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Toro A, Rapisarda M, Terrasi A, Di Carlo I. Long-term persistence of carrier-bound fibrin sealant (TachoSil ®) following abdominal surgery: a decade-long follow-up study. Updates Surg 2024:10.1007/s13304-024-01952-x. [PMID: 39052209 DOI: 10.1007/s13304-024-01952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
This study analyzed the long-term effects of carrier-bound fibrin sealant (CBFS) following abdominal surgery by tracking patients for years post-application. From 2006 to 2022, patients who underwent this procedure were contacted via telephone. Those who died due to underlying diseases, natural causes, or refused the check-up were excluded from the study. After 11 years of follow-up, CBFS was observed in different forms on computed tomography scans in four patients. Our findings indicate that CBFS can persist for years after the procedure. While we cannot confirm any secondary effects, it appears that CBFS sponges are not resorbed within 12 weeks and can remain for many years post-implantation.
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Affiliation(s)
- Adriana Toro
- Department of Surgery, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Martina Rapisarda
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, General Surgery, University of Catania, Via Messina, 829, Catania, Italy
| | - Alessandro Terrasi
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, General Surgery, University of Catania, Via Messina, 829, Catania, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, General Surgery, University of Catania, Via Messina, 829, Catania, Italy.
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Lakha AS, Chadha R, Von-Kier S, Barbosa A, Maher K, Pirkl M, Stoneham M, Silva MA, Soonawalla Z, Udupa V, Reddy S, Gordon-Weeks A. Autologous blood transfusion reduces the requirement for perioperative allogenic blood transfusion in patients undergoing major hepatopancreatobiliary surgery: a retrospective cohort study. Int J Surg 2023; 109:3078-3086. [PMID: 37402308 PMCID: PMC10583901 DOI: 10.1097/js9.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Major hepatopancreatobiliary surgery is associated with a risk of major blood loss. The authors aimed to assess whether autologous transfusion of blood salvaged intraoperatively reduces the requirement for postoperative allogenic transfusion in this patient cohort. MATERIALS AND METHODS In this single centre study, information from a prospective database of 501 patients undergoing major hepatopancreatobiliary resection (2015-2022) was analysed. Patients who received cell salvage ( n =264) were compared with those who did not ( n =237). Nonautologous (allogenic) transfusion was assessed from the time of surgery to 5 days postsurgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with allogenic blood transfusion avoidance. RESULTS 32% of the lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although the cell salvage group experienced significantly higher intraoperative blood loss compared with the noncell salvage group (1360 ml vs. 971 ml, P =0.0005), they received significantly less allogenic red blood cell units (1.5 vs. 0.92 units/patient, P =0.03). Correction of blood loss tolerance in patients who underwent cell salvage was independently associated with avoidance of allogenic transfusion (Odds ratio 0.05 (0.006-0.38) P =0.005). In a subgroup analysis, cell salvage use was associated with a significant reduction in 30-day mortality in patients undergoing major hepatectomy (6 vs. 1%, P =0.04). CONCLUSION Cell salvage use was associated with a reduction in allogenic blood transfusion and a reduction in 30-day mortality in patients undergoing major hepatectomy. Prospective trials are warranted to understand whether the use of cell salvage should be routinely utilised for major hepatectomy.
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Affiliation(s)
| | | | | | | | | | | | - Mark Stoneham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust
| | | | | | | | | | - Alex Gordon-Weeks
- Department of Hepatobiliary Surgery
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Malik AK, Amer AO, Tingle SJ, Thompson ER, White SA, Manas DM, Wilson C. Fibrin-based haemostatic agents for reducing blood loss in adult liver resection. Cochrane Database Syst Rev 2023; 8:CD010872. [PMID: 37551841 PMCID: PMC10411946 DOI: 10.1002/14651858.cd010872.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Liver resection is the optimal treatment for selected benign and malignant liver tumours, but it can be associated with significant blood loss. Numerous anaesthetic and surgical techniques have been developed to reduce blood loss and improve perioperative outcomes. One such technique is the application of topical fibrin-based haemostatic agents (FBHAs) to the resection surface. There is no standard practice for FBHA use, and a variety of commercial agents and devices are available, as well as non-FBHAs (e.g. collagen-based agents). The literature is inconclusive on the effectiveness of these methods and on the clinical benefits of their routine use. OBJECTIVES To evaluate the benefits and harms of fibrin-based haemostatic agents in reducing intraoperative blood loss in adults undergoing liver resection. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group (CHBG) Controlled Trials Register, CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index-Science up to 20 January 2023. We also searched online trial registries, checked the reference lists of all primary studies, and contacted the authors of included trials for additional published or unpublished trials. SELECTION CRITERIA We considered for inclusion all randomised clinical trials evaluating FBHAs versus no topical intervention or non-FBHAs, irrespective of publication type, publication status, language of publication, and outcomes reported. Eligible participants could have any liver pathology and be undergoing major or minor liver resections through open or laparoscopic surgery. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the literature search and used data extraction forms to collate the results. We expressed dichotomous outcome results as risk ratios (RRs) and continuous outcome results as mean differences (MDs), each with their corresponding 95% confidence interval (CI). We used a random-effects model for the main analyses. Our primary outcomes were perioperative mortality, serious adverse events, haemostatic efficacy, and health-related quality of life. Our secondary outcomes were efficacy as sealant, adverse events considered non-serious, operating time, and length of hospital stay. We assessed the certainty of the evidence with GRADE and presented results in two summary of findings tables. MAIN RESULTS We included 22 trials (2945 participants) evaluating FBHAs versus no intervention or non-FBHAs; 19 trials with 2642 participants provided data for the meta-analyses. Twelve trials reported commercial funding, one trial reported no financial support, and nine trials provided no information on funding. Below we present the most clinically relevant outcome results, also displayed in our summary of findings table. Fibrin-based haemostatic agents versus no intervention Six trials (1001 participants) compared FBHAs with no intervention. One trial was at low risk of bias in all five domains, and all other trials were at high or unclear risk of bias in at least one domain. Two trials were at high risk of bias related to blinding. It is unclear if FBHAs compared with no intervention have an effect on perioperative mortality (RR 2.58, 95% CI 0.89 to 7.44; 4 trials, 782 participants), serious adverse events (RR 0.96, 95% CI 0.88 to 1.05; 4 trials, 782 participants), postoperative transfusion (RR 1.04, 95% CI 0.77 to 1.40; 5 trials, 864 participants), reoperation (RR 2.92, 95% CI 0.58 to 14.61; 2 trials, 612 participants), or postoperative bile leak (RR 1.00, 95% CI 0.67 to 1.48; 4 trials, 782 participants), as the certainty of evidence was very low for all these outcomes. Fibrin-based haemostatic agents versus non-fibrin-based haemostatic agents Sixteen trials (1944 participants) compared FBHAs with non-FBHAs. All trials had at least one domain at high or unclear risk of bias. Twelve trials were at high risk of bias related to blinding. It is unclear if FBHAs compared with non-FBHAs have an effect on perioperative mortality (RR 1.03, 95% CI 0.62 to 1.72; 11 trials, 1436 participants), postoperative transfusion (RR 0.92, 95% CI 0.68 to 1.25; 7 trials, 599 participants), reoperation (RR 0.48, 95% CI 0.25 to 0.90; 3 trials, 358 participants), or postoperative bile leak (RR 1.15, 95% CI 0.60 to 2.21; 9 trials, 1115 participants), as the certainty of evidence was very low for all these outcomes. FBHAs compared with non-FBHAs may have little or no effect on the risk of serious adverse events (RR 0.99, 95% CI 0.95 to 1.03; 9 trials, 1176 participants; low-certainty evidence). AUTHORS' CONCLUSIONS The evidence for the outcomes in both comparisons (FBHAs versus no intervention and FBHAs versus non-FBHAs) was of very low certainty (or low certainty in one instance) and cannot justify the routine use of FBHAs to reduce blood loss in adult liver resection. While the meta-analysis showed a reduced risk of reoperation with FBHAs compared with non-FBHAs, the analysis was confounded by the small number of trials reporting the event and the risk of bias in all these trials. Future trials should focus on the use of FBHAs in people undergoing liver resection who are at particularly high risk of bleeding. Investigators should evaluate clinically meaningful and patient-important outcomes and follow the SPIRIT and CONSORT statements.
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Affiliation(s)
- Abdullah K Malik
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
| | - Aimen O Amer
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
| | - Steven A White
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Derek M Manas
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin Wilson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
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Are hemostatic agents for selective cases of tubeless percutaneous nephrolithotomy necessary for access tract control? A randomized control trial. Int Urol Nephrol 2023; 55:1093-1100. [PMID: 36847975 DOI: 10.1007/s11255-023-03492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) access tract sealing agent. Fibrin glue and Tachosil® were used for sealing the access tract and compared to the control. Post operative computed tomography (CT) scan was used to evaluate those efficacies. METHODS A total of 108 patients were randomized to three groups: In group 1, the access tract was sutured, and compressive dressing was done. In group 2, the fibrin glue was injected into the access tract with a tip applicator at the end of operation. And group 3, Tachosil® was rolled on its longitudinal axis and plugged into the access tract. Non-contrast CT at POD 1 was taken and perirenal hematoma thickness was measured and graded. Hemoglobin, hematocrit, VAS score, stone-free status, and hospital stay were analyzed. RESULTS Preoperative demographic differences were not significant in all three arms. Postoperative CT scans in all groups demonstrated mostly minimal grade access tract hematomas. Mean perirenal hematoma thickness showed no significant differences (2.66 ± 3.74, 2.73 ± 3.85, 2.54 ± 4.37 mm, p = 0.981), respectively. Postoperative hemoglobin drop (0.75 ± 0.58, 0.84 ± 0.47, 0.91 ± 0.60 g/dl, p = 0.74), stone-free rate (93.75, 87.87, 87.87%, p = 0.121), VAS (p = 0.499) and hospital stay (1.81 ± 0.84, 1.48 ± 0.71, 1.59 ± 0.75 day, p = 0.127) were not significantly different between the groups. CONCLUSION Fibrin glue and Tachosil® in tubeless PCNL were not necessary for postoperative access tract control.
