Hemostatic Techniques Research Articles

An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

Postoperative hypocalcemia (PH) is a serious complication after total thyroidectomy. This study aimed to compare PH rates between LigaSure Small Jaw (LSJ) and clamp-and-tie hemostatic technique in patients undergoing total thyroidectomy. Four hundred twenty patients were divided into two groups: group L (210 patients) performed with LSJ and group C (210 patients) with clamp-and-tie technique. Serum ionized calcium (iCa) was measured before and 12, 24, 48, 72 hours after surgery. PH was defined as iCa lower than 4.2 mg/dL in at least two measurements. There was no significant difference between groups in sex, age, extent of surgery, pathology, and the strategy of intraoperative management of parathyroid glands (PG). The PH rate was significantly lower in group L compared to group C (22.9% vs 32.4%, P = .03). Compared to clamp-and-tie technique, LigaSure is superior to decrease PH rate after total thyroidectomy.

Ovarian function after the use of various hemostatic techniques during treatment for endometrioma: protocol for a randomized clinical trial

BackgroundLaparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma.MethodsAn open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069.DiscussionBearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used.Trial registrationClinicalTrials.gov, NTC03430609. Registered on XX.10/31/2017.ISRCTN Registry, ISRCTN11469394. Registered on XX.17/12/2017.Unique Protocol ID: U1111–1203-2508.

Effectiveness of fibrin sealant as hemostatic technique in accelerating ESD-induced ulcer healing: a retrospective study.

Healing of gastric endoscopic submucosal dissection (ESD)-induced ulcer is critical for patient recovery. During ESD treatment, submucosal incisions are made with an electrosurgical knife to accomplish en bloc resections of superficial lesions. Nevertheless, excess electrocoagulation may decrease the blood supply of ESD-induced ulcer and delay the ulcer healing. The aim of this retrospective study was to evaluate the effectiveness of conservative electrocoagulation followed by porcine fibrin sealant (FS) as a wound microvessels-protective hemostatic technique in promoting the healing of ESD-induced ulcer. A total of 332 patients with early gastric cancer (EGCs), or gastric precancerous lesion and gastric adenoma were retrospectively analyzed. Propensity score matching was used to compensate for the differences in age, gender, tumor location, resected specimen area, and pathology. One-month ulcer healing rates and delayed bleeding were compared between two matched groups (combined hemostats group and electrocautery group). A total of 115 matched pairs were created after propensity score matching. There was no difference in tumor location, specimen surface area, tumor differentiation and invasion depth between groups. The completed healing rate 1month after ESD was 44.3% in combined hemostats group and 30.4% in electrocautery group (P = 0.004). There was no difference in delayed massive bleeding rate between two groups (P = 0.300). In addition, based on the multivariate regression analysis for ulcer healing rate, the use of FS (OR, 0.348, 95% CI 0.196 - 0.617, P = 0.000) and larger specimen size (OR, 2.640, 95% CI 2.015-3.458, P = 0.000) were associated with nonhealing ulcer 1month after ESD. Applying conservative electrocoagulation followed by porcine FS as a wound microvessels-protective hemostatic technique can promote ESD-induced ulcer healing without increasing delayed bleeding.

Hemostatic Agents in Endodontic Surgery: A Randomized Controlled Pilot Study of Polytetrafluoroethylene Strips as an Adjunct to Epinephrine Impregnated Gauze Versus Aluminum Chloride

IntroductionBleeding control is an important aspect in endodontic surgery. Two hemostatic techniques were compared with regard to their efficacy to bleeding control in endodontic surgery. MethodsA randomized, 2-arm, parallel pilot study involving 30 patients with periradicular lesions was performed including the following hemostatic agents: polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze (test group, n = 15) and aluminum chloride (control, n = 15). Bleeding control was independently assessed by the surgeon and 2 blinded observers before and after application of the hemostatic agent. Bleeding control was classified either as adequate (complete bleeding control) or inadequate (incomplete bleeding control). ResultsHemostasis in both groups proved similar. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosa band (≥2 mm) suggested a risk reduction for an inadequate bleeding control up to 79% (odds ratio = 0.21, P > .05). ConclusionsNo differences in the efficacy of bleeding control were observed between polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze and aluminum chloride.

The Impact on Ovarian Reserve of Different Hemostasis Methods in Laparoscopic Cystectomy: A Systematic Review and Meta-analysis.

