Reducing blood loss at myomectomy with use of a gelatin-thrombin matrix hemostatic sealant

Raga, Francisco; Sanz‐Cortes, M.; Bonilla, Francisco; Casañ, E.M.; Bonilla‐Musoles, Fernando

doi:10.1016/j.fertnstert.2008.04.038

Cited by 64 publications

(48 citation statements)

References 22 publications

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“…In the field of gynecological surgery, excluding our own preliminary data of 2012 (21), we identified only one comparison of 25 cases and 25 controls focusing on Floseal ® use and PBL (20). In abdominal conservative myomectomy, HM use was associated with decreased PBL and lower transfusion rates (20).…”

Section: Discussionmentioning

confidence: 99%

“…In abdominal conservative myomectomy, HM use was associated with decreased PBL and lower transfusion rates (20). According to other endpoints, Floseal ® has been shown to reduce bleeding and to increase the chance of organ preservation in tubal and non-tubal ectopic pregnancies (17,18).…”

Section: Discussionmentioning

confidence: 99%

“…One of the most striking observations in our cohort (see Table IV) was that within the subgroup with coagulopathy, despite significant fewer blood transfusions, patients treated with HM recovered faster and were discharged earlier. Of note, coagulopathy or history of bleeding disorder were exclusion criteria in the studies of abdominal myomectomy (20) and of thyroid surgery (16 hemorrhage on anticoagulant or antiplatelet therapy. They reported "excellent", "safe" and "reproducible" results both in terms of decreased bleeding and patient outcome (33).…”

Section: Discussionmentioning

confidence: 99%

“…visceral, cardiac and neurosurgery) (3,(14)(15)(16)), but it is less known in gynecology (3). Excluding case reports with incidental HM use in conditions associated with intra-abdominal hemorrhage, such as ectopic pregnancy (17,18) or massive obstetric hemorrhage (19), we found only few studies -including our own preliminary report of 2012 -comparing HM use with conventional hemostasis in gynecological surgery (20)(21)(22)(23).…”

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Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic–Oncological Surgery with Hemostatic Gelatin–Thrombin Matrix

Watrowski

Jäger

Förster

2017

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Abstract. Aim: To assess the impact of the use of intraoperative hemostatic gelatin-thrombin matrix (HM)( (168 vs. 199 min, p=0.02) and hospitalization (9 vs. 14 days, p<0.001) times. The mean postoperative Hb drop (3.33 vs. 4.51 g/dl, p<0.001), and the mean postoperative increase in CRP (94.9 vs. 149.1 mg/l, p<0.001) were significantly less pronounced within the HM group. Despite more prevalent coagulopathy (48 vs. 31%, p=0.02), e.g. due to anticoagulant use (15.7 vs. 3%, p<0.001), patients treated using HM needed less frequent transfusions of packed red blood cells [odds ratio (OR)= 0.13, 95% confidence interval (CI) =0.07-0.24) and fresh frozen plasma (OR=0.51,. In comparison to controls, the need for surgical revisions (OR 0.1,) and intensive-care unit admissions (OR 0.15, Intraoperative bleeding is a complication of gynecological surgery (1, 2). Increased perioperative blood loss (PBL) disrupts the operation, impairs organ exposure, contributes to prolonged surgical and hospitalization times, increases the need for transfusion, and negatively impacts therapy costs (1, 3). In non-oncological gynecological surgery, acute postoperative hemorrhage is the most frequent cause of returning to the operating theater (2). A PBL of more than 1 l complicates 15-40% of radical oncological operations, resulting in transfusion rates of 30-60% (4-6). In general surgery, intraoperative transfusion of only one to two units of packed red blood cells (PRBC) has been shown to significantly elevate the risk for surgical-site infection, pneumonia, sepsis and 30-day mortality (7). In gynecological patients, blood transfusions are clearly associated with increased surgical wound infections and composite morbidity and mortality (8). Additionally, a low perioperative hemoglobin (Hb) level and blood transfusions themselves may worsen the prognosis of pelvic cancers (9, 10). Typical intraoperative hemostatic maneuvers comprise of compression, sutures, clips and electrocoagulation. However, in some cases, conventional hemostasis can be insufficient (e.g. due to intraoperative coagulopathy), unsafe (e.g. due to proximity of structures sensitive to thermal damage) or impractical (e.g. diffuse bleeding area) (1, 11). Additionally, a subset of patients undergoing surgery have impaired hemostasis, e.g. due to use of oral anticoagulant. In the past two decades, an increasing number of topical hemostats, sealants and adhesives have been available to surgeons (1,12 in vivo 31: 251-258 (2017) Patients and MethodsPatients and definitions. This was a retrospective single-center study, conducted at the St. Josefskrankenhaus, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany. The study period was January 1, 2008 to October 30, 2013. The study was approved by the Institutional Review Board of the University of Freiburg (Reference No. 194/12), and was registered with the German Clinical Trials Register (DRKS), a primary register of the WHO International Clinical Trials Registry Platform, trial number DRKS00004...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic–Oncological Surgery with Hemostatic Gelatin–Thrombin Matrix

Watrowski

Jäger

Förster

2017

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“…However, myomectomy should be considered for patients with symptoms or for those who have large or growing tumors and want to preserve fertility. In women who have complete childbearing, to the contrary, hysterectomy is the standard treatment for symptomatic leiomyomas [4,6] . Recent lines of attack to deal with uterine fibroid symptomatology involve hormone therapy (oral contraceptives, GnRHa), uterine artery embolization and a levonorgestrel-releasing intrauterine device (LNG-IUD) [3] .…”

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confidence: 99%