Current Status and Deficiency of Hemostasis in Surgery: A Systematic Literature Review, Including Chinese Literature.

Abstract

PHP91 Current StatuS and defiCienCy of HemoStaSiS in Surgery: a SyStematiC Literature review, inCLuding CHineSe Literature Tsao J.1, Chen X.J.2, Yue N.2 1Johnson & Johnson Medical Asia-Pacific, Singapore, 2Johnson & Johnson Medical China, Beijing, China Objectives: Perioperative bleeding sometimes results in severe consequence. An understanding of hemostasis approaches is crucial in managing the operations. This review aims to show the development of hemostasis in surgery around the world including China. MethOds: Literature in PUBMED was searched between 2009 and 2014; search terms included hemostasis and surgery; filters included human, English and clinical trials. A similar search was done in Chinese CNKI database. Searching results were carefully reviewed and studies compatible with our inclusion criteria were then selected. Results: From an initial search which yielded 99 references in PUBMED and 50 references in CNKI, 54 articles in PUBMED and 16 articles in CNKI were included in the review. Operations in 11 subjects were involved in these articles. We found that conventional hemostasis (classic technique of tying and knots, resorbable ligature) was gradually replaced by novel techniques such as bipolar tissue sealant device, ultrasound scalpel, hempclips, blue-violet light emitting diode irradiation, Ankaferd Blood Stopper, etc. Fibrin sealant, collagen hemostat and chitosan gel had important roles to be supplement. Certain drugs (tranexamic acid, Fibrinogen concentrate, hemocoagulase, etc) used perioperatively could be efficient too. On the other hand, some new techniques (vascular clips) failed to show significant benefits in some subjects (thyroid surgery). Furthermore, some techniques (bipolar coagulation) might affect the postoperative function of certain organs (ovary). While some techniques (harmonic scalpel) could save the whole cost in hospital, most could not. Information in China was similar with the world. cOnclusiOns: Some of the novel hemostasis approaches in surgery could decrease blood loss perioperatively as well as reduce operative time, hospital stay, the rate of complications and the whole cost. However, some shortcomings still exist and more correlative researches should be performed in the future.