Significant Increase In Blood Loss Research Articles

Prevention of the stapler line leak after laparoscopic sleeve gastrectomy in patients with morbid obesity

Obesity has become a global pandemic, leading to increased morbidity and mortality among patients, both young and old. Bariatric surgery is the most effective method for treating pathological obesity. Laparoscopic sleeve gastrectomy has become the most popular bariatric procedure worldwide. However, staple line leak is the most dreaded postoperative complication following laparoscopic sleeve gastrectomy. In order to reduce the incidence of this complication, most surgeons prefer to reinforce the staple line. However, there is no compelling evidence to suggest that peritonealization of the staple line or the use of coated stapler cartridges during laparoscopic sleeve gastrectomy reduces the risk of leakage. Therefore, we conducted a retrospective analysis to assess the impact of coated stapler cartridges on preventing staple line leaks. The aim of the study. To evaluate the effect of using stapler with coating on preventing staple line leaks during laparoscopic sleeve gastrectomy in patients with morbid obesity. Materials and methods. This was a retrospective analysis of 45 patients who underwent laparoscopic sleeve gastrectomy using endostapler from Medtronic (Endo GIA™) without additional reinforcement (Group I) and 46 patients who underwent a similar procedure using endostapler from Medtronic (Endo GIA™) stapler with coating (Group II). Both patient groups were homogeneous in terms of demographic characteristics. We compared the duration of surgery, intraoperative blood loss, length of hospital stay, and the incidence of staple line leak. Results. The incidence of staple line leak was statistically significantly higher in Group I compared to Group II (5/40 vs. 0/46; χ2 = 5.4, p = 0.021). This resulted in a statistically significant increase in blood loss (U = 706; p = 0.006), prolonged total operation time (U = 310; p = 0.001), and extended postoperative hospital stay (U = 245; p = 0.001) in Group I. The median time to healing of the leak was 32 [20; 59] days. No patient died. Conclusions. Using the endostapler with purple cartridges with coating from Medtronic during laparoscopic sleeve gastrectomy significantly reduced postoperative leak rate and significantly decreased postoperative hospital stay.

Crucial factors for implementing treatment strategies in intractable atonic postpartum haemorrhage: early phase contrast medium extravasation on dynamic CT

To identify the relationship between contrast medium extravasation (CME) on dynamic contrast-enhanced computed tomography (DCT) and clinical information in intractable atonic postpartum haemorrhage (PPH) and its relevance to treatment with uterine artery embolisation (UAE). Of 90 patients who underwent DCT to diagnose PPH, 60 diagnosed with intractable atonic PPH were investigated retrospectively. Maternal background and clinical indicators were analysed to compare the positive and negative factors of early phase CME. Regression analysis was used to investigate the factors associated with CME. The sensitivity, specificity, and positive and negative predictive values of early phase CME for predicting UAE were calculated. Clinical outcomes were compared between the two groups according to the timing of the decision to undergo UAE. Of the 60 patients with intractable atonic PPH, 21 underwent UAE, 20 of whom had early phase CME on DCT. Pre-DCT clinical parameters and clinical indices were not significantly different in presence of early phase CME. Early phase CME was associated with UAE performance, with a sensitivity of 95%, specificity of 87%, positive predictive value of 80%, and negative predictive value of 97%. In cases where UAE was performed after conservative management, there was a significant increase in blood loss and transfusion volume. Early phase CME is not indicated by background factors or clinical findings. UAE is not required when CME cannot be detected in the uterine cavity. If early phase CME is present, UAE should be considered immediately.

