such situations.
Materials and methods
This case series describes the retrospectively analyzed outcome of 16 non-consecutive patients with advanced epithelial ovarian cancer who underwent this ‘packing’ procedure in view of diffuse oozing and deteriorating patient condition. Three to six povidone–iodine soaked roller gauges were used and removal was done through exit sites on abdomen, 48 h after packing at bedside in 14 cases. 43 patients of carcinoma ovary who underwent debulking surgery during the same period but did not need packing were analyzed to compare underlying patient- and disease-related factors and complication rates.
Results
Operative mortality due to excessive primary hemorrhage was avoided in 14 out of 16 packed patients (87.5%). There was no notable increase in morbidity in cases compared with controls.
Conclusion
Post-operative complication rates were more or less acceptable. This method can achieve acceptable survival rates in patients with advanced ovarian malignancy having severe primary hemorrhage.
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References
Guidozzi F, Ball JH (1994) Extensive primary cytoreductive surgery for advanced epithelial ovarian cancer. Gynecol Oncol 53:326–330
Nasu Kaei, Matsumoto Harunobu, Takai Noriyuki et al (2009) Current status of primary cytoreductive surgery for the treatment of advanced epithelial ovarian cancer. Curr Cancer Ther Rev 5:67–79
Kudera JS, Aanning HL (2004) Damage control for blunt hepatic trauma: case presentation and historical review. S D J Med 57:449–453
Cirese E, Larciprete G (2003) Emergency pelvic packing to control intraoperative bleeding after a Piver type-3 procedure: an unusual way to control gynaecological hemorrhage. Eur J Gynaecol Oncol 24:99–100
Suzuki Takashi, Smith WadeR, Moore ErnestE (2009) Pelvic packing or angiography: competitive or complementary? Injury. Int J Care Injured 40:343–353
Jacobs JP, Mavroudis C, Jacobs ML et al (2006) What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 81:1937–1941
Ball CG, Wyrzykowski AD, Nicholas JM, Rozycki GS et al (2011) A decade’s experience with balloon catheter tamponade for the emergency control of hemorrhage. J Trauma 70:330–333
Dryjski ML, Litwinski RA, Karakousis CP (2005) Internal packing in the control of hemorrhage from large retroperitoneal veins. Am J Surg 189:208–210
Finan MA, Fiorica JV, Hoffman MS et al (1996) Massive pelvic hemorrhage during gynecologic cancer surgery: pack and go back. Gynecol Oncol 62:390–395
Khan FA, Fang DT (1987) Management of presacral bleeding during rectal resection. Surg Gynecol Obstet 165:274–276
Guerre EF Jr, O’Keeffe DF, Elliott JP et al (1987) Uncontrollable intraabdominal hemorrhage treated with packing and use of a MAST suit: a case report. J Reprod Med 32:230–232
Braley SC, Schneider PD, Bold RJ et al (2002) Controlled tamponade of severe presacral venous hemorrhage: use of a breast implant sizer. Dis Colon Rectum 45:140–142
Luijendijk RW, Ijzermans JN, Jeekel J et al (1994) An inflated condom as a packing device for control of hemorrhage. Br J Surg 81:270
Abikhaled JA, Granchi TS, Wall MJ et al (1997) Prolonged abdominal packing for trauma is associated with increased morbidity and mortality. Am Surg 63:1109–1112
Feliciano DV, Pachter HL (1989) Hepatic trauma revisited. Curr Probl Surg 26(7):453–524 [review]
Dildy GA, Scott JR, Saffer CS et al (2006) An effective pressure pack for severe pelvic hemorrhage. Obstet Gynecol 108:1222–1226
Awonuga AO, Merhi ZO, Khulpateea N (2006) Abdominal packing for intractable obstetrical and gynecologic hemorrhage. Int J Gynaecol Obstet 93:160–163
Feliciano DV, Mattox KL, Jordan GL Jr (1981) Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma 21:285–290
Hirshberg A, Mattox KL (1995) Planned reoperation for severe trauma. Ann Surg 222:3-g
Feliciano DV, Rozycki GS (2002) Hepatic trauma. Scand J Surg 91:72–79 [review]
Sharp KW, Locicero RJ (1992) Abdominal packing for surgically uncontrollable hemorrhage. Ann Surg 215(5):467–474 discussion 474–475
Granchi TS, Abikhaled JA, Hirshberg A et al (2004) Patterns of microbiology in intra-abdominal packing for trauma. J Trauma 56:45–51
Cue JI, Cryer HG, Miller FB et al (1990) Packing and planned reexploration for hepatic and retroperitoneal hemorrhage: critical refinements of a useful technique. J Trauma 30:1007–1013
Adam DJ, Fitridge RA, Raptis S (2005) Intra-abdominal packing for uncontrollable hemorrhage during ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 30:516–519
Civelek A, Yegen C, Aktan AO (2002) The use of bonewax to control massive presacral bleeding. Surg Today 32:944–955
Harrison JL, Hooks VH, Pearl RK et al (2003) Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases. Dis Colon Rectum 46:1115–1117
Onda T, Yoshikawa H (2011) Neoadjuvant chemotherapy for advanced ovarian cancer: overview of outcomes and unanswered questions. Expert Rev Anticancer Ther 11:1055–1069
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Appendix 1
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Kumar, S., Sharma, J.B., Karmakar, D. et al. Combined intra-abdominal pelvic packing during cytoreductive surgery in advanced epithelial ovarian cancer: a case series. Arch Gynecol Obstet 285, 1125–1132 (2012). https://doi.org/10.1007/s00404-011-2101-9
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DOI: https://doi.org/10.1007/s00404-011-2101-9