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A new hemostatic agent composed of Zn2+-enriched Ca2+ alginate activates vascular endothelial cells in vitro and promotes tissue repair in vivo. Bioact Mater 2022; 18:368-382. [PMID: 35415309 PMCID: PMC8965972 DOI: 10.1016/j.bioactmat.2022.01.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
To control capillary bleeding, surgeons may use absorbable hemostatic agents, such as Surgicel® and TachoSil®. Due to their slow resorption, their persistence in situ can have a negative impact on tissue repair in the resected organ. To avoid complications and obtain a hemostatic agent that promotes tissue repair, a zinc-supplemented calcium alginate compress was developed: HEMO-IONIC®. This compress is non-absorbable and is therefore removed once hemostasis has been achieved. After demonstrating the hemostatic efficacy and stability of the blood clot obtained with HEMO-IONIC, the impact of Surgicel, TachoSil, and HEMO-IONIC on cell activation and tissue repair were compared (i) in vitro on endothelial cells, which are essential to tissue repair, and (ii) in vivo in a mouse skin excision model. In vitro, only HEMO-IONIC maintained the phenotypic and functional properties of endothelial cells and induced their migration. In comparison, Surgicel was found to be highly cytotoxic, and TachoSil inhibited endothelial cell migration. In vivo, only HEMO-IONIC increased angiogenesis, the recruitment of cells essential to tissue repair (macrophages, fibroblasts, and epithelial cells), and accelerated maturation of the extracellular matrix. These results demonstrate that a zinc-supplemented calcium alginate, HEMO-IONIC, applied for 10 min at the end of surgery and then removed has a long-term positive effect on all phases of tissue repair. A new Zn2+ enriched Ca2+ alginate hemostatic agent, HEMO-IONIC, has been developed. Non-absorbable, it achieves hemostasis with no foreign bodies left in the wound. HEMO-IONIC stimulates endothelial cell migration in vitro and angiogenesis in vivo. HEMO-IONIC, removed 10 min after application, promotes all stages of tissue repair.
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Nahm CB, Popescu I, Botea F, Fenwick S, Fondevila C, Bilbao I, Reim D, Toogood GJ. A multi-center post-market clinical study to confirm safety and performance of PuraStat® in the management of bleeding during open liver resection. HPB (Oxford) 2022; 24:700-707. [PMID: 34674951 DOI: 10.1016/j.hpb.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND PuraStat® is a non-bioactive haemostatic agent that has demonstrated efficacy in a number of different surgical procedures. We performed a prospective multi-centre post-market study to evaluate the efficacy and safety of PuraStat® in liver resections performed for metastatic tumors. METHODS This was a prospective cohort study. Patients undergoing liver resection for metastatic tumor were screened for eligibility, and included if they were ≥18 years old, undergoing open liver resection, had normal liver function, and required application of PuraStat® for haemostasis where standard haemostatic techniques were either insufficient or impractical. The primary endpoint was "time to haemostasis" (TTH). Secondary endpoints included blood loss, total postoperative drainage volume, transfusion of blood products, and ease of use. RESULTS Eighty patients were included for analysis in the intention to treat population. 207 bleeding sites were treated with PuraStat. Of these, 190 (91.7%) bleeding sites reached haemostasis after PuraStat® application. Mean TTH (mm:ss) was 1:01 (SD 1:06, range 0:09-6:55). Ease of use of the product was described as either "excellent" or "good" in 78 (98.8%) patients. No serious adverse events were identified. CONCLUSION This study confirms the safety, efficacy and ease of use of PuraStat® in the management of bleeding in liver surgery.
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Affiliation(s)
- Christopher B Nahm
- Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Surgical Innovations Unit, Westmead Hospital, Sydney, Australia.
| | - Irinel Popescu
- Institutul Clinic Fundeni - Centrul de Chirurgie Generala si Transplant Hepatic, Bucharest, Romania
| | - Florin Botea
- Institutul Clinic Fundeni - Centrul de Chirurgie Generala si Transplant Hepatic, Bucharest, Romania
| | - Stephen Fenwick
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | - Daniel Reim
- Klinik und Poliklinik für Chirurgie, München, Germany
| | - Giles J Toogood
- The University of Leeds, Leeds, UK; St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Park YM, Seo HI, Kim JH, Yoon SP, Lee H, Lee MS. Clinical application of a new hemostatic material using mussel-inspired catecholamine hemostat: A pilot study. Ann Hepatobiliary Pancreat Surg 2021; 26:98-103. [PMID: 34840145 PMCID: PMC8901974 DOI: 10.14701/ahbps.21-077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Backgrounds/Aims This study aimed to evaluate clinical application of InnoSEAL Plus (a mussel-inspired catecholamine hemostat) as a new hemostatic material for humans. Methods Patients treated with topical hemostatic patches after liver resection were enrolled. They were divided into an experimental group (InnoSEAL Plus group) and two control groups (TachoSil® group and Surgicel Fibrillar® group) for efficacy evaluation. Results A total of 15 patients were enrolled. Each group had five patients. The 3-minute hemostasis success rate was 80.0% (4/5 patients) in the InnoSEAL Plus group, 80.0% (4/5 patients) in the TachoSil® group, and 40.0% (2/5 patients) in the Surgicel Fibrillar® group, showing no significant difference in the success rate among these groups (p > 0.05). All three groups exhibited 100% success rate for 10-minute hemostasis. Both InnoSEAL Plus and TachoSil® groups had one patient developing adverse events, which were treated easily with drug administrations. Conclusions InnoSEAL Plus is expected to be functionally not inferior to other conventional hemostatic agents. However, it is necessary to confirm this through multicenter prospective studies in the future.
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Affiliation(s)
- Young-Mok Park
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyung-Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Hoon Kim
- Department of Trauma Surgery and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sung Pil Yoon
- Department of Surgery, Gang-an Hospital, Busan, Korea
| | - Haeshin Lee
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
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Yıldırım MA, Çakır M, Fındık S, Kişi Ö, Şentürk M. Comparison of the efficacy of growth factor collagen and antibiotic collagen on colon anastomosis in experimental animals with peritonitis. Indian J Gastroenterol 2021; 40:309-315. [PMID: 34019242 DOI: 10.1007/s12664-020-01145-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/28/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In spite of advances in surgical techniques, the significance of anastomosis leak continues in colorectal surgery. There is no ideal method in spite of all studies and technical advances in this field. Our aim of this study was to use fibroblast growth factor collagen (FGF-C) and antibiotic collagen (AB-C) to increase the rate of anastomosis healing in experimental animals with peritonitis. METHODS This animal experimental study received ethics committee approval. The animals were divided into three groups of seven animals each; the first group was control, the second group was the fibroblast growth factor collagen group, and the third group was the antibiotic collagen group. Under anesthesia, more than 50% of the colonic lumen was opened 4-5 cm distal to the ileocecal junction to create a defect. Twenty-four hours later, primary anastomosis was performed. The second group had the anastomosis line covered with a cover containing FGF-C. The third group had the anastomosis line covered by material containing AB-C. The experiment was concluded on the postoperative 7th day, and the anastomosis burst pressure, tissue hydroxyproline level, and histopathological assessment were performed. RESULTS Though the burst pressure was higher in the experimental groups, it was not statistically significant. In the second and third groups, vascular proliferation and fibroblastic activity appeared to be better than in the control group. Hydroxyproline values were statistically significant in the experimental groups compared to the control group. CONCLUSION FGF-C and AB-C may have potential utility in anastomosis healing, especially in those susceptible to infection due to anastomosis leak.
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Affiliation(s)
- Mehmet Aykut Yıldırım
- Meram Medical Faculty, Department of General Surgery, Necmettin Erbakan University, 42080, Konya, Turkey.
| | - Murat Çakır
- Meram Medical Faculty, Department of General Surgery, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Sıddıka Fındık
- Meram Medical Faculty, Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Kişi
- Meram Medical Faculty, Department of General Surgery, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Mustafa Şentürk
- Meram Medical Faculty, Department of General Surgery, Necmettin Erbakan University, 42080, Konya, Turkey
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Patrone R, Granata V, Belli A, Palaia R, Albino V, Piccirillo M, Fusco R, Tatangelo F, Nasti G, Avallone A, Izzo F. The safety and efficacy of Glubran 2 as biliostatic agent in liver resection. Infect Agent Cancer 2021; 16:19. [PMID: 33726798 PMCID: PMC7968309 DOI: 10.1186/s13027-021-00358-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Biloma, an encapsulated collection of bile outside the biliary tree, supported by a predominantly iatrogenic biliary fistula, and bile likeage are two of the most important surgical complications after liver resection. We, hypothesized to conduct a project aimed to prevent, or reduce, the formation of biloma or biliary fistula applying on the hepatic resection area the cyanoacrylate glue (Glubran2). Methods We searched in our surgical database all patients underwent liver resection for mCRC from January 2013 to December 2018 and we found a total of 510 patients. 205 patients for Group A (study population: included patients in which we have used Glubran2 during surgical procedure) and 113 patients for Group B (control group), were enrolled. Results In both Groups no patients died during hospitalization and the 30-day mortality was 0 %. During follow-up in Group A, a biliary fistula was found in 2 patients (1 %) versus 3 patients in the Group B (2,6 %). In patients enrolled in Group A no adverse event were reported relate to the use of Glubran2. Conclusions It is possible to affirm that the use of Glubran2 as biliostatic agent after liver resection is useful to prevent bile leakage complication and biloma formation and its use demonstrated to be safe and feasible during liver surgery.
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Affiliation(s)
- Renato Patrone
- PhD ICTH, University Federico II, Via Sergio Pansinin 5, 80131, Naples, Italy
| | - Vincenza Granata
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy. .,Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Andrea Belli
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Raffaele Palaia
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Vittorio Albino
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Mauro Piccirillo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Roberta Fusco
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Fabiana Tatangelo
- Department of Support to Cancer Pathways Diagnostics Area, Pathology and Cytopathology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Guglielmo Nasti
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Antonio Avallone
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Francesco Izzo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
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Przywózka-Suwał A, Ziółkowski B, Szczepkowski M. The use of state-of-the-art haemostatic materials in gastrointestinal surgery. POLISH JOURNAL OF SURGERY 2021; 93:49-54. [PMID: 33729174 DOI: 10.5604/01.3001.0014.7914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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.