Poster 357: Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-analysis

Objectives: Tranexamic acid (TXA) use has become common in Orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The aim of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy. Methods: This was a systematic review following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as outlined on the PRISMA checklist. Databases utilized included PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through May 21, 2022. Key words used in the search included: “tranexamic acid,” “TXA,” “foot,” “ankle,” “calcaneal,” and “surgery.” The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour postoperative blood loss, blood loss from hour 24 to hour 48, postoperative hemoglobin (Hgb), and postoperative hematocrit (Hct)), as well as wound complications and vascular events. Wound complications and vascular events were defined as infection, hematoma formation, necrosis, dehiscence, DVT, PE, myocardial infarction (MI), acute coronary syndrome (ACS), cardiovascular event (CVA), limb ischemia (LI), gastrointestinal hemorrhage (GIH), nerve damage, and any other conditions specified as wound complications or vascular events within individual studies. The Cochrane Collaboration’s Risk of Bias 2 (RoB2) tool was used to assess the risk of bias in the studies included. The quality of the studies included was scored using a modified Coleman methodology score (MCMS). Primary treatment outcomes having data from three or more studies available were summarized in forest plots using RevMan 5.4.1 software (The Cochrane Collaboration, Copenhagen, Denmark). Random-Effects models were used to calculate mean differences with 95% confidence intervals for each outcome measure. Heterogeneity of studies was assessed using Tau2, Chi2, and I2 statistics. Statistical significance was set at α=0.05 for all comparisons. Results: The literature search produced 1125 papers. The full texts of 16 studies were assessed using inclusion and exclusion criteria and seven studies met preliminary inclusion criteria. Upon further inspection, five met full inclusion criteria for the meta-analysis. All groups receiving TXA had statistically significantly lower blood loss values at 24 hours. One study found a statistically significant increase in blood loss from 24-48 hours in their A group (TXA) versus non-TXA. Three study groups demonstrated statistically significantly higher values of postoperative hemoglobin in patients receiving TXA versus patients not receiving TXA. Three study groups demonstrated statistically significantly higher values of postoperative hematocrit in patients receiving TXA versus patients not receiving TXA. No studies found statistically significant differences in wound complications between TXA and non-TXA groups. Conclusions: Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Additional literature is required to determine the best strategy for TXA use to optimize patient outcomes. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour postoperative blood loss, increased postoperative hemoglobin and hematocrit when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications.

Evaluation of novel hemostatic agents in a coagulopathic swine model of junctional hemorrhage.

Hemostatic dressings are used extensively in both military and civilian trauma to control lethal noncompressible hemorrhage. The ideal topical hemostatic agent would provide reliable hemostasis in patients with profound acidosis, coagulopathy, and shock. This study aimed to compare next-generation hemostatic agents against the current military standard in a translational swine model of vascular injury and coagulopathy. Female Yorkshire swine were randomized to eight groups (total n = 63; control n = 14, per group n = 7) of hemostatic agents and included: QuikClot Combat Gauze (Teleflex, Morrisville, NC), which served as the control; BloodSTOP IX (LifeScience Plus, Mountain View, CA); Celox Rapid (Medtrade Product, Crewe, United Kingdom); ChitoSAM 100 (Sam Medical, Tualatin, OR); EVARREST Fibrin Sealant Patch (Ethicon, Raritan, NJ); TAC Wrapping Gauze (H&H Medical, Williamsburg, VA); ChitoGauze XR Pro (Tricol Biomedical, Portland, OR); and X-Stat 30 (RevMedX, Wilsonville, OR). Hemodilution via exchange transfusion of 6% hetastarch was performed to induce acidosis and coagulopathy. An arteriotomy was created, allowing 30 seconds of free bleeding followed by application of the hemostatic agent and compression via an external compression device. A total of three applications were allowed for continued/recurrent bleeding. All blood loss was collected, and hemostatic agents were weighed to calculate blood volume loss. Following a 180-minute observation period, angiography was completed to evaluate for technical complication and distal perfusion of the limb. Finally, the limb was ranged five times to assess for rebleeding and clot stability. All swine were confirmed coagulopathic with rotational thromboelastography and acidotic (pH 7.2 ± 0.02). BloodSTOP IX allowed a significant increase in blood loss and number of applications required to obtain hemostasis compared with all other groups. BloodSTOP IX demonstrated a decreased survival rate (29%, p = 0.02). All mortalities were directly attributed to exsanguination as a result of device failure. In surviving animals, there was no difference in extravasation. BloodSTOP IX had an increased rebleeding rate after ranging compared with QuikClot Combat Gauze ( p = 0.007). Most novel hemostatic agents demonstrated comparable efficacy compared with the currently military standard hemostatic dressing, CG.

