A Randomized Clinical Trial Comparing the Effect of Different Haemostatic Agents for Haemostasis of the Liver after Hepatic Resection

Abstract

Introduction. Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it. The aim of the current study is to evaluate effects of 3 different types of these agents. Methods. In this randomized clinical trial, 45 patients undergoing liver resection were assigned to receive TachoSil, Surgicel, and Glubran 2 for controlling bleeding. Intraoperative and postoperative findings were compared between groups. Results. Postoperative bleeding (0 versus 33.3%, P = 0.04) and drainage volume first day after surgery (281.33 ± 103.98 versus 150.00 ± 60.82 mL, P = 0.02) were significantly higher in Surgicel than in TachoSil group. Postoperative complications included bile leak (3 cases in Surgicel, 1 case in TachoSil and Glubran 2), noninfectious collection (2 cases in TachoSil and Surgicel and 1 case in Glubran 2), perihepatic abscess, and massive hematoma around hepatectomy site both in Surgicel group. There was no death during the study period. Conclusion. Due to higher complications in Surgicel group, its application as hemostatic agent after liver resection is not recommended. Better results in TachoSil in comparison to the other two are indicative of its better efficacy and superiority in controlling hemostasis.

Economic and outcomes consequences of TachoSil®: a systematic review

“…Six of the selected papers were randomized controlled trials in patients undergoing hepatic, cardiac, or renal surgery 12–17. Time to hemostasis with TachoSil was less (1–4 minutes) than that using other techniques.…”

Fibrin sealant patches: powerful and easy-to-use hemostats

“…They also noted a trend toward more complications in the ORC group compared with the fibrin sealant patch. 27 In a case report 28 on the use of a fibrin sealant patch, a patient who anticoagulated with warfarin following cardiac valvular repair required emergency surgery for an actively bleeding liver laceration associated with shock. The patient was treated with a trisegmentectomy by means of total vascular occlusion, endoscopic staplers, and bipolar cautery, as well as fibrin sealant patches, without the need for postoperative transfusions.…”

Post-Operative Outcomes of Oxidized Regenerated Cellulose Use in Women Undergoing Cesarean Delivery

“…Literature within the hepatic and spinal surgery fields has supported the efficacy of these agents. [2][3] Oxidized-regenerated cellulose and microfibrillar-collagen have been used at the time of cesarean delivery. The mechanism by which these agents accelerate clotting is not completely understood but it is theorized that a physical effect and/or an alteration of normal physiologic processes may be at play.…”