Managing hepatic bleeding with autologous plasma/collagen-based fibrin sealant

Effects of primary suture and fib sealant on hemostasis and liver regeneration in an experimental liver injury

AIM: To investigate the effects of fib sealant on hemostasis and liver regeneration and intra-abdominal adhesions in an experimental liver injury.

METHODS: Thirty-six Wistar rats were randomly divided into primary suture group (n = 15), fib sealant group (n = 15) and control group (n = 6). A wedge resection was performed on the left lobe of the liver. In primary suture group, liver was sutured using polypropylene material, while fib glue was administrated on the liver surface in fib sealant group.

RESULTS: More intra-abdominal adhesions were observed in the primary suture group compared to the fib sealant group on 3^rd (2.50 ± 0.5 vs 0.25 ± 0.5, P = 0.015), 10^th (2.75 ± 0.5 vs 0.50 ± 0.6, P = 0.06) and 20^th (1.75 ± 0.5 vs 0.70 ± 0.5, P = 0.015) postoperative days. Histopathological scores were better in the fib sealant group in comparison with the primary suture group on 3^rd (8.75 ± 0.5 vs 6.75 ± 0.5, P = 0.006), 10^th (7.50 ± 1.0 vs 5.5 ± 0.6, P = 0.021) and 20^th (6.40 ± 1.7 vs 3.20 ± 1.6, P = 0.025) postoperative days.

CONCLUSION: Out data suggest that fib sealant is preferred over primary suture in appropriate cases including liver trauma since it causes less intra-abdominal adhesions while allowing shorter hemostasis time as assessed in experimental liver trauma.

Comparison of a Plasma-based Composite Biologic Sealant With Fibrin Glue (Tisseel??) for Vascular Anastomoses

Biologic sealants are needed in numerous, more and more demanding, procedures--especially with developments occurring in endovascular and laparoscopic vascular techniques. An initial pilot study in dogs showed that a 4-cm aortotomy closed with a polyester patch sutured in place by a 4-mm-spaced running suture consistently led to massive hemorrhage. We then designed a study using five dogs where two aortotomies were done to compare the effect of Tisseel to that of an autologous sealant prepared in our laboratory. Arterial pressures and heparinization were maintained throughout the surgical procedure. Both biologic sealants prevented hemorrhage from the arteriotomy at unclamping. Macroscopic and histologic assessments were performed. At killing, one week later, the autologous sealant exhibited less blood saturation of the collagen sponge compared with Tisseel. The use of autologous plasma combined with other adhesive components could be an efficient alternative to allogenic fibrin glue. Further studies are needed to confirm these observations.