Use Of Surgicel Research Articles

Wrapping method for better fat handling in endoscopic trans-sphenoidal surgery.

Fat is commonly used for preventing cerebrospinal fluid (CSF) leakage during endoscopic transsphenoidal surgery (ETSS). However, fat is soft, slippery, and sometimes not easy to handle. The present study aimed to examine the efficacy of our Surgicel® wrapping method, which allows for better fat handling, in preventing the occurrence of CSF leakage among patients undergoing ETSS. We used fat tissues removed from the abdomen. The fat was cut with scissors into pieces that were approximately 5 mm in size. Surgicel® was also cut into 2.5 cm2. The fat tissues were encased with these Surgicel® squares and slightly moistened with a saline solution. Between January 2023 and August 2024, 34 patients aged 18-86 years (average 54.9 years) underwent ETSS. Among these patients, 20 had pituitary tumors, 6 had Rathke's cysts, and 8 had other conditions. None of the patients had CSF leakage postoperatively. The use of Surgicel®-wrapped fat during ETSS is better than the use of fat alone. The Surgicel® wrapping method allows for better fat handling during ETSS.

Transvaginal sonographic appearance of Surgicel®: A case series report

BackgroundSurgicel® (oxidized regenerated cellulose) is widely used for hemostasis in gynecological surgery. Although intended to be absorbed within weeks, it can persist and be visualized on transvaginal ultrasound, potentially mimicking ovarian pathologies. The purpose of this study was to describe the appearance of Surgicel® on post-ovarian cystectomy and provide guidance on differentiating it from other conditions. MethodsWe retrospectively reviewed postoperative transvaginal sonographic examinations of 6 patients after laparoscopic ovarian cystectomy in which Surgicel® was used for hemostasis. Ultrasonographic evaluations were performed as part of routine postoperative assessment without any specific timing protocol. Sonographic examinations were performed up to 335 days after surgery. Images were reviewed for echogenicity, vascularization (color doppler) and acoustic properties. Surgical reports confirmed the use of Surgicel®in each patient. ResultsSurgicel® displayed varying ultrasonographic characteristics, lacking a uniform appearance. In all cases, it appeared as a hyperechoic, avascular lesion, sometimes with posterior acoustic shadowing and occasionally accompanied by a cystic component. In one patient, serial scans revealed a gradual reduction in size and changes in sonographic features over time. ConclusionSurgicel® can present with diverse ultrasound features. However, a hyperechoic avascular lesion is a key potential sign for distinguishing it from other conditions. Awareness of these sonographic appearances is essential to avoid misdiagnosis, highlighting the importance of collaboration between sonographers and surgeons to prevent unnecessary interventions.

Surgicel Mimicking Brain Abscess: A Case Report

Hemostasis is one of the most essential measures in Neurological procedures. Surgicel (Oxidized cellulose) is one of the most frequently used hemostatic agent used worldwide during surgical procedures. We aim to present a case of radiological diagnostic dilemma of a ring enhancing brain lesion where brain abscess, intracranial hematoma and surgicelloma was identified as challenging differential diagnosis. In this paper, we present a case, where a complication occurred with the use of surgicel following craniectomy and evacuation of hematoma.