Preoperative embolization of renal cell carcinoma metastases to the bone prior to stabilization procedures does not result in reduction in intraoperative blood loss

PurposeThe effect of preoperative embolization of bone metastases prior to stabilization procedures in reducing intraoperative blood loss remains controversial. This study aimed to analyze the effect of preoperative embolization on orthopedic stabilization procedures of the extremities and spine in cases with bone metastases from renal cell carcinomas. In particular, do these patients suffer less blood loss during the operation and do they need lesser fluid replacements or packed red cell bags intra- and perioperatively? Does preoperative embolization reduce the duration of surgery?MethodsWe retrospectively reviewed stabilization procedures of the spine and extremities at our institution between 2011 and 2021 for group differences (embolization vs. no embolization) in terms of blood loss, fluid substitution, need for packed red cell transfusions, tumor size, and duration of surgery.ResultsWe reviewed 79 stabilization procedures of the spine (n = 36) and extremities (n = 43), of which 30 included preoperative embolization procedures. Surprisingly, the embolization group showed a statistically significant increase in blood loss, the need for fluid substitution, and red cell transfusions. Subgroup analysis revealed a significant negative effect of preoperative embolization on stabilization procedures of the extremities.ConclusionBased on our data, preoperative embolization of renal cell carcinoma metastases of the extremities had a negative effect on intraoperative blood loss and the need for fluid substitution and should therefore be avoided. Our data did not show an effect on stabilization procedures of the spine.

A descriptive study of complications following vaginal surgeries for genital prolapse

Background: Pelvic organ prolapse is the descent of the pelvic organs into the vagina accompanied by urinary, bowel, and sexual. Many types of surgeries are done to fix the organ prolapse. Aims and Objectives: This study aims to study the intra-operative and immediate post-operative complications in patients undergoing surgery for genital prolapse. The study also aims to follow the patients for a period of 1 year evaluate the possible morbidity during the period and also assess the factors which contribute to this morbidity. Materials and Methods: The present study was conducted in a tertiary care hospital in Puducherry among 121 patients who were admitted in the department of obstetrics and gynecology for genital prolapse. It was intended to study the intraoperative, early post-operative, and long-term complications among these patients who underwent vaginal surgeries for genital prolapse. Results: Ward Mayo’s operation was done in the age group of 45–50 years and Manchester repair was done in the age group of 30–35 years. Patients who underwent Ward Mayo’s procedure had a parity of 3.5. Nearly 25% of patients had a parity of 25. There was a significant difference in operating time when surgeries were done by consultants when compared to senior residents (P=0.002) but there was no significant difference in blood loss (P=0.070). A significant increase in blood loss and operating time was noted when vaginal hysterectomy was combined with both anterior and posterior repair. In cases of complications, it was prolonged. Backache (4.95%, 4.13%, and 4.13) and psychological problems (4.13%. 6.61%, and 6.61%) after 6 weeks, 6 months, and 1 year, respectively, were common long-term complications that could be attributed to decreased awareness among our women. Conclusion: It is concluded from the study that vaginal surgeries for genital prolapse have lesser complications both intra-operatively and during the post-operative period. The patient’s characteristics such as age, parity, other illnesses, and surgical details such as choice of the operation, experience of the surgeon, additional procedures performed, blood loss, and antibiotic usage influence the morbidities associated with the surgery.

Аналіз ефективності використання системи гало-гравітаційної тракції як фактора, що впливає на крововтрату при хірургічній корекції складних сколіотичних деформацій у дітей

