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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the reference lists of all primary studies, and contacted the authors of included trials for additional published or unpublished trials.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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Klune JR, Watson GA, Peitzman AB. Peitzman Paste: A Novel Hemostatic Concoction for Treatment of Intraoperative Medical Bleeding. Am Surg 2023; 89:481-484. [PMID: 33283525 DOI: 10.1177/0003134820954833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John R Klune
- Department of Surgery, 1267Anne Arundel Medical Center, Annapolis, MD, USA
| | - Gregory A Watson
- Division of Trauma and Acute Care Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew B Peitzman
- Division of Trauma and Acute Care Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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3
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Bouchard ME, Stairs J, Hickling D, Clancy A, Khalil H. The use of tissue adhesive in management of genitourinary fistulas: a systematic review and case report. Int Urogynecol J 2023; 34:445-451. [PMID: 35947188 DOI: 10.1007/s00192-022-05297-0] [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: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Articles are getting published on the use of tissue adhesive for vesicovaginal fistula. The objective is to carry out a systematic review on their effectiveness and complications. METHODS A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers screened abstracts and full-text and extracted data independently. A narrative synthesis was conducted given the heterogeneity of studies. RESULTS A total of 1032 studies were identified after searching the database, and 14 articles were included in this systematic review. Of the 84 women included, 12 (14.3%) presented failure or recurrence of their fistula tract. The mean time of follow-up was 11.46 months. The average size of the fistula was 1.05 (range 0.1 to 3.9) cm. Most fistulas (81) included were vesicovaginal fistulas. Nine papers reported the usage of fibrin glue in which only three (6.5%) women reported recurrence of the fistula in a delay of 2 weeks to 26 months. The other studies used cyanoacrylate (14 women) and autologous fibrin injection from the patients' blood (31 women). No significant complications were reported. Complications reported were urinary tract infections in 3 women (3.6%), hematuria in 2 women (2.4%), overactive bladder symptoms in 6 women (7.2%) and septic pelvic thrombosis in one woman (1.2%). CONCLUSIONS Tissue adhesive appears to be a promising alternative for management of urogenital fistulas without reported important complications.
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Affiliation(s)
| | - Jocelyn Stairs
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Ottawa, 1053, Carling ave, Ottawa, ON, K1Y 4E9, Canada
| | - Duane Hickling
- Division of Female Urology, Department of Urology, University of Ottawa, Ottawa, Canada
| | - Aisling Clancy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Ottawa, 1053, Carling ave, Ottawa, ON, K1Y 4E9, Canada
| | - Hisham Khalil
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Ottawa, 1053, Carling ave, Ottawa, ON, K1Y 4E9, Canada
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4
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Lyons M, Nunley RM, Ahmed Shokri A, Doneley T, Han HS, Harato K, Kuwasawa A, Lee DH, Qi X, Qian W, Ratanachai S, Wang W, Po-Han Chen B, Danker W. Goals, challenges and strategies for wound and bleeding management in total knee arthroplasty: A modified Delphi method. J Orthop Surg (Hong Kong) 2022; 30:10225536221138985. [PMID: 36374258 DOI: 10.1177/10225536221138985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. METHODS Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September-October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. RESULTS Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. CONCLUSION Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.