B-PO05-046 USE OF SURGICEL® HEMOSTATIC AGENT ASSOCIATED WITH INCREASED RISK OF CARDIAC DEVICE INFECTION

Hemostatic agents can be used to reduce the risk of bleeding in cardiac device implantation (CDI). In October 2019, operators at our institution began to utilize Surgicel® hemostatic powder in patients with high bleeding risk. We also noted a concomitant rise in device infections. In January 2020, we discontinued Surgicel® use and infection rates returned to baseline. We conducted a retrospective case-control study to determine whether Surgicel® use was independently associated with an increased risk of CDI-related infection. We hypothesized that the use of Surgicel® was independently associated with risk of CDI-related infection. Patients undergoing implantation of pacemaker, internal cardioverter defibrillator (ICD), or cardiac resynchronization (CRT) devices were included for analysis. All CDI patients were prospectively surveilled for infection for a period of 90 days after implant. We reviewed all cardiac implants between July 1, 2019 and August 31, 2020. Surgicel® was utilized between October 2019 and January 2020. We recorded the following risk factors: age, sex, obesity (BMI >30), device type, steroid use, generator change, tobacco use, diabetes, chronic kidney disease, immunocompromised status (HIV+ or use of non-steroidal immunosupressive agent), Surgicel® use, antiplatlet agent use, anticoagulation, and post-operative hematoma. Multivariable analysis was performed using a logistic regression model including all factors that were significantly associated with infection by univariate analysis. During the study period a total of 512 patients underwent CDI with 11 confirmed infections (2.1%). 8/11 infections (73%) were associated with Surgicel® use. In multivariable analysis, factors independently associated with infection were: Surgicel® use (OR 26.15, 95% CI (4.44 - 154.100) p <0.0001), Obesity (OR 8.97 95% CI (1.45 - 55.65) p =0.018), Immunodeficiency (OR 114.32 95% CI (6.78 - 1928.26) p= 0.001), and hematoma (OR 5.51 95% CI (1.13 - 26.88) p = 0.035. Surgicel® use was strongly and independently associated with risk of CDI related infection. Other factors independently associated with increased infection risk include obesity, immunodeficiency, and hematoma.

Reaction to surgicel in neurosurgery

The use of Surgicel is one of the methods used to stop bleeding during various surgical operations, especially neurosurgery. The use of Surgicel may cause complications such as inflammation, delayed tissue repair, and necrosis. This case is a 60-year-old woman with a history of craniotomy and reaction to Surgicel who presented to the hospital with symptoms of seizures. The patient underwent craniotomy after a mass diagnosis in the parasagittal region. After reviewing this case, we concluded that the use of Surgicel can have complications for patients, Therefore, it is recommended to use Surgicel in the patient's body so that it is not treated as a mass, abscess, or hematoma in the postoperative period.

PMD48 IMPACT OF SURGICEL ON SURGICAL OUTCOMES AND HOSPITAL COSTS ASSOCIATED WITH LUMBAR SURGERY IN A CHINESE TIER III TERTIARY CARE HOSPITAL

To assess the real-world impact of Surgicel on surgical outcomes and hospital costs associated with lumbar surgery (LS) in a Chinese tier III hospital. The patients receiving LS from January 2015 to December 2017 in a Chinese tier III hospital were identified to create the two study groups for the use of Surgicel before April 30, 2016 (Surgicel group) vs. no use of Surgicel (non-Surgicel group) after April 30, 2016. The created two groups were compared for surgical outcomes and hospital costs associated with LS. Propensity score methods were used for the adjusted comparisons. Of the included 635 patients, 56 patients were included in the Surgicel group and 579 patients were included in the non-Surgicel group. The adjusted comparisons identified significantly lower perioperative blood transfusion rate (51.9% vs. 84.6%, p=0.001) and lower perioperative blood transfusion volume (272 ml vs. 489 ml, p=0.016) in the Surgicel group. The adjusted comparisons of the distribution of hospital costs observed that the Surgicel group was associated with significantly lower costs of other utilized health resources after the exclusion of medical supplies and medications (¥33,257 vs. ¥39,003, p=0.006, ¥1= US$0.15 as of January 16, 2019). The overall hospital costs associated with the Surgicel group was lower but not significant (¥160,052 vs. ¥169,886, p=0.253) in the adjusted comparison. Using Surgicel as the hemostatic agent in LS could reduce perioperative blood transfusion and might potentially save overall hospital costs.

