Is it more dangerous to perform inadequate packing?

Although small wounds of the liver parenchyma can be managed with electrocautery or simple suturing and hemodynamically stable patients, mostly with low-grade hepatic injuries due to blunt injury, can be managed nonoperatively, the treatment strategy of the patients sustaining major hepatic trauma is still controversial. Particularly deeper lacerations of the hepatic tissue are challenging for the surgeon. Abbreviated and necessary procedures such as packing procedure only done to keep the patients alive are called "damage control surgery" (DCS). In contrast, prolonged and extensive surgical procedures performed on critically injured patients often results in poor outcome with high mortality rates of 46% and 80% for grade IV and V injuries, respectively [1]. The majority of these deaths (54%) have been attributable to hemorrhage with resulting coagulopathy, acidosis, and hypothermia [2]. Peri-hepatic packing (PHP) procedure, which is the basic damage control technique to arrest hepatic hemorrhage, is one of the cornerstones of the trauma surgery and currently, this is the most commonly accepted and performed method for major liver trauma. The main goal after packing is to correct acidosis, hypothermia, and coagulopathy, the lethal triad causing death [3]. The literature review has allowed for emphasis on the most common problems of PHP, adequacy of particular indications, their evolution, timing, the results in general and critical situations in particular [4].This procedure requires caution during application, close observation after operation and experience to repair the injury in the re-look operation. Particularly, in some primary or secondary health care centers where a well-established intensive care unit or hepatobiliary or trauma surgeon is not available, the management of the trauma patients with severe hepatic injury is very difficult and mostly impossible. Thus, the damage control surgery, PHP for liver injury, has become the most common choice for tempor