Combined application of heterologous collagen and fibrin sealant for liver injuries

Abstract

Hemostasis in complex liver injuries remains a problem despite improvements in operative techniques including debridement, suturing or packing. To evaluate fibrin sealant (FS), a new biodegradable hemostatic agent in combination with porcine collagen for sealing of liver injuries, three series of experiments were performed in 132 rats. In series I, 18 rats had a 10-mm in diameter and 2-mm in depth punch defect to the left lateral lobe. In the FS group ( n = 9), bleeding was treated by insertion of an FS-soaked piece of collagen of equal size which was firmly attached to a plastic disk with wire anchor. In the control group ( n = 9), collagen alone was inserted. Fifteen minutes after the insertion the lobe was excised and pull-off experiments were performed with simultaneous script chart recording. There was a highly significant difference in the adhesion to the liver surface (85.6 ± 7.1 in the FS group versus 24.8 ± 2.6 g/cm 2 in the control group, P < 0.001). In series II, 42 anticoagulated rats (Coumadin, PT 27.5% ± 1.3) with lobectomy or liver rupture were placed in three groups ( n = 14). Group I was treated with FS, group II with FS and collagen, and group III with catgut sutures which served as controls. Fourteen days later 12 rats of group I, 13 of group II, and 7 of group III were alive yielding 85.7, 92.8, and 50% overall survival rates, P < 0.05 groups I and II versus group III. In series III, 72 non-anticoagulated rats were treated identically to series II and examined morphologically at 1, 7, 28, and 56 days. Twenty-eight days after surgery FS alone or the FS-collagen compound was completely absorbed without foreign body reaction or extensive fibrosis. It was concluded that FS-soaked porcine collagen strongly adheres to bleeding liver surfaces and may enhance survival after complex liver surgery without causing inflammatory or allogenic reactions.