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Affiliation(s)
| | - Ryan M Nunley
- 12275Washington University of Medicine, St Louis, MO, USA
| | | | - Tyson Doneley
- 95053Brisbane Private Hospital, Spring Hill, QLD, Australia
| | - Hyuk-Soo Han
- 58927Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | - Kengo Harato
- Keio University School of Medicine, Tokyo, Japan
| | | | - Dae-Hee Lee
- 36626Samsung Medical Center, Seoul, Korea, Republic of (South)
| | - Xin Qi
- The First Affiliated Hospital of Jilin University, Changchun City, China
| | - Wenwei Qian
- 34732Peking Union Medical College Hospital, Beijing, China
| | | | - Weijun Wang
- 66506Nanjing Drum Tower Hospital, Jiangsu Province, China
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5
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Jonas E, Bernon M, Robertson B, Kassianides C, Keli E, Asare KO, Alatise IO, Okello M, Blondel NO, Mulehane KO, Abubeker ZA, Nogoud AA, Nashidengo PR, Chihaka O, Tzeuton C, Dusheiko G, Sonderup M, Spearman CW. Treatment of hepatocellular carcinoma in sub-Saharan Africa: challenges and solutions. Lancet Gastroenterol Hepatol 2022; 7:1049-1060. [PMID: 35810767 DOI: 10.1016/s2468-1253(22)00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 06/15/2023]
Abstract
Most patients who develop hepatocellular carcinoma reside in resource-poor countries, a category that includes most countries in sub-Saharan Africa. Age-standardised incidence rates of hepatocellular carcinoma in western, central, eastern, and southern Africa is 6·53 per 100 000 inhabitants to 11·1 per 100 000 inhabitants. In high-income countries, around 40% of patients are diagnosed at an early stage, in which interventions with curative intent or palliative interventions are possible. By contrast, 95% of patients with hepatocellular carcinoma in sub-Saharan Africa present with advanced or terminal disease. In high-income countries, targets of 30-40% that have been set for intervention with curative intent are regularly met, with expected 5-year overall survival rates in the region of 70%. These outcomes are in sharp contrast with the very small proportion of patients in sub-Saharan Africa who are treated with curative intent. Primary prevention through the eradication and reduction of risk factors is still suboptimal because of logistical challenges. The challenges facing primary prevention, in combination with difficult-to-manage historic and emerging risk factors, such as ethanol overconsumption and metabolic dysfunction-associated liver disease, mandates secondary prevention for populations at risk through screening and surveillance. Although the increased treatment needs yielded by screening and surveillance in high-income countries are manageable by the incremental expansion of existing interventional resources, the lack of resources in sub-Saharan Africa will undermine the possible benefits of secondary prevention. An estimate of the projected effect of the introduction and expansion of screening and surveillance, resulting in stage migration and possibilities for active interventions for hepatocellular carcinoma, would facilitate optimal planning and development of resources.
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Affiliation(s)
- Eduard Jonas
- Department of Surgery, University of Cape Town, Cape Town, South Africa.
| | - Marc Bernon
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Barbara Robertson
- Division of Radiation Oncology, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
| | - Chris Kassianides
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Elie Keli
- Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Côte d'Ivoire
| | - Kwaku Offei Asare
- Department of Surgery, Korle Bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | - Isaac Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria
| | - Michael Okello
- Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Nana Oumarou Blondel
- Centre Hospitalier d'Essos and Department of Surgery, University of Yaoundé, Yaoundé, Cameroon
| | | | - Zeki Abdurahman Abubeker
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Pueya Rashid Nashidengo
- Department of Surgery, Windhoek Central Hospital, University of Namibia School of Medicine, Windhoek, Namibia
| | - Onesai Chihaka
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - Christian Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon
| | - Geoffrey Dusheiko
- Institute of Liver Studies, King's College Hospital, London, UK; University College London Medical School, London, UK
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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6
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Choi GS, Kim SH, Seo HI, Ryu JH, Yun SP, Koh MY, Lee MS, Lee H, Kim JH. A multicenter, prospective, randomized clinical trial of marine mussel-inspired adhesive hemostatic materials, InnoSEAL Plus. Ann Surg Treat Res 2021; 101:299-305. [PMID: 34796146 PMCID: PMC8564078 DOI: 10.4174/astr.2021.101.5.299] [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] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose InnoSEAL Plus is an adhesive, coagulant-free hemostatic material that mimics the adhesion mechanism of marine mussels. This study reports on the safety and efficacy of InnoSEAL Plus for patients with hemorrhage after hepatectomy despite first-line hemostasis treatments. Methods This is a multicenter, prospective, single-blinded, randomized clinical trial involving 96 hepatectomy patients. TachoSil was used as a comparator group. Three-minute and 10-minute hemostatic success rates were monitored. Rebleeding rates were also observed. Safety was assessed by recording all novel undesirable symptoms. Results InnoSEAL Plus showed a 3-minute hemostasis rate of 100%, while TachoSil had a rate of 98.0% (48 of 49 patients), demonstrating that the 2 had similar hemostatic efficacies. The difference in efficacy between the test and comparator group was 2.04%, and the lower limit of the one-sided 97.5% confidence interval was −1.92%; as this is greater than the noninferiority limit of −23.9%, the 2 treatments were equivalent. Meanwhile, the 10-minute hemostatic success rate was the same in both groups (100%). No rebleeding occurred in either group. In the safety evaluation, 89 patients experienced adverse events (45 in the test group and 44 in the comparator group). The difference between the 2 groups was not significant. No death occurred after application of the test or comparator group product. Conclusion Given that InnoSEAL Plus is a coagulation factor-free product, the hemostasis results are encouraging, especially considering that TachoSil contains a coagulation factor. InnoSEAL Plus was found to be a safe and effective hemostatic material for control of bleeding in hepatectomy patients.