The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy. The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles. We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots. Twelve trials involving 1,047 patients were evaluated. Laparoscopic suture was superior to bipolar coagulation when evaluating serum AMH and AFC, in the 1st, 3rd, 6th and 12th month after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy. We recommend suture for hemostasis during laparoscopic cystectomy.

Study to Evaluate the Safety and Efficacy of HLBLS-200 in Patients Requiring Hemostatic Technique

Study to Evaluate the Safety and Efficacy of HLBLS-200 in Patients Requiring Hemostatic Technique

Use of a vessel-sealing device versus conventional hemostatic techniques in dogs undergoing thyroidectomy because of suspected thyroid carcinoma.

To compare use of a vessel-sealing device (VSD) versus conventional hemostatic techniques in dogs undergoing thyroidectomy because of suspected thyroid carcinoma. Retrospective cohort study. 42 client-owned dogs undergoing thyroidectomy because of suspected thyroid carcinoma. Medical records of dogs treated at 4 referral centers from 2010 through 2016 were reviewed, and information was obtained on patient signalment, surgical technique, tumor-specific factors, and operative duration. Postoperative hospitalization time and complications were compared between dogs grouped on the basis of hemostatic technique. Thyroidectomy was performed with a VSD in 23 dogs and with conventional hemostatic techniques (ie, ligatures, hemoclips, or electrocautery) in 19 dogs. Hemostatic technique (ie, use of a VSD vs conventional hemostatic techniques) was the only factor significantly associated with operative duration (median time, 28 vs 41 minutes). Postoperative hospitalization times and complication rates did not differ between groups. Results suggested that use of a VSD, rather than conventional hemostatic techniques, in dogs undergoing thyroidectomy because of suspected thyroid carcinoma resulted in shorter operative times without significantly affecting complication rates or postoperative hospitalization times.

Tourniquet and adrenaline use in hypospadias surgery: a survey on the current practice in Turkey.

Aim of the study is to determine the hemostatic techniques among pediatric urologists in Turkey. Questionnaire forms were sent to 459 pediatric urologist by e-mail. Ninety eight of 459 participants answered the questionnaire forms. Eighty-one (84.4%) of the participants were using tourniquet. The participants who didn't use tourniquet stated their justifications as follows: lack of need (n=10: 66.7%), development of edema, ischemia, delay of wound-graft healing and fistula risk (n=5: 33.3%). The indications of tourniquet use were stated as follows: penile (91.4%: n=74), distal (72.8%: n=59), penoscrotal (55.6%: n=45) hypospadias; fistula repair (33.3%: n=27), cripple hypospadias (33.3%: n=27), repair with flaps (30.9%: n=25), repair with grafts (27.2%: n=22), and isolated penile curvature (21%: n=17). Most commonly used tourniquet material (49.9%) was latex glove. Erection test was applied by 43.8% of participants. Scalp vein set was the most commonly (54.8%) used injector during erection test. Only 9.4% of participants were using adrenaline. Adrenaline dosages used at 1/100.000 dilution by 55.6%, lidocaine with 1/100.000 adrenaline by 44.4% of participants. Beside a few experimental ones there is a paucity of studies that can serve as a guideline for using these techniques in the literature. There is a necessity of realizing prospective, randomized studies with long-term follow up to evidence that postoperative complications could develop secondary to hemostatic techniques and also to facilitate safe use of these techniques.

Laparoscopic Myomectomy with Temporary Bilateral Uterine Artery and Utero-Ovarian Vessels Occlusion Compared with Traditional Surgery for Uterine Fibroids: Blood Loss and Recurrence

