An update on topical haemostatic agents in liver surgery: systematic review and meta analysis

Abstract

Mortality and morbidity in hepatic surgery are affected by blood loss and transfusion. Topical haemostatic agents (THA) are composed by a matrix and/or fibrin sealants, and their association known as "carrier-bound fibrin sealant" (CBFS): despite widely used for secondary haemostasis, the level of evidence remains low. To realize a meta-analysis on the results of CBFS on haemostasis and postoperative complications. Searches in PubMed, PubMed Central, Cochrane and Google Scholar using keywords: "topical_haemostasis" OR "haemostatic_agents" OR "sealant_patch" OR "fibrin_sealant" OR "collagen_sealant" AND "liver_surgery" OR "hepatic_surgery" OR "liver_transplantation". Randomized clinical trials, large retrospective cohort studies, case control studies evaluating THA on open/laparoscopic liver surgery and transplantation. From 1993 to 2016 were found 22 studies for qualitative synthesis and 13 for quantitative meta-analysis. The time to haemostasis was lower in the CBFS group (mean difference À2.33 min; P = 0.00001). The risk of receiving blood transfusion, developing collections and bile leak was not influenced by the use of CBFS (OR 0.75; P = 0.25), (OR 0.72; P = 0.52), (OR 0.74; P = 0.30) respectively. The use of CBFS in liver surgery significantly reduce the time to haemostasis, but does not decrease transfusion, postoperative collection and bile leak.

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

“…Matrix‐bound sealants are composed of a carrier such as collagen or gelatin to stimulate endogenous coagulation, with or without additional active components (fibrinogen and thrombin). Although fibrin sealant patches were originally designed to improve haemostasis during surgery, there is an increasing number of publications about their tissue‐sealing properties for indications such as tightening anastomoses in gastrointestinal surgery, and sealing air leakage in pulmonary surgery, lymphatic leakage in urology and gynaecology, and cerebrospinal fluid leakage in neurosurgery. In the majority of previous studies in pancreatic surgery, sealant patches were used to cover the pancreatic stump after distal pancreatic resection.…”

Patient blood management for liver resection: consensus statements using Delphi methodology

“…This is based on the fact that topical hemostatic agents may decrease the time to hemostasis but have not been shown to reduce the need for RBCT in LR. 38,39 Indication for RBCT: The panel recommends that intraoperative RBCT follow published guidelines for restrictive transfusion strategies, including the Ottawa criteria for appropriate transfusion in LR. 25 It is also recommended that the decision be discussed between surgery and anesthesiology prior to administration of RBCT.…”

Update on Patient Management in Hepatic Surgery

“…A meta-analysis including randomized clinical trials, large retrospective cohort studies and case control studies was published and found no significant difference when using a carrierbound fibrin sealant (compared to the use of a product based on a human or animal matrix only or without using any hemostatic agent) in term of blood transfusion, risk of deep collections and bile leak (OR 0.75; p=0.25), (OR 0.72; p=0.52), (OR 0.74; p=0.30) respectively. There was only difference in time to obtain hemostasis (mean difference -2.33 min; p=0.00001) [43].…”