The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses.

Yasmin Abu-Ghanem,Issac Kaver,Jacob Ramon,Dorit E Zilberman,Zohar Dotan

doi:10.1038/srep32376

Yasmin Abu-Ghanem, Issac Kaver + Show 3 more

Open Access

https://doi.org/10.1038/srep32376

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Journal: Scientific Reports	Publication Date: Aug 30, 2016
Citations: 9	License type: CC BY 4.0

Affiliation: Sheba Medical Center, Tel Aviv University

Abstract

Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004–2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications.

Highlights

Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice
With increasing experience, the application of laparoscopic PN (LPN) has extended to tumors invading more deeply into the renal parenchyma up to the collecting system or renal sinus[2,3]
With many reports suggesting that allogeneic blood transfusion is associated with an adverse outcome[5,6,7], several attempts have been made to reduce the risk of bleeding

Summary

Introduction

Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). The use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. As laparoscopic surgeons approach more difficult tumors, the complexity of tumors requiring Open PN (OPN) is even further magnified In both approaches, the excision of such deeply infiltrating tumors routinely necessitates division of major intrarenal vessels and precise entry into the collecting system to ensure an adequate margin of resection. The excision of such deeply infiltrating tumors routinely necessitates division of major intrarenal vessels and precise entry into the collecting system to ensure an adequate margin of resection Such resections are associated with significant risks of bleeding and urinary leak[3].

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