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Affiliation(s)
- Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seoung Hoon Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Hyung Il Seo
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | | | | | | | - Haeshin Lee
- R&D Center, InnoTherapy Inc., Seoul, Korea.,Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Busan, Korea.,Department of Surgery, Pusan National University College of Medicine, Busan, Korea
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Danker Iii W, DeAnglis A, Ferko N, Garcia D, Hogan A. Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis. Ann Med Surg (Lond) 2020; 61:161-168. [PMID: 33425351 PMCID: PMC7782199 DOI: 10.1016/j.amsu.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background Evidence comparing fibrin sealants (FSs) in surgery are limited. This study evaluated the efficacy and safety of FSs, and manual compression in peripheral vascular surgery. Methods A systematic review of randomized trials was conducted in Medline, Embase, and Cochrane databases within the last 15 years. Data were available to conduct a network meta-analysis (NMA) in peripheral vascular surgery. Fibrin sealant treatment arms were further broken-down and assessed by clotting time (i.e., 2-min [2C] or 1-min [1C]). The primary efficacy outcome was the proportion of patients achieving hemostasis by 4 min (T4). Treatment-related serious and non-serious adverse events (AEs) were qualitatively assessed. Results Five studies (n = 693), were included in the NMA. Results predicted VISTASEAL 2C, followed by EVICEL 1C, had the highest probability of achieving T4. Compared with manual compression, significant improvements in T4 were found with VISTASEAL 2C (relative risk [RR] = 2.67, 95% CrI: 2.13–3.34), EVICEL 1C (RR = 2.58, 95% CrI: 2.04–3.23), VISTASEAL 1C (RR = 2.00, 95% CrI: 1.45–2.65), and TISSEEL 2C (RR = 1.99, 95% CrI: 1.48–2.60). TISSEEL 1C was not significantly different than manual compression (RR = 1.40, 95% CrI: 0.70–2.33). Among FSs, VISTASEAL 2C was associated with a significant improvements in T4 compared with VISTASEAL 1C (RR = 1.33, 95% CrI: 1.02–1.82), TISSEEL 2C (RR = 1.34, 95% CrI: 1.05–1.77), and TISSEEL 1C (RR = 1.90, 95% CrI: 1.18–3.74). Treatment-related serious and non-serious AE rates were typically lower than 2%. Conclusions In peripheral vascular surgeries, VISTASEAL 2C and EVICEL 1C were shown to have the highest probabilities for achieving rapid hemostasis among the treatments compared. Future studies should expand networks across surgery types as data become available. Fibrin sealants can control perioperative bleeding, yet comparative evidence is limited. This network meta-analysis compared fibrin sealants and compression in peripheral vascular surgery. VISTASEAL and EVICEL had the highest probability of achieving hemostasis by 4 min. These results show differences exist between fibrin sealants in peripheral vascular surgery.