PMD49 IMPACT OF SURGICEL ON SURGICAL OUTCOMES AND HOSPITAL COSTS ASSOCIATED WITH OPEN GASTRECTOMY IN A CHINESE TIER III TERTIARY CARE HOSPITAL

To assess the real-world impact of Surgicel on surgical outcomes and hospital costs associated with open gastrectomy (OG) in a Chinese tier III hospital. The patients receiving OG from January 2015 to December 2017 in a Chinese tier III hospital were identified to create the two study groups for the use of Surgicel before April 30, 2016 (Surgicel group) vs. no use of Surgicel (non-Surgicel group) after April 30, 2016. The created two study groups were compared for surgical outcomes and hospital costs associated with OG. Propensity score methods were used for the adjusted comparisons. Of the included 480 patients, 114 patients were included in the Surgicel group and 366 patients were included in the non-Surgicel group. The adjusted comparisons identified significantly shorter operation times associated with Surgicel group (4.0 hours vs. 4.5 hours, p=0.035). The adjusted comparisons of the distribution of hospital costs observed that the Surgicel group was associated with significantly lower costs for medical supplies (¥23,593 vs. ¥27,114, p<0.001) and other utilized hospital resources (exclusion of medical supplies and medications) (¥16,989 vs. ¥21,829, p<0.001). The overall hospital costs associated with the Surgicel group were also significantly lower (¥65,852 vs. ¥68,409, p=0.035). Using Surgicel as the hemostatic agent in OG could reduce operation time and save overall hospital costs.

PMD47 IMPACT OF SURGICEL ON SURGICAL OUTCOMES AND HOSPITAL COSTS ASSOCIATED WITH INTRACRANIAL SURGERIES IN A CHINESE TIER III TERTIARY CARE HOSPITAL

To assess the real-world impact of Surgicel on surgical outcomes and hospital costs of intracranial surgeries in a Chinese tier III hospital. The patients receiving intracranial surgeries from January 2015 to December 2017 in a Chinese tier III hospital were identified to create the two study cohorts for the use of Surgicel before April 30, 2016 (Surgicel group) vs. no use of Surgicel (non-Surgicel group) after April 30, 2016. The created two groups were compared for surgical outcomes and hospital costs associated with intranasal endoscopic tumor resection (IETR), craniotomy for non-skull base tumor resection (CNSTR), craniotomy of skull base tumor resection (CSTR), and cerebrovascular surgery (CVS), respectively. Propensity score methods were used for the adjusted comparisons. Of the included 3,002 patients, 753 patients were included in the Surgicel group and 2,249 patients were included in the non-Surgicel group. Adjusted comparisons observed that the Surgicel group was associated with lower perioperative blood transfusion rates for IETR (6.9% vs. 9.9%, p=0.606) and CSTR (37.7% vs. 41.8%, p=0.407) without reaching statistical difference. The Surgicel group was associated with significantly shorter post-surgery hospital stay length (9.4 vs. 9.9 days, p=0.005) for IETR in the adjusted comparison. The adjusted comparisons of the distribution of hospital costs observed obvious trends of less medical costs of medical supplies associated with IETR (¥16,277 vs. ¥20,091, p=0.001, ¥1=US$0.15 as of January 16, 2019) and CNSTR (¥29,668 vs. ¥35,968, p=0.008) in the Surgicel group. The Surgicel group for CNSTR was also associated with significantly lower overall hospital costs (¥82,582 vs. ¥93,806, p=0.002) in the adjusted comparison. Using Surgicel as the hemostatic agent could reduce post-surgery hospital stay length associated with IETR and might lead to less use of medical supplies associated with intracranial surgeries and save overall hospital costs.

An Outbreak of Surgical Site Infections in A Neurosurgical Ward.

Objective To survey an outbreak of surgical site infections in a neurosurgery ward of a tertiary hospital. Methods The patients of surgical site infection were investigated individually based on a uniformly designed epidemiological survey form. The distribution of cases was analyzed by characteristic epidemiology,and a case-control study was carried to explore the risk factors. Results A total of 9 patients with surgical site infections from February 5 to March 7,2014 were identified in 68 patients who had received surgery in a neurosurgery ward,yielding a prevalence of 13.24%. The infections occurred in 7 of 14 patients who had used surgicel,a hemostatic agent,and in 2 of 54 patients who had not used surgicel. (χ2=16.637,P<0.001). Conclusion The use of surgicel may be the cause of this surgical site infection outbreak.

Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy.

Nephron sparing surgery has seen a phenomenal rise in its application over the past few decades. The use of Surgicel and gel foam for closure of defect created after partial nephrectomy has become a routine practice at many centers. In this case report, we describe radiological artifact secondary to a surgical bolster mimicking a residual disease or an early recurrence in the kidney. This case highlights two facts; first, reapproximation of the renal tissue is best done without the use of Surgicel bolsters. Second, bolsteroma should always be kept in mind as a differential diagnosis in a case where computed tomography (CT) imaging is showing early recurrence. If the surgeon is sure about the surgical margins being negative and the CT image shows a bolsteroma, the patient should be observed and a repeat scan should be done at 3–6 months, which would show regression or disappearance of the lesion proving it to be an artifact rather than malignant lesion.

Effect of bupivacaine soaked gauze in postoperative pain relief in laparoscopic cholecystectomy: a prospective observational controlled trial in 120 patients.

BackgroundSymptomatic gallstone disease is one of the most common problem attended by a general surgeon. The application of minimally invasive surgical techniques for the removal of gallbladder is now an accepted and preferred method for treating this condition. The avoidance of a subcostal incision and minimal bowel handling leads to decreased postoperative pain, early returning to function and overall shorter duration of hospital stay. Nevertheless, patients do have significant postoperative pain, and newer techniques to further reduce this pain are the subject of many ongoing studies. Many intraoperative techniques for reducing postoperative pain have been described. The current practice at many institutions, including ours, is to discharge the patient on the first postoperative day on oral analgesics. Better control of postoperative pain may help establishing laparoscopic cholecystectomy as a day care procedure in selected patients. The aim of this study is to determine the effect of 0.5 % bupivacaine soaked oxidized regenerated cellulose surgical versus normal saline soaked surgical applied at the gallbladder bed on postoperative mean pain score after laparoscopic cholecystectomy for symptomatic gallstones.Patients and methodsPatients scheduled for laparoscopic cholecystectomy were enrolled in the study after meeting the inclusion criteria. Relevant history was taken and clinical examination was done. Necessary investigations were carried out. All patients were divided to receive either 0.5 % bupivacaine soaked surgicel or normal saline soaked surgicel after laparoscopic cholecystectomy with each group having equal number of patients. The pain score was measured with a visual analogue scale (VAS) at 4, 12 and 24 h after the procedure in both groups. All data was recorded on performa and SPSS-19 was used for analysis.ResultsThe demographic characteristic of the two groups has shown that studied patients were matched as regarding gender, age, weight, ASA status and duration of surgery. Post-operative abdominal pain was significantly lower in bupivacaine Group than Saline group. This difference was reported from 4 h till 12 h post-operatively. Bradycardia, Hypotension and Urinary retention were the most common perioperative symptoms reported, with an incidence of 28.3 % in the saline Group and 15 % in the bupivacaine group with no significant differences. Evaluation of postoperative details such as oral intake, time to walk and length of hospital stay revealed that bupivacaine group reported better outcomes as compared to saline group.ConclusionPlacing bupivacaine soaked surgicel has been shown to decrease the mean postoperative pain score in patients. No significant complication was noticed with the use of surgicel. Because adequate pain control requires intravenous medications, additional methods for pain control need to be studied before laparoscopic cholecystectomy can be routinely performed as a day care case.

