The use of state-of-the-art haemostatic materials in gastrointestinal surgery

Abstract

Haemostatic materials such as: gelatine sponges, oxygenated cellulose meshes, tissue sealants, collagen matrices with human thrombin and fibrinogen are gaining on popularity in gastrointestinal surgery, especially in colorectal surgery. We searched for available scientific publications in the Pubmed and Cochrane database on the use of individual hemostatic materials in the field of gastrointestinal surgery. The analysis focused on the assessment of the safety of the use of individual materials in terms of the rate of bleeding complications and the rate of anastomotic leakage cases. The use of haemostatic materials has for years been a recognized method of reducing the rate of intra- and postoperative complications, both in gastrointestinal surgery and in other surgical specialties. Based on the available studies, it can be concluded that the use of hemostatic materials such as matrices, sponges and adhesives in gastrointestinal surgery, even in patients at high risk of anastomotic leakage and bleeding complications, reduces the incidence of complications. The growing popularity of haemostatics and sealants in surgery means that they are currently used in a wide range of indications, and surgeons are more and more willing to use them even in case of standard surgical procedures, which is reflected in the available studies. Choosing a haemostat should be a conscious decision, taking into account the site and type of bleeding, mechanism of action, ease of use, efficacy, safety, and price, among others.

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

“…Recently, Chiara et al comprehensively summarized the general considerations and scientific foundations to select proper hemostatic agents correctly in four main items: adhesive hemostats, mechanical hemostats, sealants, and hemostatic dressings. [29] Due to surgical complexity and diverse hemostatic requirements, topical hemostatic agents have different forms (liquid, solid), compositions (organic, synthetic, inorganic), registration status (medical devices, drugs, medicinal products), and mechanisms of action (passive and active), [30] which facilitate surgeon's assessment and conscious decision for intraoperative utilization and correct selection with definite purpose. Recently, many FDA-approved intracorporal agents as medical devices aimed to stanch bleeding instantly and stably and achieved effective intraoperative hemostatic treatments, [28,31] which predominates future upfront research in this area and guide the development directions of hemostatic materials.…”

“…According to the material sources of hemostatic agents, topical hemostatic agents are mainly made from natural‐derived biomaterials and synthetic polymers such as fibrin, collagen, chitosan, oxidized cellulose, zeolites, albumin, gelatin, polyethylene glycol (PEG), cyanoacrylates, and so forth, which often come in various formulations such as hydrogel, gauze, dressing, adhesive, bandage, granule, tourniquet, foam, spray, powder, and tamponade. [ 27b,30,32 ] Several excellent reviews have outlined clinical applications, formulations available, and the hemostatic characteristics of various materials and polymers. [ 27b,33 ] In the perspective of biomaterial science, some critical reviews have summarized the surgical indications, decreased extent of blood loss, time of hemostasis in animal models in vivo, and multifarious formulations in hemostatic utility.…”