removing pledgets from liver

[Predator]

In Nov of 2002, I was shot in the upper right of my stomach area. The bullet entered the right lobe of my liver, went through my right kidney, cut my diaphram, and broke 4 ribs on the way out. 40% of my livers was lost and my right kidney was taken out.
To stop the bleeding in my liver, gauze pledgets were used, top and bottom, to keep the thread from pulling through. Several times over the next 4 weeks,(while I was still open), the Doctor tried to remove these pledgets but was never able to because I had such a bad reaction to it, (once I actually died and every other time my blood pressure would drop badly).
Some how I lived through this all and now they are still trying to put me together.
A few weeks ago I went in for operation #20. He went in through the exit wound, (which has been open and weeping for the last 2 years) and removed several bullet fragmants. While in there, he was able to remove two of the pledgets. The pledgets he removed were infected and now the rest need to come out.
To remove these pledgets,(which are now grown into my liver), a 1 inch slice of my liver will have to be removed. My Doctor is currently looking for a specialist to do this.
I should also probably say that my liver did regrow to full size, mainly on left lobe, and function has been normal.
Should also say that this operation will have to be done through the back because of the skin graphs now covering my stomach.
My question are: What is the success of liver resections?
What is the recovery time? Do you know of any other way to remove these without a resection? What are the risks if they dont come out?

[zokumo]

In December 2004, I started feel some kind of pain under my right ribs in the front. I ran to my doctor and he told me that area is where the liver is. he suggested i should got for a Typhoid test, which I did and it was negative. he then placed me on medications for liver infections for 4 days and stuffs like that. But the pain persisted. After 8 days of the medications, the similar pain started at the lower right part of my abdomen. I went back to the doctor with the complaint. After examining me, he said I could be having Appendicitis or problem with my Gull Bladder. He the advised me to go for a scan. I went for the scan and the result states that my liver kidney, gull bladder, pancreas, stomach and bladder are in good shape. The walls of my bladder is smooth. But in the kidney, there was increasing medullary focal. Based on the result, he asked me to take plenty of water. actually, the pain gradually reduced and left. But the pain is coming again.

My question is that is it possible for kidney related problem to have its pain at these locations? Or what do you think the problem is? Liver, Kidney or Gull blader? Please tell me what to do, as the pain is not much but I dont want it to come up at all. should I keep drinking the water of go back to the doctor. could scan be wrong sometimes? Please advise me on what to do

[surgeon]

There are gazillions of people walking around with pledgets in them; heart surgeons use them, they're used in hiatal hernia repairs, etc. And other devices made of similar material -- patches in hearts, artifical blood vessels -- are all over as well. There's no reason to remove a pledget or similar device unless it's known to be causing a problem; specifically, if there's evidence it's infected. Whereas it might be hard to be sure it is or isn't, I'd say -- as a surgeon who's operated on livers -- that the risk of doing the surgery is far greater than that of leaving it in. And that if it ever seems to be infected, the first choice for trying to get it out would be to have a radiologist place a drain into the area and then try to fish it out.

[Kevin Pho, MD]

Hello - I am not a surgeon, so I will defer my answer to the comments below.

I can say that I agree that removing the pledgets by liver resection would be the most risky, last resort approach.  Approaching it via an interventional radiology procedure should be considered first.

I will repost the comment, since they don't get saved:
"There are gazillions of people walking around with pledgets in them; heart surgeons use them, they're used in hiatal hernia repairs, etc. And other devices made of similar material -- patches in hearts, artifical blood vessels -- are all over as well. There's no reason to remove a pledget or similar device unless it's known to be causing a problem; specifically, if there's evidence it's infected. Whereas it might be hard to be sure it is or isn't, I'd say -- as a surgeon who's operated on livers -- that the risk of doing the surgery is far greater than that of leaving it in. And that if it ever seems to be infected, the first choice for trying to get it out would be to have a radiologist place a drain into the area and then try to fish it out."

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b