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Affiliation(s)
- Alicja Przywózka-Suwał
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej Centrum Medycznego Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Bartosz Ziółkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej Centrum Medycznego Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej Centrum Medycznego Kształcenia Podyplomowego, Szpital Bielański, Warszawa
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Gaizo DJD, Spotnitz WD, Hoffman RW, Hermann MC, Sher LS, Spotnitz RH, Genyk YS, Schorn IJ, Gillen DL, White BL, Miller BG, Manson RJ. SPOT GRADE II: Clinical Validation of a New Method for Reproducibly Quantifying Surgical Wound Bleeding: Prospective, Multicenter, Multispecialty, Single-Arm Study. Clin Appl Thromb Hemost 2020; 26:1076029620936340. [PMID: 32703005 PMCID: PMC7383655 DOI: 10.1177/1076029620936340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The SPOT GRADE (SG), a Surface Bleeding Severity Scale, is a unique visual method for assessing bleeding severity based on quantitative determinations of blood flow. This study assessed the reliability of the SG scale in a clinical setting and collected initial data on the safety and efficacy of HEMOBLAST Bellows (HB), a hemostatic agent, in abdominal and orthopedic operations. Twenty-seven patients were enrolled across 3 centers and received the investigational device. Bleeding severity and hemostasis were independently assessed by 2 surgical investigators at baseline and at 3, 6, and 10 minutes after application of HB and compared for agreement. The mean paired κ statistic for assignment of SG scores was .7754. The mean paired κ statistics for determining eligibility for participation in the trial based on bleeding severity and the mean paired κ statistics determining the presence of hemostasis were .9301 and .9301, respectively. The proportion of patients achieving hemostasis within 3, 6, and 10 minutes of HB application were 50.0%, 79.2%, and 91.7%, respectively. There were no unanticipated adverse device effects and one possible serious adverse device effect, as determined by the Independent Data Monitoring Committee (IDMC). The reliability of the SG scale was validated in a clinical setting. Initial data on the safety and efficacy of HB in abdominal and orthopedic operations were collected, and there were no concerns raised by the investigators or the IDMC.
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Affiliation(s)
- Daniel J Del Gaizo
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
| | - William D Spotnitz
- Department of Surgery, University of Virginia, Charlottesville, VA, USA.,Biom'Up France, SAS, Saint-Priest, France
| | - Rachel W Hoffman
- Biom'Up France, SAS, Saint-Priest, France.,NAMSA, Clinical and Consulting, Minneapolis, MN, USA
| | | | - Linda S Sher
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Yuri S Genyk
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ian J Schorn
- Biom'Up France, SAS, Saint-Priest, France.,NAMSA, Clinical and Consulting, Minneapolis, MN, USA
| | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, CA, USA
| | | | - Bruce G Miller
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
| | - Roberto J Manson
- Biom'Up France, SAS, Saint-Priest, France.,Department of Surgery, Duke University, Durham, NC, USA
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12
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Rahbari NN, Birgin E, Sturm D, Schwanebeck U, Weitz J, Reissfelder C. Randomized clinical trial of BioFoam® Surgical Matrix to achieve hemostasis after liver resection. HPB (Oxford) 2020; 22:987-995. [PMID: 31680010 DOI: 10.1016/j.hpb.2019.10.1529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Topical agents were designed to facilitate hemostasis during hepatic resection. The aim of this prospective randomized controlled clinical trial was to evaluate the effectiveness and safety of BioFoam® Surgical Matrix for achieving hemostasis after open hepatic resection. METHODS This was a prospective, randomized controlled monocentric trial of patients undergoing elective open liver resection between December 2015 and September 2017. The primary endpoint was time-to-complete hemostasis. RESULTS A total of 101 patients were enrolled in this trial, giving 51 patients in the BioFoam® group and 50 patients in the control group (without use of BioFoam®). Time-to-complete hemostasis was significantly reduced in the BioFoam® group (156 ± 129 versus 307 ± 264 s; P = 0.001). There were no significant differences in postoperative bile leaks (n = 6 (12%) vs. n = 5 (10%); P = 0.776), postoperative morbidity (n = 37 (73%) vs. n = 40 (80%); P = 0.482) or mortality (n = 3 (6%) vs. n = 1 (2%); P = 0.618) between groups. CONCLUSION BioFoam® is a safe topical agent for achieving faster hemostasis during hepatic resection, however, the true clinical relevance of this finding needs to be further evaluated. ClinicalTrials.gov ID NCT02612220.
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Affiliation(s)
- Nuh N Rahbari
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.
| | - Emrullah Birgin
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dorothée Sturm
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Uta Schwanebeck
- Coordination Center for Clinical Trials Dresden, Biostatistics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Christoph Reissfelder
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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13
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Abstract
Hemostats, sealants, and adhesives are useful adjuncts to modern surgical procedures. To maximize their benefit, a surgeon needs to understand the safety, efficacy, usability, and cost of these agents. To be truly added to a surgeon's own toolbox, the operator must also have knowledge of when and how to best use these materials. This commentary is designed to succinctly facilitate this understanding and knowledge. A nomenclature and classification system based on group, category, and class has been created to help with this process and is provided here. By using this system, materials consisting of similar design and for common indications can be compared. For example, in this system, the three functional groups are hemostats, sealants, and adhesives. The hemostats may be divided into four categories: mechanical, active, flowable, and fibrin sealant. These hemostat categories are further subdivided into generic classes based on the composition of the approved materials. Similarly, categories and classes are provided for sealants and adhesives. In this commentary, the salient points with respect to the characteristics of these agents are presented. A discussion of when these agents can be used in specific indications and how they may be applied to achieve the best results is also provided.
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Affiliation(s)
- William D. Spotnitz
- From the Surgical Therapeutic Advancement Center, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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14
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Chen K, Sinelnikov MY, Nikolenko VN, Reshetov IV, Cao Y, Li Z, Kochurova EV, Nikolenko SN, Avila-Rodríguez M, Somasundaram SG, Kirkland CE, Aliev G. The Use of Fibrin-based Tissue Adhesives for Breast in Reconstructive and Plastic Surgery. Curr Top Med Chem 2020; 19:2985-2990. [PMID: 31721704 DOI: 10.2174/1568026619666191112101448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
Background:Breast plastic surgery is a rapidly evolving field of medicine. The modern view of surgical trends reflects the desire to minimize complications and introduce advanced technologies. These always will be priorities for surgeons. Reconstructive surgery, a branch of plastic surgery focusing on restoration of lost functional and aesthetic component, seeks to enhance psychological rehabilitation and improves the quality of life, as well as aesthetic recovery.Objective:This review addresses the action of fibrin agents and their effect on the quality of surgical hemostasis.Discussion and Conclusion:The fundamental goals for the surgeon are to perform a minimally traumatic intervention and to prevent any form of complication. Achieving complete hemostasis is an intraoperative necessity. Timely prevention of bleeding and hemorrhagic phenomena can affect not only the outcome of the operation, but also the incidence of postoperative complications. Topics include the integrity of microvascular anastomoses, tissue adhesion, and the incidence of seromas and hematomas associated with fibrin glue usage. The literature on fibrin adhesives with respect to prevention of postoperative complications, and the effectiveness with active drainage also are analyzed.
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Affiliation(s)
- Kuo Chen
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Mikhail Y. Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Vladimir N. Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Igor V. Reshetov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Yu Cao
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Zhi Li
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Ekaterina V. Kochurova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Svetlana N. Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Marco Avila-Rodríguez
- Department of Clinical Sciences, Faculty of Health Sciences, University of Tolima, Ibagué –730001, Colombia
| | - Siva G. Somasundaram
- Department of Biological Sciences, Salem University, 223 West Main Street Salem, WV 26426, United States
| | - Cecil E. Kirkland
- Department of Biological Sciences, Salem University, 223 West Main Street Salem, WV 26426, United States
| | - Gjumrakch Aliev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
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15
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Abstract
Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery. Technical innovations and accumulation of surgeon's experience have allowed laparoscopic liver resection (LLR) to become an effective procedure with favorable peri- and post-operative outcomes. Through the overall process of LLR, liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line, i.e., securing major vessels and obtaining adequate surgical margin clearance for malignancies. Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR; however, technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR, and therefore represents a major concern for hepatobiliary surgeons. Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon's preference and "savoir-faire", the best technical modality in laparoscopic liver parenchymal transection remains to be determined. However, better understanding the technical issue may serve a contribution to the standardization of LLR. This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.
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Affiliation(s)
- Tomoaki Yoh
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
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16
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López-Guerra D, Santos-Naharro J, Rojas-Holguín A, Jaen-Torrejimeno I, Prada-Villaverde A, Blanco-Fernández G. Postoperative bleeding and biliary leak after liver resection: A cohort study between two different fibrin sealant patches. Sci Rep 2019; 9:12001. [PMID: 31427638 PMCID: PMC6700165 DOI: 10.1038/s41598-019-48529-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
Different topical products have been tested in liver resection to get a control of bleeding. This study compares the effectiveness and complications between two haemostatic agents Tachosil versus Hemopatch. A cohort study including patients who underwent liver resection since November 2014 to April 2016 was conducted. The study was performed in a single institution. Demographic variables, intraoperative characteristics and postoperative complications were analysed. A total of 92 patients (50 in Tachosil group and 42 in Hemopatch group) were included. No differences were found in patients who required intraoperative (Tachosil 6 (12%) vs Hemopatch 2 (4.8%); p = 0.28) and postoperative (Tachosil 4 (8%) vs Hemopatch 3 (7.1%); p = 0.87) blood transfusion. There were no differences in length of hospital stay (Tachosil 7.02 ± 4.1 days vs Hemopatch 7.63 ± 9.1; p = 0.67). Overall postoperative complications were similar between both patches (Tachosil 21 (42%) vs Hemopatch 14 (33%); p = 0.48). No differences were found in specific complications, however Hemopatch showed a higher incidence of intraabdominal abscess 5 (11.9%) and vs 0 (0%) p = 0.01.In this study no differences have been found between Hemopatch and Tachosil in the effectiveness and overall postoperative complication after liver resection, although Hemopatch shows a higher incidence of intraabdominal abscess. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Diego López-Guerra
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain.