Aim: To determine the optimal hemostatic technique for laparoscopic myomectomy (LM) by comparing temporary uterine artery blockage alone or combined with blockage of the utero-ovarian vessels. Patients: Women with symptomatic uterine myoma attending the Department of Obstetrics and Gynecology in Jinhua Municipal Central Hospital. Method: A total of 200 patients with symptomatic uterine fibroids were randomly divided into Group A (n = 65), Group B (n = 67) and Group C (n = 68). At the beginning of the procedure, 6 U of vasopressin was injected into the myometrium of all women. LM was performed in Group A; temporary bilateral uterine artery occlusion and myomectomy were performed in Group B and temporary bilateral uterine artery and utero-ovarian vessel occlusion was performed in Group C. We then evaluated operative time, perioperative bleeding, follow-up relief of menorrhagia, and the recurrence of fibroids. Results: General characteristics of the patients were similar across all 3 groups. All patients underwent successful laparoscopic operation and none of the cases needed to be converted to laparotomy; there were no intraoperative complications. There was no significant difference in the operative time between groups (p = 0.332 and p = 0.346 for single-myoma and multiple-myoma respectively), and for both single and multiple-myoma groups, the blood loss was significantly lower in Group C than Groups A and B (p < 0.001). There were no differences in the recurrence rate and menorrhagia symptom relief outcomes when ­compared across the 3 groups at the 30-month follow-up (p = 0.953 and p = 0.841, respectively). At final follow-up, the pregnancy rate of the sexually active patients without contraception was not statistically significant (p = 0.958). The fertility index of anti-Mullerian hormone showed no statistical difference between groups preoperatively or at 2 days, 3 months, 6 months, and 1 year postoperatively (p = 0.998, p = 0.965, p = 0.999, p = 0.994 and p = 0.993, respectively). Conclusion: LM with temporary bilateral uterine artery and utero-ovarian vessels occlusion has the advantages of less intraoperative bleeding compared with LM and laparoscopic transient uterine artery ligation and does not increase the mean operative time.

Clinical effect of the ultrasound monitoring curettage and balloon placement hemostas in the treatment of cesarean scar pregnancy

Objective To investigate the clinical effect of the ultrasound monitoring curettage and balloon placement hemostas in the treatment of cesarean scar pregnancy. Methods From May 2014 to May 2016, the clinical data of 13 cases with cesarean scar pregnancy in the People's Hospital of Hechuan District were retrospectively analyzed. All 13 cases received methotrexate, ultrasonic monitoring curettage and balloon placement hemostas therapy were observed. Results Of 13 cases, 11 cases were cured, including 9 cases of gestational sac endogenous type and mass type 2 cases. The intraoperative bleeding was (167±101)mL, the operation time was (12.3±6.3)min, the blood HCG dropped to normal time was (37.2±13.8)d. There were 2 cases of failure, all of which were exogenous gestational sac . Conclusion Utrasound monitoring curettage combined with balloon compression is a simple, safe and economical method for the treatment of endogenous type of caesarean scar pregnancy, which is worthy of clinical promotion. Key words: Ultrasonography; Cesarean section; Pregnancy, ectopic; Dilatation and curettage; Hemostatic techniques; Chorionic gonadotropin

Response.

We thank Wagner and Gittard1Wagner D.R. Gittard S. Hemostatic powder facts.VideoGIE. 2019; 4: 185Abstract Full Text Full Text PDF Scopus (1) Google Scholar for the opportunity to clarify our statement about known adverse events associated with hemostatic powder. Our VideoGIE abstract details the step-by-step use of hemostatic powder highlighting a case of a bleeding GI stromal tumor recalcitrant to other endoscopic hemostatic techniques, successfully bridged to definitive surgical therapy.2Storm A.C. Sawas T. Higgins T. et al.Step-by-step use of hemostatic powder: treatment of a bleeding GI stromal tumor.VideoGIE. 2019; 4: 5-6Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The commenters are correct in stating that colonic obstruction has not been reported for the device used in the video (Hemospray; Cook, Winston-Salem, NC, USA). Bowel obstruction has been reported with other surgical hemostatic matrices,3Clapp B. Santillan A. Small bowel obstruction after FloSeal use.JSLS. 2011; 15: 361-364Crossref PubMed Scopus (21) Google Scholar and we, therefore, believe it remains a theoretic risk to consider in the treatment of patients who have recently undergone hemostatic powder treatment. To mitigate this risk, the company recommends limiting the number of devices to 3, or 60 grams of bentonite powder in total, within a single session. It is worth mentioning that 1 study of the device, sometimes with the use of doses more than twice the currently recommended dose, did not report any occurrence of bowel obstruction.4Sung J.J. Luo D. Wu J.C. et al.Early clinical experience of the safety and effectiveness of hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding.Endoscopy. 2011; 43: 291-295Crossref PubMed Scopus (177) Google Scholar As we previously mentioned, biliary obstruction and perforation are adverse events previously reported with the use of hemostatic powder.5Moosavi S. Chen Y.I. Barkun A.N. TC-325 application leading to transient obstruction of a postsphincterotomy biliary orifice.Endoscopy. 2013; 45: E130Crossref PubMed Scopus (19) Google Scholar, 6Smith L.A. Morris A.J. Stanley A.J. The use of hemospray in portal hypertensive bleeding: a case series.J Hepatol. 2014; 60: 457-460Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 7Yau A.H. Ou G. Galorport C. et al.Safety and efficacy of hemospray in upper gastrointestinal bleeding.Can J Gastroenterol Hepatol. 2014; 28: 72-76Crossref PubMed Scopus (60) Google Scholar, 8Hagel A.F. Albrecht H. Nagel A. et al.The application of hemospray in gastrointestinal bleeding during emergency endoscopy.Gastro Res Pract Epub. 2017 Jan 23; Google Scholar As such, we stand by our warning for the theoretic risk of cholangitis, particularly if hemostatic powder is used in or near the biliary orifice, and would advise caution when considering use of the device in these areas. Hemostatic powder factsVideoGIEVol. 4Issue 4PreviewWe read with interest the VideoGIE article by Storm et al1 from Mayo Clinic Rochester. The case shows the unique benefits of Hemospray in offering durable hemostasis for bleeding that is resistant to conventional treatments, even in the setting of dual antiplatelet therapy. We commend the authors for their persistence in providing a positive outcome for this patient. However, we noted several errors that should be corrected because they do not accurately reflect the potential adverse events that may result from Hemospray treatment. Full-Text PDF Open Access

