Hemostatic Methods for the Management of Spleen and Liver Injuries

Uranüs, S.; Mischinger, Hans‐Jörg; Pfeifer, Johann; Kronberger, L; Rabl, Hans; Werkgartner, Georg; Steindorfer, P.; Kraft-Kirz, Julius

doi:10.1007/s002689900169

Cited by 54 publications

(36 citation statements)

References 13 publications

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“…Fibrin glue, which mimics the final stage in the coagulation cascade, is currently the most widely used hemostatic agent in liver surgery [6-8], and many studies showed its efficacy on hemostasis, biocompatibility, and biodegradability [9-11]. Therefore, we compared the properties of MAR with those of fibrin glue.…”

Section: Discussionmentioning

confidence: 99%

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Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model

et al. 2018

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Background: Topical hemostatic agents are useful when hepatic hemorrhage is difficult to control. The aim of this study was to evaluate the hemostatic efficacy and safety of a biodegradable polyurethane-based adhesive, MAR VIVO-107 (MAR), in comparison with a clinically used fibrin glue. Methods: Thirty female New Zealand white rabbits were randomly assigned to 3 study groups as follows: MAR (n = 10), fibrin glue (n = 10), and saline groups (n = 10). After standardized partial liver resection was performed, each agent was immediately applied to the wound area. Bleeding time until hemostasis and blood loss were recorded. After 7 days, body weight, hematology parameters, and serum levels of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase were measured. Simultaneously, the severity of intra-abdominal adhesion was evaluated. Results: The mean bleeding time in the MAR (38 ± 10 s) and fibrin glue groups (65 ± 17 s) was significantly shorter than that in the saline group (186 ± 12 s). Similarly, the mean blood loss in the MAR (9 ± 3 g) and fibrin glue groups (9 ± 3 g) was significantly less than that in the saline group (23 ± 4 g). No significant differences in bleeding time and blood loss were found between the MAR and fibrin glue groups. The postoperative survival rate was 100% in all the groups. Body weight as well as hematological and serum biochemical values on day 7 were within the small and physiological range when compared with the preoperative baseline values, and significant differences were not detected among the MAR, fibrin glue, and saline groups. The severities of adhesion were similar between the 3 groups. Conclusion: Our data demonstrated that MAR was not inferior to fibrin glue in terms of hemostatic efficacy and safety.

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Section: Discussionmentioning

confidence: 99%

“…Although several topical hemostatic agents have been developed and used in various surgical disciplines [5], fibrin glue is currently the most widely used in liver surgery [6-8]. This is because fibrin glue has been proved to have a hemostatic effect, biocompatibility, and biodegradability in many studies [9-11].…”

Section: Introductionmentioning

confidence: 99%

Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model

et al. 2018

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“…The surgical procedure used for the control of the bleeding can be chosen between: selective individual control of the bleeding vessels, compression of injure, mass ligature of the injured parenchymal tissue, partial resection of the organ, coagulation with electric scalpel, haemostatic sponges or application of topic haemostatic agents (collagen, gelatin or cellulose) 1,2,3 . One non-surgical alternative is the procedure involving the transfusion of haemoderivates 1,3 .…”

Section: Introductionmentioning

confidence: 99%

The role of biological adhesive and suture material on rabbit hepatic injury

2006

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Purpose:To evaluate the performance of fibrin adhesive and absorbable suture thread in the repairing of hepatic injures in rabbits. Methods: New Zealand albino rabbits (n=16), males and females, from 5 to 6 months old, average weight of 2500 g, were distributed randomly in Group A (n-8) -biological adhesive and Group B (n=8) -suture thread. After anesthesia with acepromazine (1mg/Kg), ketamine (50mg/Kg) and fentanyl EV (0,5ml/Kg), it was performed a supra-umbilical median laparotomy, the median hepatic lobe was isolated and subjected to severe standardized incision. In the group B the incision edges were sutured with simple 4-0 catgut, in separated stitches. It was evaluated the total time of the procedure, the hemostasis time and hemorrhage volume. In the 21 st post-operative day it was evaluated the presence of adherences and signs of infection in the abdominal cavity, and it was followed by the resection of the median hepatic lobe for the histological evaluation. Results: The calculated mean and standard deviation showed that the procedure time, hemostasis time and bleeding amount were significantly smaller in the group of animals subjected to the use of fibrin adhesive. The surgical abdominal incision was significantly more extensive in the animals of the suture group (average of 6,8 cm) in relation to the adhesive group (average of 3,8), as well as the number of occurrences of abscesses. The adherence of the intestinal ansas to the sutured incision (group B) occurred in five cases and the major omentum adhesion occurred in all animals. In the group A (adhesive) it occurred adherences of the major omentum in three cases. The microscopy of the hepatic incision repaired with the use of fibrin showed that the inflammatory infection is less intense, not associated with the formulation of secretion in the abscesses, and therefore has a more favorable later cicatricial aspect than a conventional suture with surgical thread. Conclusion:In agreement with other biomedical literature works, the fibrin adhesive is a viable option for the performance of hemostasis in a animal model (rabbit) with severe hepatic injury. Key words: Liver. Fibrin Tissue Adhesive. Sutures Techniques. RESUMO Objetivo:Avaliar o desempenho do adesivo de fibrina e do fio de sutura absorvível no reparo de lesões hepáticas provocadas em coelhos. Métodos: Coelhos (n=16),Nova Zelândia, albinos, machos e fêmeas, 5 a 6 meses de idade, peso médio de 2500 gramas, foram distribuídos aleatoriamente em Grupo A(n = 8) -adesivo biológico e Grupo B(n=8) -fio de sutura. Após anestesia com acepromazina (1mg/Kg), quetamina (50mg/Kg) e fentanylEV (0,5ml/Kg), realizou-se laparotomia mediana supra-umbilical, o lobo hepático médio foi isolado e submetido a uma lesão padronizada grave. No grupo A foi aplicado o adesivo de fibrina. No grupo B as bordas da lesão foram suturadas com categute 4-0 simples, em pontos separados. Avaliou-se o tempo total de procedimento, tempo de hemostasia e volume da hemorragia. No 21 o dia de pós-operatório avaliou-se a presença ...

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“…The best approach in these cases is splenorrhaphy with an absorbable mesh. An appropriately sized piece of Vicryl mesh with an absorbable thread is wrapped around the spleen, and the thread is pulled together on the hilar face to produce hemostasis without compromising intraparenchymal circulation [26]. It is extremely important that the pouch be slightly smaller than the spleen itself, so that the thread lies on the margin when it has been pulled taut.…”

Section: Mesh Splenorrhaphymentioning

confidence: 99%