| | - Jesús Santos-Naharro
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Isabel Jaen-Torrejimeno
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Aranzazu Prada-Villaverde
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
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17
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Could we reduce adhesions to the intra-abdominal mesh in the first week? Experimental study with different methods of fixation. Hernia 2019; 24:1245-1251. [PMID: 31338720 DOI: 10.1007/s10029-019-02005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adhesion formation is a major problem when a mesh is exposed to intraabodminal viscera, with potential severe complications (bowel occlusion, fistulas or abscesses). New methods for preventing adhesions from a polypropylene mesh placed intra-abdominally or to solve difficult situations, such as when the peritoneum cannot be closed during a TAPP repair for an inguinal hernia, are still being seeked. This study mimics in an animal model a situation that can be found in clinical practice during laparoscopic inguinal hernioplasty. A polypropylene mesh could be exposed to the intra-abdominal cavity even when the peritoneum is closed due to different circumstances, with no options to guarantee the prosthetic material of being exposed to the intrabdominal viscera. Different options have been suggested to solve these situations, being proposed in this study to cover the visceral surface of the mesh with an absorbable sponge containing thrombin, fibrinogen, and clotting factors (Tachosil®, Nycomed, Takeda, Osaka, Japan), to assess its use as a barrier to prevent postoperative adhesion formation. MATERIAL AND METHODS Thirty Wistar white rats (300-450 mg) were included in this study as experimental animals, being randomized into three groups (A, B, and C). We performed a bilateral prosthetic repair with conventional polypropylene mesh (2 × 2 cm, 82 kD). Prosthesis fixation was performed as follows. Group A: absorbable suture; group B: metal staples; group C: metal tackers. A piece of insulating absorbable sponge (Tachosil® 5 × 5 cm) was placed to cover the visceral surface of mesh placed at the right side of each animal. After 10 days, we performed a gross examination (by laparoscopy and laparotomy), measuring the quantity and the quality of the adhesions. Samples were taken for histopathological analysis. RESULTS Tachosil®-treated prostheses showed a statistically significant decrease in the quality of the adhesion found (p < 0.05). In addition, a smaller quantity of adhesions was identified in barrier-treated animals, although this lacked statistical significance. The histologic analysis showed no significant differences: more edema with the untreated mesh and increased angiogenesis and a lower degree of necrosis in mesh covered with Tachosil®. CONCLUSIONS The use of Tachosil® as a barrier material led to the absence of strong adhesions as it prevented direct contact between the mesh and the internal organs, preventing major problems associated with strong adhesions.
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18
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Ardehali A, Spotnitz WD, Hoffman RW, Olson SA, Bochicchio GV, Hermann MC, Lakshman S, Dang NC, Centis V, Gillen DL, Schorn IJ, Spotnitz RH. Evaluation of the safety and efficacy of a new hemostatic powder using a quantitative surface bleeding severity scale. J Card Surg 2019; 34:50-62. [PMID: 30629770 DOI: 10.1111/jocs.13982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS OF THE STUDY The safety and efficacy of a hemostatic powder (HP) versus a control agent, absorbable gelatin sponge and thrombin (G + T), were assessed, using a validated, quantitative bleeding severity scale. METHODS Subjects were randomized to receive HP (256 subjects) or G + T (132 subjects) for treatment of minimal, mild, or moderate bleeding at 20 investigational sites. The primary efficacy endpoint was non-inferiority of HP relative to G + T for success at achieving hemostasis within 6 minutes. Secondary endpoints in rank order included: superiority of HP relative to G + T in mean preparation time; non-inferiority of HP relative to G + T for achieving hemostasis within 3 min; superiority of HP relative to G + T for achieving hemostasis within 6 min; and superiority of HP relative to G + T for success for achieving hemostasis within 3 min. RESULTS A total of 388 subjects were included in the primary efficacy analysis. At 6 min, hemostasis was achieved in 93.0% (238/256) of the HP group compared to 77.3% (102/132) of the G + T group (non-inferiority P < 0.0001, superiority P < 0.0001). All secondary endpoints were met. Complications were comparable between treatment groups. CONCLUSIONS HP had superior rates of hemostasis, shorter preparation time, and a similar safety profile compared to G + T in this prospective, randomized trial using quantitative bleeding severity criteria.
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Affiliation(s)
- Abbas Ardehali
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - William D Spotnitz
- Department of Surgery, University of Virginia, Charlottesville, Virginia.,Department of Medical Affairs, Biom'up, Lyon, France
| | | | - Steven A Olson
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Grant V Bochicchio
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Mark C Hermann
- General Orthopedics and Surgery, Spectrum Medical, Danville, Virginia
| | - Shankar Lakshman
- Department of Surgery, Huntington Hospital, Pasadena, California
| | - Nick C Dang
- Department of Surgery, Queens Hospital, Honolulu, Hawaii
| | - Valerie Centis
- Department of Research and Development, Biom'up, Lyon, France
| | - Dan L Gillen
- Department of Statistics, Department of Epidemiology, University of California at Irvine, Irvine, California
| | - Ian J Schorn
- NAMSA, Clinical and Consulting, Minneapolis, Minnesota
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- Advanced Powder Investigators Group (APIG)
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19
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Al-Saeedi M, Fonouni H, Kashfi A, Ghamarnejad O, Majlesara A, Gharabaghi N, Stahlheber O, Kraus TW, Mehrabi A, Kulu Y. Mechanical strength of biliary defect closure after topical sealing: Comparison of four sealants in a porcine model. Asian J Surg 2019; 42:723-730. [PMID: 30600147 DOI: 10.1016/j.asjsur.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE Biliary leakage is a potential complication of liver resection and is still a concern. The aim of the present study was to evaluate the effectiveness of four routinely used sealants in preventing bile leakage under pressure from an induced perforation of the gallbladder in a porcine model. METHODS Forty Landrace pigs were randomly assigned to one of five groups. These included a control group (n = 8) and one group each for the sealants TachoSil®, TissuCol Duo®, Coseal®, and FloSeal® (n = 8 per group). In the control group, the perforation was left unsealed. To evaluate the biliostatic potential of the sealants, we measured the pressure that was needed to induce leakage (mmHg) and the gallbladder volume (cc) at the time of leakage in each group. RESULTS A significantly higher mean pressure was required to induce leakage in the sealant groups compared with the control group. However, the biliostatic effects were heterogeneous among the sealant groups. Sealants with the highest to lowest effectiveness were TachoSil, Coseal, TissuCol, and FloSeal. The mean gallbladder volume at the time of leakage also varied between sealant groups. CONCLUSION Biliostatic properties are markedly improved by the use of modern sealants compared with using no sealant. However, the advantages and disadvantages of using sealants should be carefully considered in each clinical situation. The effectiveness of the sealants should be evaluated in chronic and clinical studies.
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Affiliation(s)
- Mohammad Al-Saeedi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Thomas W Kraus
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
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20
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Abbas MS, Mohamed KS, Ibraheim OA, Taha AM, Ibraheem TM, Fadel BA, Elawamy A, Abbas AM. Effects of terlipressin infusion on blood loss and transfusion needs during liver resection: A randomised trial. Acta Anaesthesiol Scand 2019; 63:34-39. [PMID: 30079635 DOI: 10.1111/aas.13226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Blood loss and perioperative blood transfusion requirements affect the long-term survival after liver resection for malignant tumours. Terlipressin is a synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction with subsequent reduction of blood loss during abdominal surgeries. We tried to examine the impact of terlipressin on blood loss and blood transfusion needs during liver resection. METHODS In this randomised, double-blind placebo-controlled trial 84 patients scheduled for major liver resections were randomly assigned to receive either terlipressin at the onset of surgery as an initial bolus dose of (1 mg over 30 minutes) followed by a continuous infusion of 2 μg/kg/h throughout the procedure (Terlipressin group) or the same volume and rate of 0.9% saline (Placebo group).The primary outcome was the amount of intra-operative blood loss. RESULTS The mean (SD) of the amount of intra-operative blood loss was 1351 (887) in the terlipressin group versus 1892 (889) mL in the placebo group (P = 0.006). Thirteen (30%) patients received blood transfusion in the terlipressin group compared with t27 (64.2%) in the placebo group (P = 0.002) with a statistically significant difference in the median (range) number of the transfused units of packed RBCs [0 (0-5) units and 1 (0-6) units in the two groups respectively; P = 0.001]. CONCLUSION Terlipressin infusion during major liver resection was associated with less bleeding compared to placebo. More studies are required to confirm our results especially in patients with normal portal pressure.
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Affiliation(s)
- Mostafa S. Abbas
- Anesthesia and Intensive Care Department; Assiut University; Assiut Egypt
| | - Khaled S. Mohamed
- Anesthesia and Intensive Care Department; Assiut University; Assiut Egypt
| | - Osama A. Ibraheim
- Anesthesia and Intensive Care Department; Assiut University; Assiut Egypt
| | - Ahmed M. Taha
- Unit of Hepatobiliary Surgery; General Surgery Department; Al Rajhi Liver Hospital; Assiut University; Assiut Egypt
| | - Tameem M. Ibraheem
- Unit of Hepatobiliary Surgery; General Surgery Department; Al Rajhi Liver Hospital; Assiut University; Assiut Egypt
| | - Bashir A. Fadel
- Unit of Hepatobiliary Surgery; General Surgery Department; Al Rajhi Liver Hospital; Assiut University; Assiut Egypt
| | | | - Ahmed M. Abbas
- Obstetrics and Gynaecology Department; Assiut University Hospital; Assiut University; Assiut Egypt
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21
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Bjelović M, Ayguasanosa J, Kim RD, Stojanović M, Vereczkei A, Nikolić S, Winslow E, Emre S, Xiao G, Navarro-Puerto J, Courtney K, Barrera G. A Prospective, Randomized, Phase III Study to Evaluate the Efficacy and Safety of Fibrin Sealant Grifols as an Adjunct to Hemostasis as Compared to Cellulose Sheets in Hepatic Surgery Resections. J Gastrointest Surg 2018; 22:1939-1949. [PMID: 29967969 DOI: 10.1007/s11605-018-3852-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/18/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local hemostatic agents have a role in limiting bleeding complications associated with liver resection. METHODS In this randomized, phase III study, we compared the efficacy and safety of Fibrin Sealant Grifols (FS Grifols) with oxidized cellulose sheets (Surgicel®) as adjuncts to hemostasis during hepatic resections. The primary efficacy endpoint was the proportion of patients achieving hemostasis at target bleeding sites (TBS) within 4 min (T4) of treatment application. Secondary efficacy variables were time to hemostasis (TTH) at a later time point if re-bleeding occurs and cumulative proportion of patients achieving hemostasis by time points T2, T3, T5, T7, and T10. RESULTS The rate of hemostasis by T4 was 92.8% in the FS Grifols group (n = 163) and 80.5% in the Surgicel® group (n = 162) (p = 0.01). The mean TTH was significantly shorter (p < 0.001) in the FS Grifols group (2.8 ± 0.14 vs. 3.8 ± 0.24 min). The rate of hemostasis by T2, T5, and T7 was higher and statistically superior in the FS Grifols group compared to Surgicel®. No substantial differences in adverse events (AE) were noted between treatment groups. The most common AEs were procedural pain (36.2 vs. 37.7%), nausea (20.9 vs. 23.5%), and hypotension (14.1 vs 6.2%). CONCLUSIONS FS Grifols was safe and well tolerated as a local hemostatic agent during liver resection surgeries. Overall, data demonstrate that the hemostatic efficacy of FS Grifols is superior to Surgicel® and support the use of FS Grifols as an effective local hemostatic agent in these surgical procedures.
