A Randomized Clinical Trial Comparing the Effect of Different Haemostatic Agents for Haemostasis of the Liver after Hepatic Resection

Farzad Kakaei,Behnam Sanei,Afshin Habibzadeh,Mir Salim Seyyed Sadeghi,Shahryar Hashemzadeh

doi:10.1155/2013/587608

Abstract

Introduction. Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it. The aim of the current study is to evaluate effects of 3 different types of these agents. Methods. In this randomized clinical trial, 45 patients undergoing liver resection were assigned to receive TachoSil, Surgicel, and Glubran 2 for controlling bleeding. Intraoperative and postoperative findings were compared between groups. Results. Postoperative bleeding (0 versus 33.3%, P = 0.04) and drainage volume first day after surgery (281.33 ± 103.98 versus 150.00 ± 60.82 mL, P = 0.02) were significantly higher in Surgicel than in TachoSil group. Postoperative complications included bile leak (3 cases in Surgicel, 1 case in TachoSil and Glubran 2), noninfectious collection (2 cases in TachoSil and Surgicel and 1 case in Glubran 2), perihepatic abscess, and massive hematoma around hepatectomy site both in Surgicel group. There was no death during the study period. Conclusion. Due to higher complications in Surgicel group, its application as hemostatic agent after liver resection is not recommended. Better results in TachoSil in comparison to the other two are indicative of its better efficacy and superiority in controlling hemostasis.

Highlights

Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it
Advances in surgical technique have reduced the occurrence of postoperative complications following liver resection [1] and resulted in low surgical mortality and morbidity rates in high-volume centers [2,3,4]
We could not increase the number of our patients because of the invasive nature of these procedures, and it was the first time that Glubran 2 was used in liver resection procedure

Summary

Introduction

Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it. In this randomized clinical trial, 45 patients undergoing liver resection were assigned to receive TachoSil, Surgicel, and Glubran 2 for controlling bleeding. Postoperative bleeding (0 versus 33.3%, P = 0.04) and drainage volume first day after surgery (281.33 ± 103.98 versus 150.00 ± 60.82 mL, P = 0.02) were significantly higher in Surgicel than in TachoSil group. Due to higher complications in Surgicel group, its application as hemostatic agent after liver resection is not recommended. Advances in surgical technique have reduced the occurrence of postoperative complications following liver resection [1] and resulted in low surgical mortality and morbidity rates in high-volume centers [2,3,4]. These products include gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues [7,8,9,10,11]

Objectives

Methods

Results

Conclusion