International Surgery Journal | September 2017 | Vol 4 | Issue 9 Page 3038 International Surgery Journal Arora BK et al. Int Surg J. 2017 Sep;4(9):3038-3043 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Pedicled omentum hepatorrhaphy in blunt hepatic trauma Bhavinder K. Arora 1 *, Rachit Arora 2 , Akshit Arora 2 INTRODUCTION Liver is the most common solid viscera involved in blunt traumatic injury of abdomen. Although liver is protected under the rib cage but gets injured because of its large size. As more young people are involved in vehicular accidents, blunt hepatic trauma is the leading cause of death in young persons. Blunt hepatic trauma can occur as isolated liver injury but usually associated with other injuries. Now there is a trend towards nonoperative management of blunt liver trauma but severe liver injuries continue to require operative treatment. 1 Old age, male patient, decreasing Glassgow Coma Scale, increasing injury severity score and hypotension are predictors of failure of nonoperative management of blunt hepatic trauma. These factors help in selection of patients for operative management. 2 Liver parenchymal injuries are most common in blunt hepatic trauma but porta-hepatis injuries, hepatic vein injuries and retrohepatic venacava injuries do occur rarely. Various surgical procedures commonly used in liver parenchymal ABSTRACT Background: The liver is the most common solid viscera injured in motor vehicle accidents. Advances in radiological diagnostic techniques and critical care have increasing trend towards the nonoperative management. Still operative management is needed if there is continuous bleed or haemodynamic instability. The omentum commonly known as policeman of abdomen as it reaches intra-abdominal injury site. It is known to adhere to the site of injury and seals it. It increases the vascularity and starts neoangiogenesis. This produces haemostasis and promotes wound healing. Methods: In this study 24 patients were managed by this technique of pedicled omentoplasty. These patients were in the age group of 22 to 42 years. There was male dominance, 22 patients were males (91.7%) while only 2 patients were females (8.3%). The use of omentum in packing is described here. The omentum is converted to a pedicled flap based on right omental artery by tailoring it. The active bleeding vessels can be ligated. The whole length of pedicled omentum is packed in liver cavity. Using liver sutures two or more sutures are applied for stabilization. Results: On exploration, the hepatic injury was assigned grade as per AAST liver injury scale. Out of 24 patients included in this study; two (8.33%) were grade I patients, three (12.5%) were grade II patients, nine (37.5%) were grade III patients and ten (41.67%) were grade IV patients. Patients with grade V and grade VI were dealt by perihepatic packing as damage control surgery were excluded from this study. Conclusions: Pedicled omentoplasty in blunt hepatic trauma can be used irrespective of the grade of liver injury. It should be used in combination with other procedures like debridement, segmental or unsegmental resection, control of active bleeding vessels, use of Pringles manoeuvre, selective hepatic artery ligation and even with deep mattress suturing. This helps in haemostasis, early healing and rapid recovery with minimum complications. Keywords: Blunt abdominal trauma, Damage control surgery, Hepatic trauma, Hepatorrhaphy, Liver injury, Omental packing, Perihepatic packing 1 Department of Surgery, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, Haryana, India 2 MBBS student, VMMC and Safdarjung Hospital, New Delhi, India Received: 11 July 2017 Accepted: 04 August 2017 *Correspondence: Dr. Bhavinder K. Arora, E-mail: drbhavinderarora@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20173883