Halo-gravity traction (HGT) systems are widely used in leading clinics around the world as a staged method for correcting complex (>100°) scoliotic deformities of the spine in children. Today there is no single approach to the use of this technique, and each doctor makes a decision regarding the treatment regimen empirically, based on his clinical experience. Purpose - to identify the factors that affect the amount of blood loss during surgical correction of scoliotic deformity in children. Materials and methods. 76 patients aged 7 to 17 years were examined, on average 11.0±2.8 years. I (experimental) group - 38 children were treated with HGT using the developed tactics of staged surgical treatment; II (control) group - 38 children who underwent one-step surgical correction. The age of children in the groups in group I was 11.0±2.8 years, in group II - 11.2±2.8 years, the age of children in groups was statistically the same (t=-0.409; p=0.684). There were 28 (36.8%) boys and 48 (63.2%) girls. The distribution of children by age and sex in the groups was the same. Data on operative blood loss were statistically processed. Results. According to the statistical study, it can be argued that the blood loss during surgical correction of scoliotic deformity is most affected by the angle of deformation and age of the patient. At an angle of deformation of >100° blood loss is significantly greater than at an angle of <100°, children over 14 years also observed a significant increase in blood loss, and this is associated not only with greater body weight but also with the fact that these children the greater the angle of deformation of the spine, as well as the use of HGT, the angle of deformation decreases less than in younger children. Conclusions. It was determined that after HGT in children the angle of deformation decreased statistically significantly (p<0.001) by an average of 36.5±14.9°. The change in deformation in boys and girls was the same. With surgical correction of scoliotic deformity <100° blood loss (1025.0±235.9 ml), (statistically significant) (p<0.001) is statistically significantly less than blood loss with correction of deformity greater than 100° (1297.5±327.8 ml). With age, blood loss increases in children, and this difference between age subgroups is statistically significant (α=0.05). The value of the angle of scoliotic deformity after surgical correction has a statistically significant (r=0.576; p=0.001) effect on blood loss, the value of surgical correction of deformity on blood loss (r=0.015; p=0.879) does not affect. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: intraoperative bleeding, spinal deformity, halo-gravity traction.

Случай успешной плазменной трансуретральной энуклеации аденомы простаты размером 530 см3

The article presents a description of the clinical case. Surgical treatment by plasma transurethral enucleation of the prostate was performed in patients with benign prostatic hyperplasia of giant size - 530 cm3. Observation in the short term showed the absence of functional and organic complications. Comparison with the results of surgical treatment of giant prostate adenoma by classical transurethral enucleation of the prostate, obtained in our urological clinic in 2015, showed a reduction in operating time by 1 hour without a significant increase in blood loss during surgery and without operational complications. The results demonstrate the prospects of the widespread introduction of plasma methods of transurethral operations in urological practice.

The Jellyfish Sign: A New Sonographic Cervical Marker toPredict Maternal Morbidity in Abnormally Invasive Placenta Previa.

To investigate the value of a new cervical sonographic sign, called the jellyfish sign (JS), for predicting the risk of maternal morbidity in cases of abnormally invasive placenta (AIP) previa totalis. Retrospective evaluation of transvaginal (TV) and transabdominal (TA) scans performed in all singleton pregnancies with placenta previa totalis. JS, i. e. theabsence of the normal linear demarcation between the placenta previa and the cervix, was evaluated by TV scans. The presence/severity of AIP and outcomes of maternal morbidity were related to this sign. JS was noted in 8/39 (20.5 %) patients. The two analyzed groups, i. e. with and without JS, were similar. The specificity of JS in AIP diagnosis, histological findings of accreta/increta/percreta, need for caesarean hysterectomy or blood loss > 2000 ml ranges between 92 % and 96.2 %, with the PPV and NPV ranging between 71.4 % and 85.7 % and 61.3 % and 80.6 %, respectively. The JS group had a significant increase in blood loss (ml) (p = 0.003), transfusions (%) (p = 0.016), red blood cells (p = 0.002) and plasma (p = 0.002), admission to an postoperative intensive care unit (ICU) (%) (p = 0.002), hospitalization length (p < 0.001) and the need of cesarean hysterectomy (%) (p < 0.001). JS was independently correlated to cesarean hysterectomy (OR 25.6; 95 % CI 2.0:322.3, p = 0.012) and blood loss > 2000 ml (OR 16.6; 95 % CI 1.5:180.1, p = 0.021) also in a logistic regression model. JS is useful in predicting the increase in maternal morbidity: massive transfusion, admission to the ICU and cesarean hysterectomy related to intraoperative bleeding in patients with a previa AIP.