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Affiliation(s)
- Miloš Bjelović
- Department for Minimally Invasive Upper Digestive Surgery, Clinical Center of Serbia, Hospital for Digestive Surgery - First Surgical Hospital, Dr Koste Todorovica Street No 66, Belgrade, 11000, Serbia.
| | | | - Robin D Kim
- Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - András Vereczkei
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Srdjan Nikolić
- Clinic of Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Emily Winslow
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sukru Emre
- Department of Surgery: Transplant & Immunology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Gary Xiao
- Division of Multi-Organ Transplantation and Hepato-Pancreato-Biliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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22
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Centeno A, Rojas S, Arias B, Miquel I, Sánchez P, Ureta C, Rincón E, López R, Murat J. Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding. J INVEST SURG 2018; 33:339-349. [DOI: 10.1080/08941939.2018.1517840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alberto Centeno
- Unit of Experimental Surgery, Institute of Biomedical Investigation of A Coruña, Xubias de Arriba, 84, A Coruña 15006, Spain
| | - Santiago Rojas
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
- Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès 08193, Spain
| | - Belén Arias
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Ignasi Miquel
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Pilar Sánchez
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Claudia Ureta
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Esther Rincón
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Ramón López
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
| | - Jesús Murat
- Thombotargets Europe S.L. Mediterranean Technology Park, Av. Canal Olímpic, s/n, Edif, B 6, 2ª, Castelldefels 08860, Spain
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23
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Long-term outcome after grafting with small intestinal submucosa and collagen fleece in patients with Peyronie's disease: a matched pair analysis. Int J Impot Res 2018; 31:256-262. [DOI: 10.1038/s41443-018-0071-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/03/2018] [Accepted: 08/20/2018] [Indexed: 12/19/2022]
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24
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Glowka TR, Paschenda P, Czaplik M, Kalff JC, Tolba RH. Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo. J Vis Exp 2018. [PMID: 30124636 DOI: 10.3791/57355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Plasma coagulation as a form of electrocautery is used in liver surgery for decades to seal the large liver cut surface after major hepatectomy to prevent hemorrhages at a later stage. The exact effects of plasma coagulation on liver tissue are only poorly examined. In our porcine model, the coagulation effects can be examined close to the clinical application. A combined laser Doppler flowmeter and spectrophotometer documents microcirculation changes during coagulation at 8 mm tissue depth noninvasively, providing quantifiable information about hemostasis beyond the subjective clinical impression. The temperature at coagulation site is assessed with an infrared thermometer prior and post coagulation and with a thermographic camera during coagulation, a measurement of the gas beam temperature is not possible due to the upper threshold of the devices. The depth of coagulation is measured microscopically on hematoxylin/eosin stained sections after calibration with an object micrometer and gives an exact information about the power setting-coagulation depth-relation. The sealing effect is examined on the bile ducts as it is not possible for a plasma coagulator to seal larger blood vessels. Burst pressure experiments are carried out on explanted organs to rule out blood pressure related effects.
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Affiliation(s)
| | - Pascal Paschenda
- Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University
| | | | | | - René H Tolba
- Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University
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25
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Weber WP, Tausch C, Hayoz S, Fehr MK, Ribi K, Hawle H, Lupatsch JE, Matter-Walstra K, Chiesa F, Dedes KJ, Berclaz G, Lelièvre L, Hess T, Güth U, Pioch V, Sarlos D, Leo C, Canonica C, Gabriel N, Zeindler J, Cassoly E, Andrieu C, Soysal SD, Ruhstaller T, Fehr PM, Knauer M. Impact of a Surgical Sealing Patch on Lymphatic Drainage After Axillary Dissection for Breast Cancer: The SAKK 23/13 Multicenter Randomized Phase III Trial. Ann Surg Oncol 2018; 25:2632-2640. [PMID: 29948418 DOI: 10.1245/s10434-018-6556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies and a meta-analysis showed that fibrin sealant patches reduced lymphatic drainage after various lymphadenectomy procedures. Our goal was to investigate the impact of these patches on drainage after axillary dissection for breast cancer. METHODS In a phase III superiority trial, we randomized patients undergoing breast-conserving surgery at 14 Swiss sites to receive versus not receive three large TachoSil® patches in the dissected axilla. Axillary drains were inserted in all patients. Patients and investigators assessing outcomes were blinded to group assignment. The primary endpoint was total volume of drainage. RESULTS Between March 2015 and December 2016, 142 patients were randomized (72 with TachoSil® and 70 without). Mean total volume of drainage in the control group was 703 ml [95% confidence interval (CI) 512-895 ml]. Application of TachoSil® did not significantly reduce the total volume of axillary drainage [mean difference (MD) -110 ml, 95% CI -316 to 94, p = 0.30]. A total of eight secondary endpoints related to drainage, morbidity, and quality of life were not improved by use of TachoSil®. The mean total cost per patient did not differ significantly between the groups [34,253 Swiss Francs (95% CI 32,625-35,880) with TachoSil® and 33,365 Swiss Francs (95% CI 31,771-34,961) without, p = 0.584]. In the TachoSil® group, length of stay was longer (MD 1 day, 95% CI 0.3-1.7, p = 0.009), and improvement of pain was faster, although the latter difference was not significant [2 days (95% CI 1-4) vs. 5.5 days (95% CI 2-11); p = 0.2]. CONCLUSIONS TachoSil® reduced drainage after axillary dissection for breast cancer neither significantly nor relevantly.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland.
| | | | | | | | - Karin Ribi
- SAKK Coordinating Center, Bern, Switzerland.,IBCSG Coordinating Center, Bern, Switzerland
| | | | - Judith Eva Lupatsch
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | | | - Federica Chiesa
- Breast Center Zürich, Zurich, Switzerland.,Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Konstantin Johannes Dedes
- Breast Cancer Center, Comprehensive Cancer Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | | | - Loic Lelièvre
- Centre du sein, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland
| | - Thomas Hess
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Uwe Güth
- Breast Center Zürich, Zurich, Switzerland.,Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | | | | | | | | | - Jasmin Zeindler
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Savas Deniz Soysal
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Ruhstaller
- Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter Martin Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Michael Knauer
- Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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26
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Buelens S, Van Praet C, Poelaert F, Van Huele A, Decaestecker K, Lumen N. Prospective Randomized Controlled Trial Exploring the Effect of TachoSil on Lymphocele Formation After Extended Pelvic Lymph Node Dissection in Prostate Cancer. Urology 2018; 118:134-140. [PMID: 29775698 DOI: 10.1016/j.urology.2018.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore whether TachoSil, a hemostatic patch, can reduce the incidence of lymphocele formation. Development of a lymphocele is a frequent complication after pelvic lymph node dissection (PLND) for nodal staging in prostate cancer. MATERIALS AND METHODS From 2013 to 2017, 100 patients with prostate cancer who were set to undergo a staging PLND before external beam radiotherapy (n = 50) or PLND concomitant with radical prostatectomy (RP) (n = 50) were prospectively randomized 1:1 between bilateral TachoSil placement or nonplacement. Primary end points were radiographic lymphocele development, lymphocele volume (1 week and 1 month postoperatively), and the duration and volume of postoperative catheter drainage. RESULTS Patient, tumor, and surgical characteristics of the TachoSil and the control groups did not differ significantly. In total, 65 patients (65%) experienced a radiographic lymphocele up to 3 months after surgery: 29 (58%) in the TachoSil group and 36 (72%) in the control group (P = .34). Significantly less radiographic lymphoceles were observed 1 week postoperatively for patients who underwent sole PLND and 1 month postoperatively for patients who underwent PLND with RP in the TachoSil group compared with the control group (16% vs 48%, P = .024, and 24% vs 52%, P = .047, respectively). The other postoperative characteristics presented no significant differences between the 2 groups, neither for patients undergoing sole PLND nor for patients undergoing PLND with RP. CONCLUSION Patients undergoing bilateral TachoSil placement after PLND seem less likely to develop a radiographic lymphocele early postoperatively. Nevertheless, the clinical relevance of the use of TachoSil remains highly debatable.
