Abstract

Through innovative technologies and refinement of surgical technique over the last several decades, hepatopancreatobiliary (HPB) surgeries have become increasingly common for both malignant and benign disease. HBP surgeries often present unique challenges even for the experienced surgeon, whether due to liver cirrhosis causing portal hypertension and impairment of natural clotting abilities or a large pancreatic mass invading into nearby mesenteric vessels. Major intraoperative blood loss is still a concern and is known to be a major factor influencing morbidity and mortality. Biosurgicals are increasingly used as adjuncts to reduce blood loss during these complex procedures, but also to even reduce rates of biliary and pancreatic leaks and fistulas postoperatively. While initially biosurgical agents offered some hope to make the difference in completing a safe and effective operation, more recent and rigorous studies have failed to demonstrate reproducible benefits. This chapter reviews the use of hemostatic agents in the setting of hepatobiliary and pancreatic surgery, including for the maintenance of hemostasis and the prevention of biliary and pancreatic leaks. We also discuss what factors should be considered when choosing the correct agents for different clinical scenarios during HPB surgery.

Highlights

  • Hepatobiliary surgery has increased in frequency throughout the United States and the rest of the world over the past several decades

  • It is clear to see why substantial time and resources have been put into finding adjuncts to obtaining and maintaining hemostasis in hepatic surgery

  • While initial animal models often showed great promise in reducing intraoperative hemorrhage and postoperative bleeding complications, these benefits have generally not translated to real life clinical settings in humans

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Summary

Introduction

Hepatobiliary surgery has increased in frequency throughout the United States and the rest of the world over the past several decades. Extensive en bloc pancreatic surgeries, and major hepatic resections involving multiple liver segments are performed regularly at high volume centers with little blood loss This is in part due to increased incidence of pancreatic and hepatic malignancies requiring resection along with innovations and improvements of surgical technique such that patients once considered inoperable are able to successfully undergo extensive surgery. Given that colorectal cancer alone accounts for nearly 150,000 new cancer cases yearly in the United States [1], this quickly adds up to a significant number of patients that have the potential to receive and benefit from hepatic resection or transplantation Both morbidity and mortality have significantly decreased over the years as the number of hepatobiliary and pancreatic surgeries have increased. In these scenarios biosurgicals represent another tool for the surgeon to utilize in order to perform safe and effective surgery

Hepatic surgery
Preventing and maintaining hemostasis in hepatic surgery
Preventing biliary leak/fistula
Pancreatic surgery
Preventing and maintaining hemostasis in pancreatic surgery
Graft bleeding (after venous resection/reconstruction)
Preventing pancreatic leak/fistula
Findings
Conclusions
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