Application Of Fibrin Sealant Research Articles

Application of Fibrin Sealant in the Treatment of Root Coverage Procedure - A Case Report

Application of Fibrin Sealant in the Treatment of Root Coverage Procedure - A Case Report

The benefit of tissue sealant on urethroplasty in hypospadias patients - A systematic review and meta-analysis.

Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term ("glue" OR "sealants" OR "tissue glue" OR "tissue sealant" OR "tissue adhesive") AND ("hypospadias" OR "urethrocutaneous fistula" OR "urethral repair" OR "urethroplasty" OR "hypospadiology"). Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.

Subfascial drains are safe and effective in preventing postoperative cerebrospinal fluid leaks after intradural spine tumor surgery.

Delayed cerebrospinal fluid (CSF) leaks are a known complication following intradural spinal tumor surgery. The placement of subfascial drains in these patients undergoing requisite intradural surgery is controversial. Here, we demonstrated that placing a subfascial drain on partial suction for 48 h, with early ambulation, proved to be safe and effective in preventing early/delayed recurrent CSF fistulas. Medical records of 17 patients undergoing surgery for intradural spinal tumors over a 30-month were reviewed. All patients underwent intradural tumor resection followed by primary dural closure, placement of Gelfoam in a non-compressive fashion, application of fibrin sealant, and utilization of a subfascial drain placed on partial suction for 48 h postoperatively. Patients are mobilized the morning following surgery. We tracked the incidence of postoperative recurrent CSF leaks, over drainage, infection, wound dehiscence, pseudo meningocele formation, and the reoperation rate. For the 17 patients, our programmed average utilization of subfascial drains was 48 h. Moreover, the average drain output was 165 mL. Over the 1-year follow-up period, no patient developed a recurrent early/ delayed CSF leak, there were no wound complications, nor need for revision surgery. Utilizing subfascial drains on partial suction following the resection of intradural spinal tumors with primary dural closure proved to be safe and effective.

296. FIBRIN SEALANT FOR THE PREVENTION OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: INTERIM REPORT OF A PROSPECTIVE, PHASE III, RANDOMIZED CONTROLLED STUDY

Abstract Purpose Anastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy. Methods In this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5 mL Bioseal applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively. Result From February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively. Conclusion The application of Bioseal intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.

Fibrin sealant for the prevention of anastomotic leakage after esophagectomy for esophageal or esophagogastric junction cancer: interim report of a prospective, phase III, randomized controlled study

PurposeAnastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy.MethodsIn this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5ml FS applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively.ResultFrom February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively.ConclusionThe application of FS intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.Trial registrationThis trial was registered at ClinicalTrials.gov (NCT03847857) on February 19th, 2019.

The safety and efficacy of fibrin sealant for thyroidectomy: a systematic review and meta-analysis of randomized controlled trials.

Fibrin sealants have recently been thoroughly studied in several surgical specialties; however, results are conflicting. We aimed to examine the safety and efficacy of fibrin sealant patients having thyroidectomies. A thorough, systematic literature search was carried out using the terms thyroidectomy and fibrin sealant using PubMed, Cochrane Library, and Clinicaltrials.gov on December 25, 2022. The primary outcome of interest in this review was the amount of drainage, whereas hospitalization, the length of drain retention, and temporary dysphonia were secondary outcomes. Our meta-analysis (n = 249) showed that application of fibrin sealant is associated with lesser total drainage [SMD -2.76 (-4.83, -0.69); P = 0.009; I2 97%], but not with retention time of drainage [SMD -2.35 (-4.71, 0.01); P = 0.05; I2 98%], hospitalization time [SMD -1.65 (-3.70, 0.41); P = 0.12; I2 97%], and transient dysphonia [RR 1.01 (0.27, 3.82); P = 0.99; I2 0%]. The systematic review found that the use of fibrin sealant in thyroid surgery is positive in total volume drainage but not with the retention time of drainage, hospitalization time, and transient dysphonia. It is notable to remember that this interpretation is complicated by uneven, occasionally subpar technique and trial reporting, according to this systematic review's findings.

Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery.

Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery.

A Systematic Review of the Efficacy of Haemostatic Interventions in Primary Cleft Palate Repair.

To evaluate the effectiveness of adrenaline infiltration, topical adrenaline, systemic tranexamic acid, fibrin tissue sealants and alginate-based topical coagulants at reducing blood loss and post-operative bleeding in primary cleft palate repair. Systematic review according to PRISMA-P guidelines, using Covidence systematic review software to facilitate 3-stage screening and data extraction by two reviewers. Academic cleft surgery center. Any peri-operative intervention to reduce intra-operative and post-operative bleeding. Estimated blood loss, rate of post-operative bleeding, rate of return to theatre for haemostasis. Sixteen relevant studies were identified, with a total of 1469 study participants. Nine studies examined efficacy of infiltrating vasoconstrictors and all concluded that 1:100,000-1:400,000 adrenaline infiltration reduced intra-operative blood loss, to the range of 12-60 ml. Secondary bleeding and re-operation for haemostasis were uncommon. Tranexamic acid was studied in five randomised controlled trials, two of which demonstrated a significant reduction in blood loss compared to a control group. Use of fibrin and gelatin sponge products was examined in 3 studies, all of which reported no or minimal bleeding, but did not have quantifiable outcome measures. Infiltration with vasoconstricting agents, administration of systemic tranexamic acid and application of fibrin sealants have a well-studied and favorable safety profile in pediatric cases, and likely contribute to the relatively low incidence of post-operative bleeding and intra-operative blood loss in primary cleft palate repair.

MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL Tejas Mistry, Mrinal Pahwa, and Vipin Tyagi Tejas MistryTejas Mistry More articles by this author , Mrinal PahwaMrinal Pahwa More articles by this author , and Vipin TyagiVipin Tyagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative bleeding is one of the major complications associated with vascular anastomosis in kidney transplant. One of the novel measures for its prevention is the application of fibrin sealant over renal vein anastomotic site after completing the suturing. Till date, there is no study published to evaluate its role for this purpose. Hence, the current study was undertaken to evaluate the hemostatic role of fibrin sealant on renal vein anastomosis during renal transplant surgery. METHODS: This was a prospective randomised study (FORVEIN stands for Fibrin sealant On Renal VEIN anastomosis) done in our institute from April 2017 to March 2022. Approval of the study protocol was obtained from the Institutional review board. Total 307 renal allograft recipients (with age 18 to 60 years) who had undergone live related renal transplant at our center were included in the study as per the inclusion and exclusion criteria. Patients were randomised according to computer generated random numbers into test group in whom fibrin sealant was to be used and control group in whom saline was to be applied. Time to hemostasis was measured from removal of venous clamps to complete hemostasis at the site and was compared between both the groups. Data regarding age, sex, body mass index, number of vessels was recorded for subgroup analysis. Statistical analysis was done using t-test and MedCalc software (Version 20, Ostend, Belgium). RESULTS: Out of 307 cases, fibrin sealant was applied in 129 cases, whereas 178 cases received saline application. There was significant difference between mean time to hemostasis in fibrin sealant group (7.2min) and in control group (10.2min) (p<0.0001). On subgroup analysis, it was found that hemostasis time was significantly lower in fibrin sealant group for multiple vessels, obese and complex cases with multiple factors (p=0.02, p=0.005, p=0.04 respectively). No case of venous thrombosis was observed. CONCLUSIONS: Application of fibrin sealant over renal vein anastomosis during renal transplant surgery is safe and effective for achieving early hemostasis. Larger multi-centric randomised controlled studies would be needed for its generalized extrapolation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e432 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tejas Mistry More articles by this author Mrinal Pahwa More articles by this author Vipin Tyagi More articles by this author Expand All Advertisement PDF downloadLoading ...

Mechanical Evaluation of Commercially Available Fibrin Sealants for Cartilage Repair.

Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of <8 and <30 kPa, respectively. There were no differences in COF between the sealants when tested alone or with minced cartilage. A double application of fibrin sealant did not alter the mechanical properties compared with a single application of fibrin sealant. Fibrin sealant adhesive properties are not affected by the sealant type studied or the number of applications in a bovine cartilage-bone model. Fibrin sealant tribological properties are not affected by sealant type or the addition of minced cartilage. The adhesive properties of Tisseel and Vistaseal were less than those desired for the in vivo fixation of cartilage repair implants. These findings motivate the development of an improved cartilage-specific adhesive for cartilage repair applications.

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts.

Single-step all-arthroscopic techniques have gained popularity recently in the treatment of osteochondral lesions of the talus (OLT). Concomitant subchondral bone defects led surgeons to add autologous bone grafting to the surgical procedures. Collagen scaffolds have been used widely for stabilization of the reconstruction and regeneration of the articular surface. To compare single-step all-arthroscopic treatment of OLT consisting of debridement, microfracture, autologous bone grafting, and application of fibrin sealant in 2 patient groups: with versus without collagen scaffold. Cohort study; Level of evidence, 3. Included were 94 patients who underwent single-step all-arthroscopic treatment for OLT. Autologous bone grafting was applied to 48 patients (BG group), while autologous bone grafting plus collagen scaffold was applied to 46 patients (BG+S group). A fibrin sealant was applied to both groups. Clinical outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the visual analog scale (VAS) for pain. Radiological outcomes were evaluated with the magnetic resonance observation of cartilage repair tissue score. The mean follow-up time was 69.3 ± 20.7 months. Patients in both groups showed statistically significant improvement in pre- to postoperative AOFAS and VAS scores (P < .001 for all), with no difference between groups in AOFAS and VAS score improvement. Complete healing with or without hypertrophy was achieved in 42 patients in the BG group (87.5%) and 38 patients in the BG+S group (82.6%). The treatment of bone lesions in OLT may be the ultimate goal to obtain successful outcomes, in which case using a collagen scaffold besides grafting may not affect clinical and radiological outcomes.

Topical hemostatic application on staple line in laparoscopic sleeve gastrectomy: a single-surgeon experience.

Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure with low complication rates. Several hemostatic agents have been used to reduce staple line bleeding, but its impact is unclear. The primary endpoint of this study was to compare the early (30-day) complications comparing oxidized regenerated cellulose (ORC) and fibrin sealant (FS) application on the staple line. The secondary endpoints were to compare the need for postoperative blood transfusion, postoperative blood work values of hemoglobin (Hb), white blood cell (WBC), C-reactive protein (CRP), drain output volume and hospital length of stay (LOS). A retrospective analysis of all patients who underwent LSG between January and October 2021 was performed. Subjects were divided into two groups according to the use of ORC versus FS on the staple line. Early postoperative complications, Hb level, WBC count, and drain output volume were compared between groups. A total number of 77 patients were included: 27 in the ORC-group and 50 in the FS-group. No major complication was recorded in both groups. There was no significant difference in the need for blood transfusion, Hb value, and drain output volume on postoperative day (POD) 1 and 2. There was a significantly higher WBC count in the ORC-group on POD 1 and 2. There was no difference in hospital LOS between the groups. The use of FS and ORC was associated with a comparable low rate of bleeding. ORC causes an increased WBC count postoperatively, but this showed no clinical relevance.

Coating of Intestinal Anastomoses for Prevention of Postoperative Leakage: A Systematic Review and Meta-Analysis.

BackgroundFor several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic review and meta-analysis were conducted.MethodPubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien–Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsOverall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis (I2 < 50%), patients with coated intestinal anastomoses presented significantly lower AL rates (OR = 0.37; 95% CI 0.27–0.52; p < 0.00001), reoperation rates (OR, 0.21; 95% CI, 0.10–0.47; p = 0.0001), and Clavien–Dindo major complication rates (OR, 0.54; 95% CI, 0.35–0.84; p = 0.006) in comparison to controls, with results remaining stable in sensitivity and subgroup analyses (stratified by study design, age group, intervention used, location of anastomoses, and indication for surgery). The length of hospitalization was significantly shorter in the intervention group (weighted mean difference (WMD), −1.96; 95% CI, −3.21, −0.71; p = 0.002) using random-effects meta-analysis (I2 ≥ 50%), especially for patients with surgery of upper gastrointestinal malignancy (WMD, −4.94; 95% CI, −7.98, −1.90; p = 0.001).ConclusionThe application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.