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Affiliation(s)
- Sarah Buelens
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium.
| | - Charles Van Praet
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Filip Poelaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | | | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
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27
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Takagi T, Tsujimoto H, Torii H, Ozamoto Y, Hagiwara A. Two-layer sheet of gelatin: A new topical hemostatic agent. Asian J Surg 2018; 41:124-130. [DOI: 10.1016/j.asjsur.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022] Open
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28
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Grimm C, Polterauer S, Helmy-Bader S, Zikan M, Cibula D, Heitz F, Harter P, Giese A, Reinthaller A, Tempfer C. A collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies: A randomized clinical trial. Gynecol Oncol 2018; 149:140-145. [PMID: 29395308 DOI: 10.1016/j.ygyno.2018.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies. METHODS In a multicenter, randomized, clinical trial, 164 women with pelvic lymphadenectomy were allocated either to bilateral pelvic application of two collagen-fibrin patches or no intervention. Main outcome was efficacy, defined as reduction of symptomatic lymphocele rate diagnosed within four weeks after surgery. Secondary outcomes were asymptomatic lymphoceles and subsequent interventions. Sample size was based on the assumption that application of a collagen-fibrin patch reduces the prevalence of symptomatic lymphoceles by at least 66%. The study was single-blinded, i.e., patients and primary outcome assessors, but not surgeons, were blinded to the treatment allocation. RESULTS A total of 75 women were randomized to the intervention and 89 to the control group. All women received the allocated intervention. In total, 42 (27.4%) lymphoceles and 8 (5.2%) symptomatic lymphoceles were observed. Symptomatic lymphoceles were observed in 5/68 (7.4%) women in the intervention group and 3/85 (3.5%) women in the control group (p = 0.47). Asymptomatic lymphoceles were observed in 16 (23.5%) women in the intervention group compared to 18 (21.2%) in the control group (p = 0.85). In a multivariate logistic regression model, no independent risk factor for the development of a symptomatic lymphocele was ascertained. DISCUSSION Intraoperative application of collagen-fibrin patches to the pelvic side walls does not reduce the incidence of symptomatic lymphoceles in women with gynecologic malignancies undergoing pelvic lymphadenectomy.
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Affiliation(s)
- Christoph Grimm
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Samir Helmy-Bader
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Michal Zikan
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University Prague, Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University Prague, Prague, Czech Republic
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Arnd Giese
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany; Department of Gastroenterology, St. Josef Hospital, Bochum, Germany
| | - Alexander Reinthaller
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Clemens Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
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29
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Edwards SJ, Crawford F, van Velthoven MH, Berardi A, Osei-Assibey G, Bacelar M, Salih F, Wakefield V. The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms. Health Technol Assess 2018; 20:1-224. [PMID: 28051764 DOI: 10.3310/hta20940] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use. OBJECTIVES To systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults. DATA SOURCES Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms. REVIEW METHODS This review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis. RESULTS We included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04; p = 0.13; I2 = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01; I2 = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays. LIMITATIONS It was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available. CONCLUSIONS The effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020710. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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30
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Garcia-Gomez B, Ralph D, Levine L, Moncada-Iribarren I, Djinovic R, Albersen M, Garcia-Cruz E, Romero-Otero J. Grafts for Peyronie's disease: a comprehensive review. Andrology 2017; 6:117-126. [DOI: 10.1111/andr.12421] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/17/2017] [Accepted: 08/02/2017] [Indexed: 12/28/2022]
Affiliation(s)
- B. Garcia-Gomez
- Department of Urology; 12 de Octubre University Hospital; Madrid Spain
| | - D. Ralph
- Departments of Urology and Andrology; University College Hospital; London UK
| | - L. Levine
- Department of Urology; Rush University; Chicago IL USA
| | | | | | - M. Albersen
- Department of Urology; University Hospitals Leuven; Leuven Belgium
| | | | - J. Romero-Otero
- Department of Urology; 12 de Octubre University Hospital; Madrid Spain
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31
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Oliveira FMD, Carvalho MVHD, Marchi E, Pinto CAL. The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries. Rev Col Bras Cir 2017; 43:110-6. [PMID: 27275592 DOI: 10.1590/0100-69912016002007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/17/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. METHODS we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. CONCLUSION the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.
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Affiliation(s)
- Frederico Michelino de Oliveira
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Marcus Vinícius H de Carvalho
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Evaldo Marchi
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Clóvis Antônio Lopes Pinto
- Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
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32
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Vicentine FPP, Gonzalez AM, Beninni BB, Azevedo RAD, Linhares MM, Goldenberg A, Lopes GDJ, Martins JL, Salzedas AA. Use of fibrinogen and thrombin sponge in pediatric split liver transplantation. Acta Cir Bras 2017; 32:673-679. [PMID: 28902943 DOI: 10.1590/s0102-865020170080000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/18/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Sciences, Universidade Federal de São Paulo (UNIFESP), Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; statistics analysis; final approval of the version to be published
| | - Adriano Miziara Gonzalez
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Barbara Burza Beninni
- Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study; acquisition, analysis and interpretation of data
| | - Ramiro Anthero de Azevedo
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Marcelo Moura Linhares
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Alberto Goldenberg
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Gaspar de Jesus Lopes
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Jose Luiz Martins
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Alcides Augusto Salzedas
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
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Glowka TR, Standop J, Paschenda P, Czaplik M, Kalff JC, Tolba RH. Argon and helium plasma coagulation of porcine liver tissue. J Int Med Res 2017; 45:1505-1517. [PMID: 28661266 PMCID: PMC5718717 DOI: 10.1177/0300060517706576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Argon plasma coagulation (APC) and helium plasma coagulation (HPC) are electrosurgical techniques that provide noncontact monopolar electrothermal haemostasis. Although these techniques have been widely used clinically during the last three decades, their in vivo effects on liver tissue remain unclear. Methods We investigated the effects of different power levels (10–100 W) of APC and HPC on liver coagulation in 11 Landrace pigs. Capillary blood flow and capillary blood flow velocity were recorded with a combined laser Doppler flowmeter and spectrophotometer. The temperature, clinical biochemical parameters, blood gas parameters, bile duct-sealing effect, and coagulation depth were measured. Results APC and HPC significantly reduced the capillary blood flow and capillary blood flow velocity compared with baseline flow. No significant temperature change was measured on the liver surface immediately after coagulation. The clinical biochemical and blood gas parameters were not different before and after coagulation. The coagulation depth was positively correlated with the device power setting. Conclusions These results prove that APC and HPC provide sufficient superficial haemostasis. No significant systemic effects occurred following coagulation. The depth of the coagulation effect can be controlled through selection of the output power level.
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Affiliation(s)
- Tim R Glowka
- 1 Department of Surgery, University of Bonn, Bonn, Germany
| | - Jens Standop
- 1 Department of Surgery, University of Bonn, Bonn, Germany
| | - Pascal Paschenda
- 2 Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University, Aachen, Germany
| | - Michael Czaplik
- 3 Department of Anesthesiology, RWTH Aachen University, Aachen, Germany
| | - Jörg C Kalff
- 1 Department of Surgery, University of Bonn, Bonn, Germany
| | - René H Tolba
- 2 Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University, Aachen, Germany
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Akahoshi K, Ochiai T, Takaoka A, Kitamura T, Ban D, Kudo A, Tanaka S, Tanabe M. Emergency Cholecystectomy for Patients on Antiplatelet Therapy. Am Surg 2017. [DOI: 10.1177/000313481708300523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
The use of antiplatelet therapy (APT) and/or anticoagulant therapy (ACT) continues to increase due to the aging population. Because the management of patients with acute cholecystitis receiving APT/ACTis still unclear, surgeons are sometimes faced with the difficult decision to delay surgery. We aimed to analyze characteristics and surgical risks of patients who underwent emergency cholecystectomy for acute cholecystitis without discontinuing APT. We conducted a retrospective review of 113 patients between 2006 and 2014. Treatment outcomes among 13 patients who underwent cholecystectomy without discontinuing APT (the cAPT group), 11 patients who discontinued APT and ACT (the D group), and 89 patients who did not receive preoperative APT and/or ACT (the No APT group) were compared. There were no significant differences in intraoperative blood loss, conversion to open surgery, and bleeding-related complications. However, the incidence of intraoperative blood transfusion was higher in the cAPT group (P = 0.04). They presented with severe local inflammation; thus, it was difficult to stop bleeding from the gallbladder bed. Hemostatic tools for liver surgery were used to control bleeding. Emergency cholecystectomy was tolerable for patients with acute cholecystitis while continuing APT. However, in case of severe local inflammation, there is a greater risk for massive hemorrhage.
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Affiliation(s)
| | | | - Ayumi Takaoka
- Departments of Hepatobiliary and Pancreatic Surgery and
| | | | - Daisuke Ban
- Departments of Hepatobiliary and Pancreatic Surgery and
| | - Atsushi Kudo
- Departments of Hepatobiliary and Pancreatic Surgery and
| | - Shinji Tanaka
- Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Tanabe
- Departments of Hepatobiliary and Pancreatic Surgery and
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Kawasaki S, Origasa H, Tetens V, Kobayashi M. Comparison of TachoSil and TachoComb in patients undergoing liver resection-a randomized, double-blind, non-inferiority trial. Langenbecks Arch Surg 2017; 402:591-598. [PMID: 28365804 PMCID: PMC5437221 DOI: 10.1007/s00423-017-1571-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/22/2017] [Indexed: 01/19/2023]
Abstract
Background This study aimed to demonstrate the noninferior efficacy of TachoSil vs. TachoComb in Japanese patients undergoing liver resection and to assess the safety of TachoSil vs. TachoComb in these patients. Methods This randomized, double-blind, noninferiority study (JapicCTI-090684) involved participants scheduled for liver resection/living donors (age ≥ 20 years). TachoSil or TachoComb (1:1 allocation ratio) was applied to control persistent exudative bleeding after primary hemostasis during liver resection/removal for donation. The primary outcome was hemostasis 5 min after study treatment application. The 95% confidence interval (CI) for the difference in the proportion of participants with hemostasis 5 min after application of TachoSil/TachoComb was determined; noninferiority of TachoSil was indicated if the lower limit of the CI was ≥−14%. Adverse events (AEs) were recorded. Results All participants in the efficacy analysis (TachoSil: 54/54, 100%; TachoComb: 54/54, 100%) achieved hemostasis 5 min after study treatment application. Therefore, TachoSil was noninferior to TachoComb. All participants experienced ≥1 AE; however, none discontinued because of an AE. Most (≥97.8%) AEs were mild or moderate in severity. Conclusions These findings confirm the safety profile and noninferior hemostatic efficacy of TachoSil compared with TachoComb.
