Abstract
The present study aimed to determine the impact of different sealant materials on histopathological changes to the liver surface after liver resection. Thirty-six landrace pigs underwent left anatomical hemihepatectomy and were assigned to a histopathological control group (HPC, n = 9) with no bleeding control, a clinically simulated control group (CSC, n = 9) with no sealant but bipolar cauterization and oversewing of the liver surface, and two treatment groups (n = 9 each) with a collagen-based sealant (CBS) or a fibrinogen-based sealant (FBS) on resection surface. After postoperative day 6, tissue samples were histologically examined. There were no significant differences in preoperative parameters between the groups. Fibrin production was higher in sealant groups compared with the HPC and CSC groups (both p < 0.001). Hepatocellular regeneration in sealant groups was higher than in both control groups. A significantly higher regeneration was seen in the FBS group. Use of sealants increased the degree of fibrin exudation at the resection plane. Increased hepatocellular necrosis was seen in the CBS group compared with the FBS group. The posthepatectomy hepatocellular regeneration rate was higher in the FBS group compared with the CBS group. Randomized studies are needed to assess the impact of sealants on posthepatectomy liver regeneration in the clinical setting.
Highlights
Liver resection is the treatment of choice for patients with primary and secondary liver malignancies[1,2]
The relative bleeding time was significantly lower in the fibrin-based sealant (FBS) group compared with the collagen-based sealant (CBS) group (p = 0.022)
According to post-hoc analysis there were no significant differences in relative bleeding time between FBS (p = 0.478) or CBS (p = 0.233) groups and the CSC group
Summary
Liver resection is the treatment of choice for patients with primary and secondary liver malignancies[1,2]. The most commonly used dressing materials in hepatobiliary surgery are fibrin-impregnated and collagen-based fleeces[8]. Some experimental studies have compared the impact of sealants with other coagulation techniques and have demonstrated that sealants reduce necrosis[9], fluid collection, and abscess formation[10], and increase regeneration of the resection plane after liver resection[11]. To our knowledge, the postoperative histopathological effects of different sealant materials on the liver surface after hepatectomy have not been compared in detail so far. The aim of the present experimental study is to provide evidence-based data to determine the histopathological interactions of different sealants with the liver surface following liver resection. We assessed the postoperative histopathological effects of commonly used topical hemostats – a fibrin-based sealant (FBS) and a collagen-based sealant (CBS) – on resected liver surfaces in a swine model. Variables Weight (kg) Preoperative ALT (U/L) Preoperative AST (U/L) Preoperative total bilirubin (mg/dL) Preoperative albumin (g/L) Preoperative INR Pre-resection heart rate Pre-resection mean arterial pressure (mmHg) Pre-resection hepatic arterial flow (ml/min) Pre-resection portal vein flow (ml/min) Relative bleeding time (sec) Absolute bleeding time (sec) Blood loss (g) Postoperative ALT (U/L) Postoperative AST (U/L) Postoperative total bilirubin (mg/dL) Postoperative albumin (g/L) Postoperative INR
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