MANAGEMENT OF SEVERE PERIOPERATIVE BLEEDING IN PATIENTS DURING EXTENSIVE LIVER RESECTIONS FOR COLORECTAL METASTASES

Aim of the study. To estimate an influence of the Cavitron ultrasonic surgical aspirator (CUSA) on intraoperative blood loss. Material and methods. An analysis of 185 cases of extensive liver resections in patients for colorectal liver metastases has been performed. All patients were assigned to CUSA group (n = 56) or clamp crashing group (n = 129). Patients from the first group received regional FOLFOX6 or FOLFOX6 + bevacizumab chemotherapy. Preoperative chemotherapy did not performed for second group of patients. Results. Liver transection with CUSA did not lead to the decline in intraoperative blood loss (p = 0.35). Conclusion. Median intraoperative blood loss was 1065 and 1180 ml respectively. Method for liver transection did not lead to the decline in intraoperative blood loss (p = 0.35). Intraoperative blood loss increases from standard to extensive liver resection (p = 0.0007). Resection of contralateral blood lobe metastases did not lead to statistically significant increase in blood loss as compared with standard mode of the operation (p = 0.005).

Development of Collateral Pathways in Tumor Obstruction of Confluence of the Hepatic Veins: Neither Fortuitous nor Innocuous

Except in Budd-Chiari syndrome, alternative drainage pathways have been described rarely. The aim was to describe the alternative collaterals pathways due to tumor hepatic vein (HV) confluence obstruction and its impact in the setting of liver resection. Between 2006 and 2014, preoperative CT scans of 41 patients resected for malignant tumor(s) compressing the HV confluence were assessed for the presence of accessory veins and collateral veins. A 2:1 matched control group was used for comparison of intraoperative outcomes. Intrahepatic collaterals were observed in 28 (68%) patients, mostly between segments 3/4b and 5/4b, and subcapsular collaterals were observed in 12 (29%) patients. Patients with isolated right HV obstruction and with an accessory right HV present had fewer collateral pathways develop than patients without (6 of 10 patients [60%] vs 18 of 19 [95%]; p= 0.036). Segment 1 hypertrophy was present in only 6 (15%) patients. Compared with the control group, there was a significant increase in blood loss (900 mL [range 100 to 3,500 mL] vs 500 mL [range 100 to 2,600 mL]; p < 0.001), transfusion requirements (71% vs 15%; p< 0.001), and vascular clamping (hepatic pedicle: 85% vs 72%; p < 0.001, inferior vena cava: 41% vs 11%; p < 0.001) in case of HV obstruction. Development of collateral pathways is not fortuitous and depends on the number of HVsinvolved and pre-existing accessory veins. The increased blood loss observed in patients with collaterals leads to consider specific vascular clamping.

Impaired platelet activation and cAMP homeostasis in MRP4-deficient mice

AbstractMolecules that reduce the level of cyclic adenosine 5′-monophosphate (cAMP) in the platelet cytosol, such as adenosine 5′-diphosphate (ADP) secreted from dense granules, trigger platelet activation. Therefore, any change in the distribution and/or availability of cyclic nucleotides or ADP may interfere with platelet reactivity. In this study, we evaluated the role of multidrug resistance protein 4 (MRP4, or ABCC4), a nucleotide transporter, in platelet functions in vivo and in vitro by investigating MRP4-deficient mice. MRP4 deletion resulted in a slight increase in platelet count but had no impact on platelet ultrastructure. In MRP4-deficient mice, the arterial occlusion was delayed and the tail bleeding time was prolonged. In a model of platelet depletion and transfusion mimicking a platelet-specific knockout, mice injected with MRP4−/− platelets also showed a significant increase in blood loss compared with mice injected with wild-type platelets. Defective thrombus formation and platelet activation were confirmed in vitro by studying platelet adhesion to collagen in flow conditions, integrin αIIbβ3 activation, washed platelet secretion, and aggregation induced by low concentrations of proteinase-activated receptor 4–activating peptide, U46619, or ADP. We found no role of MRP4 in ADP dense-granule storage, but MRP4 redistributed cAMP from the cytosol to dense granules, as confirmed by increased vasodilator-stimulated phosphoprotein phosphorylation in MRP4-deficient platelets. These data suggest that MRP4 promotes platelet aggregation by modulating the cAMP–protein kinase A signaling pathway, suggesting that MRP4 might serve as a target for novel antiplatelet agents.

Cutting an episiotomy at 60 degrees: how good are we?