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Affiliation(s)
- S Kawasaki
- Department of Hepatobiliary Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama City, Japan
| | - V Tetens
- Clinical Science, Takeda Development Centre Europe Ltd, London, UK
| | - M Kobayashi
- R&D Japan, CSL Behring K.K, 1-7-12 Shinonome, Koto-ku, Tokyo, 135-0062, Japan.
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Vicentine FPP, Gonzalez AM, Azevedo RAD, Benini BB, Linhares MM, Lopes-Filho GDJ, Martins JL, Salzedas-Netto AA. PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:236-239. [PMID: 28076477 PMCID: PMC5225862 DOI: 10.1590/0102-6720201600040006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/30/2016] [Indexed: 01/13/2023]
Abstract
Background Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion There was a lower number of reoperations due to bleeding of the wound area of the hepatic graft when the human fibrinogen and thrombin sponge were used.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | | | - Barbara Burza Benini
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Moura Linhares
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Jose Luiz Martins
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Alcides Augusto Salzedas-Netto
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
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Moggia E, Rouse B, Simillis C, Li T, Vaughan J, Davidson BR, Gurusamy KS. Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev 2016; 10:CD010683. [PMID: 27797116 PMCID: PMC6472530 DOI: 10.1002/14651858.cd010683.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Liver resection is a major surgery with significant mortality and morbidity. Specialists have tested various methods in attempts to limit blood loss, transfusion requirements, and morbidity during elective liver resection. These methods include different approaches (anterior versus conventional approach), use of autologous blood donation, cardiopulmonary interventions such as hypoventilation, low central venous pressure, different methods of parenchymal transection, different methods of management of the raw surface of the liver, different methods of vascular occlusion, and different pharmacological interventions. A surgeon typically uses only one of the methods from each of these seven categories. The optimal method to decrease blood loss and transfusion requirements in people undergoing liver resection is unknown. OBJECTIVES To assess the effects of different interventions for decreasing blood loss and blood transfusion requirements during elective liver resection. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Science Citation Index Expanded to September 2015 to identify randomised clinical trials. We also searched trial registers and handsearched the references lists of identified trials. SELECTION CRITERIA We included only randomised clinical trials (irrespective of language, blinding, or publication status) comparing different methods of decreasing blood loss and blood transfusion requirements in people undergoing liver resection. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials and collected data. We assessed the risk of bias using Cochrane domains. We conducted a Bayesian network meta-analysis using the Markov chain Monte Carlo method in WinBUGS 1.4, following the guidelines of the National Institute for Health and Care Excellence Decision Support Unit guidance documents. We calculated the odds ratios (OR) with 95% credible intervals (CrI) for the binary outcomes, mean differences (MD) with 95% CrI for continuous outcomes, and rate ratios with 95% CrI for count outcomes, using a fixed-effect model or random-effects model according to model-fit. We assessed the evidence with GRADE. MAIN RESULTS We identified 67 randomised clinical trials involving a total of 6197 participants. All the trials were at high risk of bias. A total of 5771 participants from 64 trials provided data for one or more outcomes included in this review. There was no evidence of differences in most of the comparisons, and where there was, these differences were in single trials, mostly of small sample size. We summarise only the evidence that was available in more than one trial below. Of the primary outcomes, the only one with evidence of a difference from more than one trial under the pair-wise comparison was in the number of adverse events (complications), which was higher with radiofrequency dissecting sealer than with the clamp-crush method (rate ratio 1.85, 95% CrI 1.07 to 3.26; 250 participants; 3 studies; very low-quality evidence). Among the secondary outcomes, the only differences we found from more than one trial under the pair-wise comparison were the following: blood transfusion (proportion) was higher in the low central venous pressure group than in the acute normovolemic haemodilution plus low central venous pressure group (OR 3.19, 95% CrI 1.56 to 6.95; 208 participants; 2 studies; low-quality evidence); blood transfusion quantity (red blood cells) was lower in the fibrin sealant group than in the control (MD -0.53 units, 95% CrI -1.00 to -0.07; 122 participants; 2; very low-quality evidence); blood transfusion quantity (fresh frozen plasma) was higher in the oxidised cellulose group than in the fibrin sealant group (MD 0.53 units, 95% CrI 0.36 to 0.71; 80 participants; 2 studies; very low-quality evidence); blood loss (MD -0.34 L, 95% CrI -0.46 to -0.22; 237 participants; 4 studies; very low-quality evidence), total hospital stay (MD -2.42 days, 95% CrI -3.91 to -0.94; 197 participants; 3 studies; very low-quality evidence), and operating time (MD -15.32 minutes, 95% CrI -29.03 to -1.69; 192 participants; 4 studies; very low-quality evidence) were lower with low central venous pressure than with control. For the other comparisons, the evidence for difference was either based on single small trials or there was no evidence of differences. None of the trials reported health-related quality of life or time needed to return to work. AUTHORS' CONCLUSIONS Paucity of data meant that we could not assess transitivity assumptions and inconsistency for most analyses. When direct and indirect comparisons were available, network meta-analysis provided additional effect estimates for comparisons where there were no direct comparisons. However, the paucity of data decreases the confidence in the results of the network meta-analysis. Low-quality evidence suggests that liver resection using a radiofrequency dissecting sealer may be associated with more adverse events than with the clamp-crush method. Low-quality evidence also suggests that the proportion of people requiring a blood transfusion is higher with low central venous pressure than with acute normovolemic haemodilution plus low central venous pressure; very low-quality evidence suggests that blood transfusion quantity (red blood cells) was lower with fibrin sealant than control; blood transfusion quantity (fresh frozen plasma) was higher with oxidised cellulose than with fibrin sealant; and blood loss, total hospital stay, and operating time were lower with low central venous pressure than with control. There is no evidence to suggest that using special equipment for liver resection is of any benefit in decreasing the mortality, morbidity, or blood transfusion requirements (very low-quality evidence). Radiofrequency dissecting sealer should not be used outside the clinical trial setting since there is low-quality evidence for increased harm without any evidence of benefits. In addition, it should be noted that the sample size was small and the credible intervals were wide, and we cannot rule out considerable benefit or harm with a specific method of liver resection.
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Affiliation(s)
- Elisabetta Moggia
- IRCCS Humanitas Research HospitalDepartment of General and Digestive SurgeryVia Manzoni 5620089 RozzanoMilanItalyItaly20089
| | - Benjamin Rouse
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Constantinos Simillis
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Tianjing Li
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Jessica Vaughan
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Brustia R, Granger B, Scatton O. An update on topical haemostatic agents in liver surgery: systematic review and meta analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:609-621. [PMID: 27580747 DOI: 10.1002/jhbp.389] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/29/2016] [Indexed: 12/31/2022]
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 -2.33 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.
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Affiliation(s)
- Raffaele Brustia
- Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France.,Université Pierre et Marie Curie, Paris, France
| | - Benjamin Granger
- Department of Biostatistics, Public Health and Medical Information, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France. .,Université Pierre et Marie Curie, Paris, France.
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OLIVEIRA FREDERICOMICHELINODE, CARVALHO MARCUSVINÍCIUSHDE, MARCHI EVALDO, PINTO CLÓVISANTÔNIOLOPES. Collagen, fibrinogen and thrombin biological addesive is effective in treating experimental liver injuries. Rev Col Bras Cir 2016; 43:254-61. [DOI: 10.1590/0100-69912016004004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/26/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective : to evaluate the effectiveness of a collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injury in rats. Methods : the study included 30 Wistar rats randomly divided into three groups: A, B and C. All underwent standard liver traumatic injury. In group A the lesion was treated with the adhesive; in group B, with conventional absorbable suture; and in group C, there was no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results : there was no statistical difference in relation to mortality (p = 0.5820). The group treated with the adhesive showed the lowest hemostasis times (p = 0.0573, odds ratio 13.5) and lower incidence of adhesions (p = 0.0119). Microscopic histological alterations of Groups A and B were similar, with foreign body granuloma formation separating the adhesive material or the suture from the hepatic stroma. Conclusion : the adhesive of collagen associated with fibrinogen and thrombin was effective in the treatment of experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.
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40
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Haas S. The Use of a Surgical Patch Coated With Human Coagulation Factors in Surgical Routine: A Multicenter Postauthorization Surveillance. Clin Appl Thromb Hemost 2016; 12:445-50. [PMID: 17000889 DOI: 10.1177/1076029606293420] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Local hemostyptic agents are of great value to significantly reduce bleeding complications and various devices have become available for clinical use. The aim of this multicenter postauthorization surveillance was to study the surgeons’ expectations regarding efficacy and safety of the surgical patch coated with human coagulation factors (TachoSil) under routine clinical conditions. A total of 408 patients had been included in this trial and the patients had to have an expected increased bleeding risk either due to patient related hemorrhagic risk factors or operations associated with an expected increase of bleeding complications. The main types of surgical interventions were operations on the liver (26%), vascular system (16%), gastrointestinal tract (10%), heart (8%), kidney (7%), thorax (7%), spleen (4%), and pancreas (4%). Other operations (18%) were reported in the fields of neurosurgery, urology, gynecology, dermatology, and on the thyroid gland. Based on subjective assessments the results have shown that TachoSil has met the surgeons’ expectations to be efficacious and safe as a hemostatic treatment in a broad variety of surgical interventions. The observed benefits far exceed the frequencies of complications and many of the observed benefits easily translate into cost savings. In almost 50% of the cases the surgeons thought that the use of the topical hemostat TachoSil may have led to savings in blood component therapy. The savings of intra- and postoperative transfusions may lead to less frequent transfusion-related adverse effects and the lower probability of postoperative complications is of clinical importance. In particular, it is worth mentioning that based on the surgeons’ assessment, the use of TachoSil may have helped to save the organ in 17% of the cases. Thus, these clinically relevant benefits may offer opportunities for improvements of hemostasis in patients at risk for bleeding complications and may facilitate the management of excessive bleeding.
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Affiliation(s)
- Sylvia Haas
- Institut für Experimentelle Onkologie und Therapieforschung, Technische Universität München, Germany.