Accuracy of diagnosis on CT scan of Surgicel® Fibrillar: results of a prospective blind reading study

ObjectiveOxidized regenerated cellulose is a hemostatic agent used in surgery to control bleeding. Some case reports have suggested that it could lead to a mistaken diagnosis of abscess on postoperative CT scan. The objective of this study was to evaluate the diagnostic accuracy of CT scan for Surgicel® Fibrillar. Study designWe prospectively registered all patients who had Surgicel® Fibrillar left in the operative site during one year. Patients who had a CT scan for medical reasons (e.g. fever, pain, or occlusive syndrome) were evaluated and we compared the radiologists’ conclusions with or without information about the use of Surgicel® (two different radiologists, one blinded to the use of Surgicel®). Results18 patients who underwent pelvic laparotomy had Surgicel® Fibrillar left in the operative site. On first interpretation, the radiologist's conclusion was an abscess in 11% of cases, hematoma in 28%, collections with hydro-aeric levels in 33%, lymphocele in 6% and no conclusion in 11% of cases. For only 2 patients (11%) was the conclusion Surgicel® Fibrillar. After second interpretation by a radiologist aware of the presence of Surgicel® Fibrillar, Surgicel® Fibrillar was the main conclusion on 15 CT scans (83%). ConclusionOxidized regenerated cellulose is a differential diagnosis for abscess or collection. The radiologist should be informed about its presence to increase appropriate evaluation of CT scans and avoid inappropriate treatment.

Use of Surgicel® and cyanoacrylate glue to seal iatrogenic rupture of cysts and tumours during surgery

Use of Surgicel® and cyanoacrylate glue to seal iatrogenic rupture of cysts and tumours during surgery

Sialocele after Parotid Surgery

To assess possible factors contributing to the occurrence of a sialocele after parotid surgery. Case series with chart review. Secondary otolaryngology service. One hundred two consecutive parotid operations by 1 surgeon were recorded. A high rate of sialocele formation was addressed by identifying possible contributing factors, sequentially introducing changes, and then analyzing the effect of such changes. Twenty patients developed a sialocele (19.6%). Demographic variables of those who developed a sialocele were similar to those who did not. Factors examined included partial versus complete superficial parotidectomy, use of Surgicel, vacuum drain pressure, and postoperative duration for surgical drain. The only significant factor on regression analysis for increasing the risk of a sialocele development was the use of Surgicel (P = .023). Once the use of Surgicel stopped, the rate of sialocele formation diminished markedly (from 28.6% to 11.3%). Sialocele can cause significant problems for the patient and surgeon in terms of delayed wound healing and increased clinic resources and frustration. This study suggests that the use of products such as Surgicel increases the risk of postoperative sialocele formation.

Barrier methods used to prevent pelvic adhesions in videolaparoscopy: experimental study in female rabbits

This study was designed to evaluate the effectiveness of barrier methods to prevent adhesions in videolaparoscopy, comparing the use of Surgicel(®) and Interceed(®) with the control group. We performed a controlled, randomized study in healthy adult female rabbits Oryctolagus cuniculu, inducing adhesions in the abdominal wall by resection of a peritoneal fragment and cauterization. In the control group, surgery was performed, and the other group was randomized to the use of the barrier method. After 21 days, videolaparoscopy was repeated, and the presence or absence of adhesions and their score were verified by performing biopsies of the surgical site in all groups. No statistical differences were found in the results on adhesion formation and adhesions score among the three groups. In the control group, there were 54.5% cases of adhesion formation; the median score of adhesions was 6 (range, 3-10). In the Surgicel(®) group, there were 45.5% cases of adhesion formation; median score of adhesions was 6 (range, 4-10). In the Interceed(®) group, there were 45.5% cases of adhesion formation; median score of adhesions was 5 (range, 3-11). No difference was found using barrier methods, Surgicel(®), and Interceed(®) for preventing adhesion formation in videolaparoscopy.

Surgicel as an unusual cause of prolonged drainage

A 1.2-year-old female baby with features of left hemihypertrophy associated with complex cystic mass in upper pole of left kidney underwent partial nephrectomy. During partial nephrectomy hemostasis was achieved by ligation of vessels and surgicel was applied in multiple layers after application of Glubran 2 tissue glue. In postoperative period, an increase in drainage in the form of yellowish thick fluid approximately 5-10 ml in 24 hours was observed from fourth postoperative day. The biochemical analysis of fluid in form of creatinine and sodium values done twice on the fifth and eighth postoperative day, corresponded to serum values, thus confirming absence of urine leak. The microbiological analysis showed absence of inflammatory pathology. Thus, presence of thick yellowish sterile fluid was attributed to biodegradation of thick layer of surgicel and the correlation of drain output with ultrasonic thickness of surgicel showed progressive decrease in drainage by the end of second week, which coincided with decrease in ultrasonic thickness of surgicel. Thus, the serum values of fluid and the correlation of ultrasonic thickness with drain output provided evidence that excessive use of surgicel may be a contributing factor for prolonged drainage. The patient recovered well and is asymptomatic on