The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis

Background: Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications5.However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. Methods: The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term ("glue" OR "sealants" OR "tissue glue" OR "tissue sealant" OR "tissue adhesive") AND ("hypospadias" OR "urethrocutaneous fistula" OR "urethral repair" OR "urethroplasty" OR "hypospadiology"). Result: Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. UCF complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. Conclusions: This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.

Effectiveness of fibrin sealant after pulmonary resection: a propensity score matching analysis.

Alveolar air leak is a common and troublesome complication after pulmonary resection because it can lead to longer hospital stay and chest tube drainage time. As fibrin sealants are useful in the management of alveolar air leaks, we evaluated their benefit in patients undergoing pulmonary resection. This retrospective study included patients who underwent pulmonary resection in our hospital between 2016 and 2021. We grouped patients on the basis of whether fibrin sealant was used during surgery and compared outcomes between those with (fibrin sealant group) and without (control group) sealant use after propensity score matching (1 : 1). During the study period, 375 patients underwent pulmonary resection; of these, fibrin sealant was applied at the staple line in 107 patients (fibrin sealant group), whereas sealant was not used in 268 patients (control group). After propensity score matching (1 : 1), there were 95 patients in both groups. There were no differences between the two groups in duration of chest tube drainage (3 days vs. 3 days; p = 0.753) or length of hospital stay (5 days vs. 4 days; p = 0.499). However, the sealant group showed higher cost of hospitalization (USD 4,360 vs. 3,614; p < 0.001). Multivariate analysis for identifying risk factors of persistent air leak revealed that male sex and chronic obstructive pulmonary disease were associated. Our results indicate that application of fibrin sealant was not effective in reducing length of hospital stay, duration of chest drains or air leakage.

Fibrin glues — the current state of knowledge

Fibrin glue is a two-component biological material obtained as result of extemporaneous preparation of equal volumes of fibrinogen concentrate and thrombin solution. On a mass scale fibrin glue is acquired either commercially by way of plas ma fractionation, or in laboratory setting by chemical precipitation or cryoprecipitate method. Fibrin glue mimics the blood clotting mechanism. Thrombin converts fibrinogen into fibrin clot, which — due to hemostatic properties contributes to sealing the wound and supporting damaged tissue regeneration. The clot adheres to adjacent tissues, and the structure becomes a natural scaffold for precursor and effector cells as well as hematopoietic growth factors that actively promote wound healing. Fibrin glue has found application as wound sealant mostly for patients with coagulation factor deficiencies and problems with spontaneous wound repair. The material is commonly used i.a. in general surgery (wound sealing or vascular suture ), regenerative surgery (bone implant fixation), plastic surgery (better cosmetic results, prevention of unaesthetic scarring), skin tissue regeneration for burn injury, neurosurgery (prevention of cerebrospinal fluid leak and nerve repair), cardiovascular surgery and stomatology. Fibrin glue embedded with drugs, antibiotics, cytostatic agents or stem cells, may increase the effectiveness of therapy and facilitate targeted delivery of active substances for localized drug release. The aim of the article is to present the current state of knowledge on the methods of preparation and application of fibrin sealants as well as on other possible use in various fields of medicine.