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41
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Genyk Y, Kato T, Pomposelli JJ, Wright JK, Sher LS, Tetens V, Chapman WC. Fibrin Sealant Patch (TachoSil) vs Oxidized Regenerated Cellulose Patch (Surgicel Original) for the Secondary Treatment of Local Bleeding in Patients Undergoing Hepatic Resection: A Randomized Controlled Trial. J Am Coll Surg 2016; 222:261-8. [DOI: 10.1016/j.jamcollsurg.2015.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022]
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Filosso PL, Guerrera F, Sandri A, Zenga F, Lanza GV, Ruffini E, Bora G, Lyberis P, Solidoro P, Oliaro A. Efficacy and safety of human fibrinogen-thrombin patch (Tachosil(®)) in the management of diffuse bleeding after chest wall and spinal surgical resection for aggressive thoracic neoplasms. J Thorac Dis 2016; 8:E152-6. [PMID: 26904247 DOI: 10.3978/j.issn.2072-1439.2016.01.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Diffuse bleeding after chest wall and spine resection represents a major problem in General Thoracic Surgery. Several fibrin sealants (FS) have been developed over the years and their use has been gradually increasing over time, becoming an important aid to the surgeons, justifying their use across numerous fields of surgery due to its valid haemostatic properties. Among the several FS available, TachoSil(®) (Takeda Austria GmbH, Linz, Austria) stands out for its haemostatic and aerostatic properties, the latter being demonstrated even in high-risk patients after pulmonary resections for primary lung cancers. Several papers available in literature demonstrated TachoSil(®)'s effectiveness in controlling intraoperative and postoperative bleeding in different surgical branches, including hepatic and pancreatic surgery, as well as cardiac and thoracic surgery. However, the use of TachoSil(®) to control diffuse bleeding following major resections for advanced lung cancers, with requirement of chest wall and vertebral body resection for oncological radicality, was never published so far. In this paper, we report three cases of pulmonary lobectomy associated to chest wall resection and haemivertebrectomy for primary malignant lung neoplasms and for a recurrence of malignant solitary fibrous tumour of the pleura in which we used TachoSil(©), which demonstrated its efficacy in controlling diffuse bleeding following resection.
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Affiliation(s)
- Pier Luigi Filosso
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Francesco Guerrera
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Alberto Sandri
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Francesco Zenga
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Giovanni Vittorio Lanza
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Enrico Ruffini
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Giulia Bora
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Paraskevas Lyberis
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Paolo Solidoro
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
| | - Alberto Oliaro
- 1 Department of Thoracic Surgery, 2 Unit of Neurosurgery, University of Torino, Via Genova, 3 10126 Torino, Italy ; 3 Unit of Pulmonology, San Giovanni Battista Hospital, 10126 Torino, Italy
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Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2016. [PMID: 26897031 DOI: 10.1007/s00423-016-1382-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results. METHODS A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil(®) to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals. RESULTS Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil(®). A sensitivity analysis of only randomised controlled trials confirmed the results. CONCLUSIONS The application of Tachosil(®) to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.
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Hüttner FJ, Mihaljevic AL, Hackert T, Ulrich A, Büchler MW, Diener MK. Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2016; 401:151-9. [PMID: 26897031 DOI: 10.1007/s00423-016-1382-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/08/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results. METHODS A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil(®) to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals. RESULTS Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil(®). A sensitivity analysis of only randomised controlled trials confirmed the results. CONCLUSIONS The application of Tachosil(®) to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.
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Affiliation(s)
- Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
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Technical Feasibility of TachoSil Application on Esophageal Anastomoses. Gastroenterol Res Pract 2015; 2015:534080. [PMID: 26101523 PMCID: PMC4458550 DOI: 10.1155/2015/534080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023] Open
Abstract
Purpose. Sealing esophageal anastomoses with a sealant patch (TachoSil) containing human fibrinogen and thrombin may improve mechanical strength. The aim was to evaluate the technical feasibility of the application of a sealant patch in upper gastrointestinal surgery. Methods. In total 15 patients, 18–80 years old, undergoing thoracolaparoscopic esophagectomy with esophagogastrostomy or laparoscopic total gastrectomy with esophagojejunostomy was included. Different techniques of anastomotic TachoSil patch application were tested and recorded on video. Results. TachoSil was successfully applied to the esophagogastrostomy (n = 11) and to the esophagojejunostomy (n = 4). A median of 2 (1–6) attempts was necessary to reach successful application. The median duration was 7 (3–26) minutes before successful application was accomplished. The best technique in esophagectomy was the application of TachoSil with the use of 2 cellophane sheets. For total gastrectomy, the patch was folded into a harmonica shape and wrapped around the esophagojejunostomy. Although not significant, the number of attempts and time to success showed a decreasing trend along with the increased experience. Conclusion. Application of TachoSil as a sealant of esophageal anastomoses was technically feasible. Future studies may investigate the value of TachoSil application on the prevention of anastomotic leakage.
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Ruitenbeek K, Ayez N, Verhoef C, de Wilt JHW, Bottema J, Rijken AM, van Rij M, Koopman J, Zuckerman LA, Frohna P, Porte RJ. Safety and efficacy of a novel, dry powder fibrin sealant for hemostasis in hepatic resection. Dig Surg 2015; 31:422-7. [PMID: 25592001 DOI: 10.1159/000370006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/16/2014] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Fibrocaps is a dry powder fibrin sealant containing human plasma-derived fibrinogen and thrombin. The safety, efficacy, and application methods for Fibrocaps were evaluated in an exploratory, first-in-human, noncomparative, clinical study. METHODS Patients with minor bleeding/oozing after elective partial hepatic resection had Fibrocaps applied to the bleeding site either directly from the vial or from a spray device, with manual pressure applied using a cellulose, collagen, or gelatin sponge, if needed. Safety was evaluated at screening and postoperative days 1, 2, and 5, and weeks 4 and 12. The formation of anti-thrombin antibodies was assessed at baseline, and after 4 and 12 weeks. Time to hemostasis (TTH) within 10 min was determined. RESULTS Twenty-nine patients were treated with Fibrocaps; 6 experienced serious adverse events that were not related to the course of treatment. Adverse events occurring in >10% of patients were nausea, constipation, hypotension, obstipation, hypokalemia, and postoperative pain. Most adverse events were mild or moderate in severity. No patient developed anti-thrombin antibodies. The percentage of patients who achieved hemostasis was 93%; the median TTH was 3.8 min (range 0.3-10.3). Manual pressure was applied with Fibrocaps in 19 patients and considered beneficial in most. CONCLUSION Fibrocaps was well tolerated in patients undergoing elective hepatic resection and resulted in rapid hemostasis. These safety and efficacy results support further clinical testing of this ready-to-use fibrin sealant as an adjunct to surgical hemostasis.
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Affiliation(s)
- Karin Ruitenbeek
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Pandanaboyana S, Bell R, Shah N, Lodge JPA, Hidalgo E, Toogood GJ, Prasad KR. A cost-effective analysis of fibrin sealants versus no sealant following open right hemihepatectomy for colorectal liver metastases. ANZ J Surg 2014; 87:E11-E14. [DOI: 10.1111/ans.12948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Sanjay Pandanaboyana
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - Richard Bell
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - Nehal Shah
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - J. Peter A. Lodge
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - Ernest Hidalgo
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - Giles J. Toogood
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
| | - K. Raj Prasad
- Department of Hepatobiliary and Transplant Surgery; St James University Hospital; Leeds UK
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Fibrocaps for surgical hemostasis: two randomized, controlled phase II trials. J Surg Res 2014; 194:679-687. [PMID: 25586331 DOI: 10.1016/j.jss.2014.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Fibrocaps, a ready-to-use, dry-powder fibrin sealant containing human plasma-derived thrombin and fibrinogen, is being developed as an adjunct for surgical hemostasis. MATERIALS AND METHODS Safety and efficacy of Fibrocaps applied directly or by spray device, in combination with gelatin sponge, was compared with that of gelatin sponge-alone in two randomized, single-blind controlled trials: FC-002 US (United States) and FC-002 NL (the Netherlands). A total of 126 adult patients were randomized (Fibrocaps: n = 47 [FC-002 US], n = 39 [FC-002 NL]; gelatin sponge alone: n = 23 [FC-002 US], n = 17 [FC-002 NL). One bleeding site was treated during a surgical procedure (n = 125). Time to hemostasis (primary end point) was measured, with a 28-d safety follow-up. Four surgical indications included hepatic resection (n = 58), spinal procedures (n = 37), peripheral vascular procedures (n = 30), and soft tissue dissection (n = 1). RESULTS Mean (standard deviation) time to hemostasis was significantly shorter after Fibrocaps treatment than after gelatin sponge alone (FC-002 US: 1.9 [1.3] versus 4.8 min [3.1], P < 0.001; FC-002 NL: 2.2 [1.3] versus 4.4 min [3.1], P = 0.004). The incidence of hemostasis was greater after Fibrocaps compared with that of gelatin sponge alone within 3 min (FC-002 US: 83% versus 35%, P < 0.001; FC-002 NL: 77% versus 53%, P = 0.11), 5 min (94% versus 61%, P = 0.001; 95% versus 71%, P = 0.022), and 10 min (100% versus 78%, P = 0.003; 100% versus 82%, P = 0.025). Adverse events were consistent with surgical procedures performed and patients' underlying diseases and generally similar between treatment arms; most were mild or moderate in severity. Non-neutralizing antithrombin antibodies were detected in 5% of Fibrocaps-treated patients on day 29. CONCLUSIONS Fibrocaps had good safety and efficacy profiles, supporting continuing clinical development as a novel fibrin sealant.
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Tollec S, Trossaert M, Duveau D, Grimandi G, Sellal KO. Proposition d’un modèle d’évaluation des hémostatiques chirurgicaux. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.phclin.2013.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Navarro-Rodríguez E, Gómez-Luque I, Díaz-Jiménez N, Rioja-Torres P, Bascuñana-Estudillo G, Ruiz-Rabelo JF, Ciria-Bru R, Álvarez-Benito M, Rufián-Peña S, Briceño-Delgado J. Effectiveness of an absorbable fibrin sealant patch to reduce lymphoceles formation after axillary lymphadenectomy for breast cancer: a matched-pair analysis. Am J Surg 2014; 208:824-830. [DOI: 10.1016/j.amjsurg.2013.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/29/2013] [Accepted: 12/23/2013] [Indexed: 11/15/2022]
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