11-HEMOSTASIS WITH SURGICEL FOR TONSILLECTOMY: A PILOT STUDY

This study aimed to evaluate the use of surgicel as the primary hemostasis method in tonsillectomy. It is a cross-sectional prospective study included 211 patients who underwent tonsillectomy alone or with conjugation with adenoidectomy over a period of 4 years in a tertiary centre. The surgeon used cold steel dissection and surgicel as primary Hemostasis technique. There was no post-tonsillectomy hemorrhage in this study, giving a 0% risk of post tonsillectomy bleeding. It is concluded that the use of surgicel is a valid technique to achieve hemostasis in tonsillectomy. Larger number of patients has to be operated on using this technique in order to validate the comparison between our technique and techniques currently used.

A Randomized Controlled Trial of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

We established whether totally tubeless percutaneous nephrolithotomy with no nephrostomy or ureteral stent is a safe management technique. Patients were randomized to have a nephrostomy placed (group 1 control) or none (group 2 treatment). A total of 25 patients were randomized to each group. Cases were considered uncomplicated and suitable for randomization if there was no significant bleeding or residual stone load, the pelvicaliceal system was intact and there was no evidence of a residual ureteral stone. The primary outcome measure was length of stay, and secondary outcomes were analgesic requirements and postoperative complications such as bleeding, infection or ureteral obstruction. Hospital readmission rates and stone clearance rates were also recorded. Mean stone size was 21.6 vs 17.5 mm. There were no transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in hemorrhage, infection and serum parameters. There were no readmissions in either group. Mean length of stay was 3.4 vs 2.3 days (p <0.05). This trial demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a safe and well tolerated procedure in selected patients. Length of stay was reduced with no major complications in either group. We believe that totally tubeless percutaneous nephrolithotomy may be considered an accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.

Postoperative Surgicel mimicking abscesses following cholecystectomy and liver biopsy

In postoperative patients presenting with abdominal pain or fever, a computed tomography (CT) finding of gas in the operative site raises concern for abscess but can be mimicked by the normal postoperative appearance of oxidized regenerated cellulose (Surgicel). Information about the operative use of Surgicel and its location is important for accurate CT interpretation of postoperative studies. This case illustrates a scenario in which knowledge of the use of Surgicel offered an explanation for the CT findings, resulting in successful conservative management.

Use of Surgicel for Sealing Nephrostomy Tract after Totally Tubeless Percutaneous Nephrolithotomy

Fibrin glue and gelatin matrix have been used to seal nephrostomy tracts to reduce bleeding and extravasation after tubeless percutaneous nephrolithotomy (PCNL). In this study, Surgicel (oxidized cellulose) was used to seal the nephrostomy tract after totally tubeless PNL. Twenty patients with kidney calculi were treated with totally tubeless PNL. According to randomization, at the conclusion of surgery, the nephrostomy tracts were sealed with Surgicel in ten patients and left unsealed in the other ten. Postoperatively, the two groups were compared with respect to hematocrit changes and extravasation as detected by abdominal ultrasonography and wound-dressing inspection. There was statistically significant decrease in the hematocrit in both the study (P = 0.017) and the control (P = 0.003) group. When the two groups were compared with respect to the decrease in hematocrit, no statistically significant difference was seen (P = 0.241). Similarly, extravasation from the nephrostomy tract was not significantly different in the two groups. Sealing the nephrostomy tract with Surgicel after totally tubeless PNL did not decrease bleeding or extravasation from the tract.