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Affiliation(s)
| | | | - Nicole Ferko
- CRG-EVERSANA Canada Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | - David Garcia
- CRG-EVERSANA Canada Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | - Andrew Hogan
- CRG-EVERSANA Canada Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada
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Haemostatic Efficacy of Topical Agents During Liver Resection: A Network Meta-Analysis of Randomised Trials. World J Surg 2020; 44:3461-3469. [PMID: 32488664 DOI: 10.1007/s00268-020-05621-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. Topical haemostatic agents are frequently used to control bleeding during hepatectomy, with multiple products currently available. However, it remains unknown which of these is most effective for achieving haemostasis and improving peri-operative outcomes. METHODS A systematic review and random-effects Bayesian network meta-analysis of randomised trials investigating topical haemostatic agents in hepatic resection was performed. Interventions were analysed by grouping into similar products; fibrin patch, fibrin glue, collagen products, and control. Primary outcomes were the rate of haemostasis at 4 and 10 min. RESULTS Twenty randomized controlled trials were included in the network meta-analysis, including a total of 3267 patients and 7 different interventions. Fibrin glue and fibrin patch were the most effective interventions for achieving haemostasis at both 4 and 10 min. There were no significant differences between haemostatic agents with respect to blood loss, transfusion requirements, bile leak, post-operative complications, reoperation, or mortality. CONCLUSIONS Amongst the haemostatic agents currently available, fibrin patch and fibrin glue are the most effective methods for reducing time to haemostasis during liver resection, but have no effect on other peri-operative outcomes. Topical haemostatic agents should not be used routinely, but may be a useful adjunct to achieve haemostasis when needed.
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Sousa F, Machado V, Botelho J, Proença L, Mendes JJ, Alves R. Effect of A-PRF Application on Palatal Wound Healing after Free Gingival Graft Harvesting: A Prospective Randomized Study. Eur J Dent 2020; 14:63-69. [PMID: 32168533 PMCID: PMC7069756 DOI: 10.1055/s-0040-1702259] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective
The aim of this study was to investigate the healing effect of advanced platelet-rich fibrin (A-PRF) clot membranes in palatal wounds, resulting from free gingival graft (FGG) harvesting, on the reepithelization rate and on the pain experience after surgery.
Materials and Methods
Twenty-five patients requiring FGG have participated in this prospective cohort study. After FGG harvesting, the test group (
n
= 14) received A-PRF clot membranes at the palatal wound and the control group (
n
= 11) received a gelatin sponge. Epithelialization rate of the palatal wound, wound healing area, correspondent percentage of reduction, and postsurgical pain experience were assessed at 2, 7, 14, 30, and 90 days.
Results
A-PRF group had higher palatal wound reduction than the control group, at 7, 14, and 30 days of follow-up. The highest difference between the groups was attained at 30 days (91.5% for A-PRF vs. 59.0% control group). At 14 days, a significant difference in the proportion of patients showing total epithelization was found: 64.3% for A-PRF versus 9.1% for the control group. At 90 days, both groups showed total recovery. The control group experienced higher pain level and discomfort until the 14th day, being notably higher on the second day.
Conclusion
The results suggest that A-PRF membranes haste the healing process, and promote greater reduction along the recovery period and less painful postoperative period.