Episiotomy is regarded as the most common maternal obstetric surgical procedure. It is associated with a significant increase in blood loss, lower pelvic floor muscle strength, dyspareunia, and perineal pain compared with a perineal tear. We tested the hypothesis that all doctors and midwives can perform an episiotomy when prompted to, specifically cut at 60° from the midline (in a simulation model). Doctors and midwives attending the BMFMS Annual Meeting (2014), Croydon Perineal Trauma Course and staff at Poole General Hospital were invited to cut a paper replica of the perineum with a commonly used episiotomy incision pad. Participants were prompted to cut an episiotomy at 60° to the perineal midline with the anus as a reference point. The angles and distances were measured using protractors and rulers. A 58-62° band was deemed acceptable to account for measurement errors. A total of 106 delegates participated. Only 15 % of doctors and midwives cut an episiotomy between 58 and 62°. Over one third (36 %) cut the episiotomy between 55 and 65° (inclusive). Nearly two thirds either underestimated the angle (<55°; 44 %), or overestimated the angle (>66°; 18 %). Thirty-six and 7.5 % of episiotomies were cut at <50 and >70° respectively. The origination point of the episiotomy was 5 mm away from the midline (IQR 1-8 mm). This original observational study shows that doctors and midwives were poor at cutting at the prompted episiotomy angle of 60°. This highlights the need to develop structured training programmes to improve the visual accuracy of estimating angles or the use of fixed angle devices to help improve the ability to estimate the desired angle.

Extensive liver resection with preoperative regional chemotherapy for colorectal metastases in patients with high risk of blood loss

Objective: to study influence of regional chemo- and biotherapy on intraoperative blood loss. Materials and methods: An analysis of 122 cases of extensive liver resection accompanied with regional chemotherapy in colorectal metastases patients has been performed. 69 (57%) of them had bilobar lesions, 58 (48%) - had multiple metastases, 27 (22%) - had been resected for extrahepatic metastases. Results: bevacizumab inclusion in preoperative regional chemotherapy did not lead to increase of intraoperative blood loss. Conclusion: Median intraoperative blood loss was 1200 ml in both groups. Up to 6 courses of preoperative antitumor therapy, regardless of route of drug introduction did not increase blood loss. Intraoperative blood loss increases from standard to extended liver resection. Resection of contralateral lobe metastases did not lead to statistically significant increase in blood loss as compared with standard operation.

Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty.

Background:This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]).Patients and Methods:After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded.Results:There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in “r” and “k” times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A.Conclusion:Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.

Blood loss and risk of blood transfusion in patients undergoing caesarean section

Background: Caesarean delivery is one of the most common operations performed worldwide. Maternal morbidity and risk of blood transfusion increased greatly with caesarean compared with that of vaginal delivery. Aims: This study was carried out to evaluate blood loss and requirement of blood transfusion in patients undergoing caesarean section. Materials and methods: A prospective observational study was carried out in a peripheral military hospital, India where 173 women underwent caesarean section and data were obtained on age, parity, gestational age, delivery type (elective/ emergency), indication for caesarean section, pre operative and post operative haemoglobin levels. Number of patients required blood transfusion were also noted. Results: There was no significant increase in blood loss by indication of caesarean section (p<0.05). A total of 1.7% patients received blood transfusion. Conclusion: Transfusion risk in patients undergoing caesarean section is low and haemoglobin testing after caesarean section should be limited to women at high risk of blood transfusion.

Robot-Assisted Radical Prostatectomy in Patients with a Pathologic Prostate Specimen Weight ≥100 Grams versus ≤50 Grams: Surgical, Oncologic and Short-Term Functional Outcomes

Introduction: The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods: The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B). Results: Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates. Conclusions: Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience.

Cord blood collection for banking and the risk of maternal hemorrhage

We determined the effect of cord blood collection before placental expulsion on postpartum maternal blood loss in a retrospective study between a group of cord blood donors and a group of non-donors. The study was conducted in a university hospital blood bank and obstetric services and included Spanish women entered in a European study project (EUPHRATES) and who had consented to donate cord blood for public banking purposes. We measured blood volume lost during delivery by a bag collection method, as well as the need for transfusion and postpartum anemia symptoms. Deliveries at which cord blood was collected presented a significant increase in blood loss (321 ± 273 vs. 255 ± 237 ml, p=0.02). Instrumental deliveries were associated with higher postpartum blood loss than spontaneous deliveries. Cord blood collection can increase intrapartum blood loss, especially at instrumental deliveries. Additional staff who handle the collection are required to allow the leading clinician to focus on maternal care.