Abstract P2-14-24: Argon scalpel in the surgical treatment of breast cancer

Abstract Summary: Surgery is a key part of the treatment of breast cancer. The adoption of electric scalpel began to be used in breast surgeries in 1970 and this equipment uses high frequency electric current to create the following effects: cutting, coagulation or mixing of the two. Data show a decrease in the intraoperative bleeding, however, can also increase complications, such as seroma and thermal lesions in the surgical flaps. A new technique that could be used is the coagulation with argon plasma which is a method of non-contact thermal hemostasis. Objectives: to compare the electric scalpel with the scalpel by coagulation with argon plasma about aspects surgical and pathological. Methods: this is a prospective cohort study in which 60 patients with breast cancer were selected at the Discipline of Breast Diseases of the Department of Gynecology of the Federal University of São Paulo (UNIFESP) at any clinical stage where the surgical treatment was indicated, from March 2014 to August 2014. The patients were consecutively selected and randomized into two groups: electric scalpel surgery (ES) and argon plasma coagulation surgery (APC). Inclusion criteria were: 18 to 90 years old patients with breast cancer at any clinical stage where surgical (conservative or radical) treatment was indicated. Intraoperative bleeding was assessed by measuring the weights of the compresses. The patients who underwent surgery were evaluated at 7, 14 and 30 postoperative days. In these returns, the appearance of the surgical wound, the presence and amount of seroma (in mL), hematoma or infection were analyzed. Surgical site infection was considered when there was erythema, increased local or systemic temperature, pain, suture dehiscence or presence of purulent exudate. The surgical specimen was studied in the Department of Pathological Anatomy of UNIFESP. The pathological analysis as recommended by the WHO and particular evaluations were carried out in order to observe the extent and degree of the thermal effect produced in surgical specimens by the two hemostatic techniques (ES and APC). Results: The mean age of the patients was 56.0 years for the ES group and 54.9 for the APC. There was no significant difference between the groups regarding intraoperative bleeding. However, a statistically significant difference was observed when the days with drain were compared in the postoperative period, with a mean of 10.1 days for the SE group and 7.1 days for the APC group. The study demonstrated that the APC group had a significant greater thermal effect on the margins of the surgical specimen. Table 1.Thermal effect on the margins of the surgical specimens by study group (p=0.032)Thermic EffectEletric N (%)Argon N (%)Total N (%)Absent7 (23.3)0 (0)7 (11.7)G110 (33.3)12 (40.0)22 (36.4)G211 (36.7)13 (43.3)24 (40.0)G32 (6.7)5 (16.7)7 (11.7) Conclusions: the use of argon scalpel, when compared to the electric scalpel, allowed hemostasis to be performed adequately without altering the rates of bleeding, surgical time and postoperative complications, and reduced the number of days with the drain. The thermal effect on the surgical specimen was significant greater with the argon scalpel. Citation Format: Giordano R, Bromberg S, Elias S, Nazário A, Waitzberg A, Sá R, Facina G. Argon scalpel in the surgical treatment of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-24.