A Prospective, Randomized, Double-blind Trial of the Use of Fibrin Sealant for the Bilateral Sagittal Split Ramus Osteotomy (BSSRO)

Background: Bilateral sagittal split ramus osteotomy surgery (BSSRO) was done by splitting the mandibular ramus and re-positioning the Mandibular arch to achieve the proper dental occlusion. The common postoperative complication is bleeding and hematoma. The suction drains were used to prevent such problems. Fibrin sealant has been used in several surgical procedures to aid in hemostasis. Objective: The present study aims to study whether the intraoperative application of Fibrin sealant can reduce the amount of postoperative drainage in BSSRO operation. Materials and Methods: We performed a prospective, randomized, double-blind study of 20 patients who underwent BSSRO surgery or BSSRO with combined Le fort I and Genioplasty surgery between September 2018 and October 2019, so the total samples were 40 operative sides. Patients were randomly divided into one of two groups based on whether they received intraoperative Fibrin sealant. The volume of the wound drainage was recorded every 24 hours for 72 hours. Results: The amount of postoperative drainage of the first and second 24 hours was not significantly different. The difference in the pain score and satisfaction score between the two groups were also the same. Conclusion: The intraoperative fibrin sealant did not have a significant benefit in BSSRO to reduce bleeding. Retaining the vacuum drainage only is sufficient and cost-effective to prevent hematoma in BSSRO. Keywords: Fibrin glue; Fibrin sealant; BSSRO; Hunsuck; Hematoma

Intraoperative anaphylaxis due to aprotinin after local application of fibrin sealant diagnosed by skin tests and basophil activation tests: a case report

BackgroundThere are few cases of anaphylaxis after local application of fibrin sealant diagnosed by skin tests.Case presentationA 49-year-old woman underwent partial lung resection under general anesthesia. Anesthesia was induced uneventfully. Shortly after applying absorbable suture reinforcement felt that contained fibrin sealant, her systolic blood pressure fell to approximately 70 mmHg, along with facial flushing. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase levels. Three months after the event, skin tests were performed with all agents and were positive only for fibrin sealant vial no. 2, whose main component is aprotinin. Subsequently, basophil activation tests using fibrin sealant vial no. 2 and pure aprotinin demonstrated that the causative agent was likely aprotinin.ConclusionsWe diagnosed aprotinin-induced anaphylaxis using skin tests and basophil activation tests. The occurrence of anaphylaxis should be considered when changes in vital signs are observed after the use of fibrin sealant.

Application of platelet-rich plasma in rectovaginal fistulas in the patients with ulcerative colitis

BackgroundThere is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC).Patients and methodsMedical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients.ResultsComplete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months.ConclusionsThe application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.

PSU6 Cost-Eectiveness Analysis of the Application of Porcine-Derived Fibrin Sealant for the Treatment of IntraOperative Cerebrospinal Fluid Leak in China

Cerebrospinal fluid leak (CSFL) after craniotomy may incur serious sequelae, such as meningitis and hematoma. A porcine-derived fibrin sealant (FS) has been introduced and used in conjunction with sutures for dural closure at hospitals in China. This study aimed to evaluate the cost-effectiveness of using FS for the treatment of intraoperative CSFL. A decision tree was constructed in R 3.6.3 to assess the cost-effectiveness of using FS with sutures compared to sutures alone for treatment of intra-operative CSFL from the perspective of the Chinese healthcare system. Efficacy and safety information were extracted from a randomized, single-blinded clinical trial comparing the two interventions (NCT03110783). Costs were obtained through the analysis of real-world databases of provincial procurement costs. All costs were converted to USD based on the published exchange rate on 12/23/2020 (6.5400 RMB to 1 USD). The effectiveness of the interventions was measured both as the success rate of CSFL treatment and as the reduction of postoperative complications. The CSFL treatment success rate was higher in patients using FS with sutures than using sutures alone (97.8% vs. 49.2%). Postoperative complication rates were lower for the group with FS (9.5% vs. 14.5%). Higher costs for using FS ($248.5 vs. $7.7) were offset by savings from higher treatment success rate and lower post-operative complication rates. The FS group saved $375.0 in additional CSFL repairs compared to the sutures group ($18.1 vs. $393.0), and $66.7 in treatment for complications ($131.9 vs. $198.6). Total costs per patient were lower by $200.8 in the FS plus suture group ($398.5 vs. $599.3). The cost effectiveness analysis demonstrated that using FS with sutures could provide improved clinical outcomes at reduced costs. FS used in combination with sutures was the dominant strategy vs sutures alone for the treatment of intra-operative CSFL.