Stopping Aspirin Before Coronary Artery Surgery

Coronary artery bypass grafting (CABG) aims to reduce immediate and longer-term risks of myocardial infarction and death in patients with coronary artery disease. CABG is, however, associated with its own thrombotic risks of perioperative myocardial infarction, stroke, pulmonary embolism, and bowel infarction.1 These risks are of major concern to the patient and referring cardiologist. Although antiplatelet drugs such as aspirin and clopidogrel can reduce thrombotic events, they might add to a competing risk of excessive bleeding during and after surgery.2,3 Excessive bleeding leads to intraoperative and postoperative hypovolemia and hypotension, delayed completion of surgery, and higher rates of blood transfusion, postoperative tamponade, and reoperation for bleeding.3,–,6 The bleeding risks most often trouble the cardiac surgeon, and the traditional practice has been to stop aspirin before elective cardiac surgery. Article see p 577 How can we resolve the competing risks of bleeding complications (not uncommon, but sometimes serious and life threatening) versus thrombotic complications in the immediate preoperative and early postoperative period (far less common, but usually serious)? Is it true that efforts to minimize perioperative thrombotic risk will invariably increase bleeding complications? Cardiologists and surgeons have different perspectives and may weigh these issues differently, and it remains unclear as to how most CABG patients would perceive these risks and what their preferences may be. Cardiologists in particular will be familiar with this issue in the nonsurgical setting. The decision to commence anticoagulation for chronic atrial fibrillation must consider the likelihood of embolic stroke versus the possibility of serious bleeding complications, such as intracerebral hemorrhage.7 The latter situation is guided by numerous large-scale clinical trials. This is not the case in the CABG setting. Aspirin is associated with bleeding in both cardiac3,8,–,12 and noncardiac …

Blood Loss During Laparoscopic Radical Prostatectomy

To determine the impact of a variety of intraoperative parameters that may affect blood loss during laparoscopic radical prostatectomy (LRP). Intraoperative blood loss was calculated for 757 consecutive LRPs performed by the same surgeon (CE) over a 6-year period. The impact of a number of intraoperative factors that may affect blood loss was studied. These factors include the operative approach (transperitoneal or extraperitoneal), neurovascular bundle (NVB) preservation, lateral prostatic fascia preservation, prostate weight, and the impact of the learning curve for the primary surgeon and trainees. Multivariate and univariate analyses were performed to determine the significance of these factors on intraoperative blood loss during LRP. Mean (+/-standard deviation) blood loss in the 757 patients was 263 +/- 206 mL. Five (0.7%) patients received transfusions. There was a statistically significant difference between extraperitoneal (256 +/- 207 mL) and transperitoneal (308 +/- 199 mL) LRP in terms of blood loss. Nerve preservation [standard or with preservation of the lateral prostatic fascia (LPF)] resulted in a statistically significantly increase in blood loss (205 mL vs 321 mL, respectively, P < 0.001). It also appears that lateral prostatic fascia dissection, as part of a modified NVB preservation, increases blood loss with statistical significance (295 mL vs 353 mL, respectively P < 0.001). There was no statistically significant increase in blood loss with increasing prostate weight (<30 g, 30-50 g, 50-80 g, >80 g). The learning curve also had no impact on blood loss. Trainees were able to perform LRP without an increase in blood loss when mentored by the primary surgeon (CE). There was a low requirement for transfusion in this cohort of patients undergoing LRP, and the average blood loss is comparable with the most recently reported minimally invasive prostatectomy series. Blood loss during LRP is mainly affected by nerve preservation, with an average increase of 90 mL for a standard NVB and 150 mL when the lateral prostatic fascia is preserved. It is clear, however, that although NVB preservation may increase blood loss, it does not increase the risk of transfusion for patients or impact on postoperative recovery.