Efficacy of Therapeutic Endoscopy for Gastrointestinal Lesion (GI): A network meta-analysis.

Objective:Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this systematic review was to compare the different modalities of endoscopic therapy for GI bleeding.Methods:Studies were identified by searching electronic databases MEDLINE. We selected all available clinical studies published after 2000 that assessed efficacy and/or safety of different endoscopic hemostatic techniques in treating GI bleeding. The outcomes evaluated included initial hemostasis, rebleeding rate, and 30-day all-cause mortality. Network meta-analyses were performed to summarize the treatment effects.Results:Total 20 studies involving 1845 patients were evaluated. Ten different treatment categories including mechanic, ablative, injection, and combined therapy were compared in our analysis in terms of their efficacy in stopping bleeding and complications. Band ligation [rate: 0.757; 95% Credible Interval (0.565, 0.887)] and injection therapy [rate: 0.891; 95% CI (0.791, 0.944)] had inferior efficacy in attaining initial hemostasis compared to others. Combined therapy of band ligation and HPC and hemoclip may represent the best options for preventing rebleeding and mortality respectively. No significant difference was found among other treatments in terms of complications.Conclusions:We recommend the application of hemoclips in treating GI bleeding due to its high hemostasis efficacy and low risk of 30-day mortality.

Compared to Conventional Dressing Techniques, Tranexamic Acid Injection Provide Better Surgical Outcomes in Spinal Fusion Surgery

The use of mechanical and chemical hemostatic control techniques in spinal fusion surgery is common in Indonesia. However, there has been no study comparing the two in a single clinical trials. This study aims to find out which best of tranexamic acid injection, a bulky compression dressing and a standard dressing in providing surgical outcomes in spinal fusion surgery. Thirty patients were grouped into three, 10 patients each. To Group 1, tranexamic acid at a dose of 500 mg/ml was administered pre operation and 2 hours later. For Group 2, a bulky compression dressing was performed by covering the surgical wounds with a low-adherent dressing, overlaid with four layers of sterile gauze and then sealed with a conformable adhesive retention tape. Standard dressing was applied to the patients of Group-3 using the same type of bandage and adhesive tape given to the Group-2, but only overlaid with two layers of sterile gauze. There is no statistical difference among trials groups for preoperative (P &gt; 0.220) and postoperative (P &gt; 0.380) hemoglobin levels and the level of perioperative blood loss (P &gt; 0.110). With respect to number of transfusion required, the tranexamic acid group was significantly lower compared to the standard dressing group (P = 0.018). No abnormality of wound seen in all three trials groups and only 2 patients of bulky compression dressing group reported experience of headache. In conclusion, tranexamic acid is better to promote hemostasis compared to conventional dressing techniques.

Major vessel sealing in laparoscopic surgery for colorectal cancer: a single-center experience with 759 patients

BackgroundEfficient hemostatic techniques are essential in laparoscopic surgery for ideal intraoperative and postoperative results. A variety of advanced devices are available for the sealing of major vascular structures. The aim of this study is to assess effectiveness and safety of major vessel sealing with a radiofrequency device during laparoscopic colorectal resections for cancer based on the experience of a single hospital.MethodsEarly outcomes of a consecutive series of patients who received elective laparoscopic colorectal resections for cancer over a 10-year period (January 2008–September 2017) are analyzed.In all procedures, the Ligasure® electrothermal bipolar device was used for the closure of the major colonic vessels and the dissection of all the structures. No other products such clips, staplers, hemostatic products, or other devices were used.ResultsSeven-hundred fifty-nine procedures were performed in laparoscopy: 179 rectal resections, 247 sigmoidectomies and left hemicolectomies, 240 right hemicolectomies, 33 resections of the splenic flexure, 35 transverse colonic resections, and 25 other procedures.In 39 cases, the laparoscopic procedure was converted to open surgery, and in these cases, vessel sealing was also achieved with the radiofrequency device alone.Vessel dissection and sealing was realized in all cases without any intraoperative or postoperative bleeding. No reoperations for bleeding from major vessels were performed in any patients. One case of reoperation was recorded postoperatively, at 3 h after right hemicolectomy, due to a small bleeding from the fat of the transverse colon stump.ConclusionsThe use of Ligasure® radiofrequency device for sealing and dividing the major colonic vessels is safe, fast, and effective during laparoscopic colorectal resections.

Role of hemostatic powders in the management of lower gastrointestinal bleeding: A review.

Despite the recent advances in endoscopic hemostatic techniques, the management of lower gastrointestinal bleeding could be sometimes challenging. Hemostatic powders such as Hemospray, EndoClot, and Ankaferd Blood Stopper have found their way into digestive endoscopy and are licenced in many countries especially for use in upper gastrointestinal bleeding. We reviewed the literature on the use of these hemostatic powders in different situations in lower gastrointestinal bleeding and looked at the success rate and rebleeding rate. Most of the data are derived from case reports, retrospective and prospective case series with absence of any randomized controlled trials. Hemostatic powders were used as primary or salvage therapy to control bleeding from polypectomy site, colonic tumors, diverticula, arteriovenous malformations, radiation proctitis, ischemic colitis, and surgical intestinal anastomosis. The rate of immediate control of bleeding is in the range of 88-100% with a recurrence rate of 3-13% except for radiation proctitis bleeding where rebleeding rate can be as high as 77%. Although there are many advantages for the use of local hemostatic agents in lower gastrointestinal bleeding, future randomized controlled trials comparing them with conventional methods are needed.

Research progress in hemorrhage control products of U. S. army

From Vietnam War to Operation Iraqi Freedom and Operation Enduring Freedom, hemorrhage remains the leading cause of combat death. The U. S. army has made great strides in research and development of hemorrhage control products and various tourniquets and hemostatic dressings have been fielded on the battlefield. This paper introduces current status of hemostatic products and hemorrhage control products. Currently, there are extremity tourniquets and junctional tourniquets. The hemostatic products include HemCon bandages, QuciClot granular and gauze, Celox gauze, XStat, etc. Meanwhile, the author summarizes three development trends of US military hemostatic products, ie, prehospital application of tourniquets, emphasis on hemorrhage control in junctional regions, and gauze hemostatic adjuncts preference. This review offers materials for fully understanding war wound treatment of U. S. army. Key words: Tourniquets; Hemostatic techniques; U. S. armed forces

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates.

Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be appropriate anticoagulation" for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.

The perioperative maternal outcomes of bilateral internal iliac artery ligation in morbidly adherent placenta previa

Objective The aim was to detect the effects of bilateral internal iliac artery ligation (IIAL) either before or after placental separation on the intraoperative and postoperative maternal outcomes. Background Morbidly adherent placenta (MAP) is abnormal adherence of the placenta to the underlying uterine wall. It can cause significant adverse maternal consequences including the risk of severe intrapartum and/or postpartum bleeding, cesarean hysterectomy, intensive care unit admission, and prolonged hospitalization days. Early diagnosis of MAP helps optimal management with decrease of maternal and neonatal compromise. Uterine sparing can be attempted for patients seeking for fertility preservation. For those patients, several surgical hemostatic techniques including the prophylactic IIAL seemed to reduce blood supply to the pelvic organs and consequently, prevent life-threatening intraoperative blood loss and reduce transfusion requirements. Participants and methods The research is a randomized clinical trial that was conducted on 30 inpatient pregnant women – with inclusion and exclusion criteria – diagnosed by ultrasound to have placenta previa with MAP. The study population is divided into test and control groups according to the intervention of bilateral IIAL. The primary operative outcome was the direct blood loss assessment, the secondary outcomes were the indirect measures of blood loss (shock index, hemoglobin and hematocrite concentrations, and blood transfusion units), and the tertiary outcomes were the maternal mortality and morbidities and the operative and postoperative time variables. Results The prophylactic IIAL (group 1) significantly decreased the intraoperative time by approximately 48 min, the bleeding control time by 47%, operative blood loss by 40%, the number of transfusion units of packed red blood cells, and the shock index (a mean of 1.12). There were marked significant blood hemoglobin and hematocrit differences, with the highest mean in group 1 (8.66 g/dl and 28.3%, respectively). The postoperative results revealed decrease in the hospital stay time and the febrile period in prophylactic IIAL, with means difference of −1.7 and −2 days, respectively. The frequencies of emergency hysterectomy (2/30 cases), urinary tract injuries (1/30 case), and maternal mortality (1/30 case) were absolutely confined to the group without the intervention of IIAL (group B). Conclusion In placenta previa with MAP, the operative bilateral IAAL either before or after placental separation – but the superiority for prophylactic IAAL – decreased intrapartum and postpartum complications and minimized the risk of the emergent hysterectomy.