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Affiliation(s)
- Filipa Sousa
- Department of Periodontology, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
| | - Vanessa Machado
- Department of Periodontology, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
| | - João Botelho
- Department of Periodontology, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
| | - Luís Proença
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
| | - Ricardo Alves
- Department of Periodontology, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Almada, Portugal
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Du ZC, Zhu LX. A Heterologous Fibrin Glue Enhances the Closure Effect of Surgical Suture on the Repair of Annulus Fibrous Defect in a Sheep Model. Curr Med Sci 2019; 39:597-603. [PMID: 31346996 DOI: 10.1007/s11596-019-2079-2] [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] [Received: 09/21/2018] [Revised: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Improving the closure effect of surgical suture for repair of annulus fibrosus defects remains an unsolved problem. A new type of porcine fibrin glue was reported for the repair of annulus fibrous defects in sheep models in this study. Continuous axial loading test showed that this glue could effectively improve the closure effect of surgical suture for annulus fibrous defect. Magnetic resonance imaging (MRI) of the lumbar spine confirmed that, compared with non-fibrin glue treated intervertebral discs, it contributed to preservation of the nucleus pulposus and maintained the physiological hydration of the intervertebral discs. Moreover, histomorphology evaluation showed that the porcine fibrin glue could partially reverse degeneration of the injured intervertebral discs. Taken together, porcine fibrin glue can effectively enhance the closure effect of surgical suture on annulus fibrosus, improve the repair effect and slow down the degeneration of the intervertebral disc, and provide a potential therapeutic strategy for degenerative intervertebral disc disease.
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Affiliation(s)
- Zhi-Cai Du
- Southern Medical University, Guangzhou, 510515, China.,Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010030, China
| | - Li-Xin Zhu
- Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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Wakabayashi T, Yagi H, Tajima K, Kuroda K, Shinoda M, Kitago M, Abe Y, Oshima G, Hirukawa K, Itano O, Kitagawa Y. Efficacy of New Polylactic Acid Nonwoven Fabric as a Hemostatic Agent in a Rat Liver Resection Model. Surg Innov 2019; 26:312-320. [PMID: 30895890 DOI: 10.1177/1553350619833582] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND During minimally invasive surgery, efficient and nontoxic hemostats are important for difficult to access bleeding areas. Polylactic acid is an ecofriendly hemostatic agent and we aimed to evaluate the efficacy of a polylactic acid nonwoven fabric (PLAF) developed by Toray Industries, Inc, on liver hemostasis in a preclinical study. MATERIALS AND METHODS PLAF consists of both 1-µm diameter fibers and 100-µm diameter beaded fibers. Four rats were used, and 2 trough-shaped resections of the liver parenchyma were performed (n = 8 lobes). Immediately after the resection, PLAF (PLAF group: n = 4 lobes) or rayon gauze (Rayon group: n = 4 lobes) were applied on the resected plane and compressed manually. We compared the mean time to hemostasis and blood loss per lobe, as well as histological findings between the groups. RESULTS The PLAF group had a significantly shorter bleeding time ( P = .006), and showed lower blood loss compared with the Rayon group ( P = .076). Histopathological evaluation showed a large amount of beads on the liver surface in the PLAF group. Aggregated red blood cells evident by electron microscopy and von Willebrand factor immunofluorescence were seen surrounding the beads. The PLAF group showed significantly greater von Willebrand factor expression than the Rayon group ( P = .004). DISCUSSION This new PLAF showed superior outcomes thanks to its unique characteristic of forming beaded nanofibers, and it has the potential to be an efficient hemostat in minimally invasive surgery in the human body.
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Affiliation(s)
| | - Hiroshi Yagi
- 1 Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Tajima
- 1 Keio University School of Medicine, Tokyo, Japan
- 2 Kitasato University School of Veterinary Medicine, Aomori, Japan
| | - Kohei Kuroda
- 1 Keio University School of Medicine, Tokyo, Japan
| | | | | | - Yuta Abe
- 1 Keio University School of Medicine, Tokyo, Japan
| | - Go Oshima
- 1 Keio University School of Medicine, Tokyo, Japan
| | | | - Osamu Itano
- 3 International University of Health and Welfare School of Medicine, Chiba, Japan
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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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13
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Theys T, Van Hoylandt A, Broeckx CE, Van Gerven L, Jonkergouw J, Quirynen M, van Loon J. Plasma-rich fibrin in neurosurgery: a feasibility study. Acta Neurochir (Wien) 2018; 160:1497-1503. [PMID: 29872915 DOI: 10.1007/s00701-018-3579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery. METHODS A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries. RESULTS L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair. CONCLUSION L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery.
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Tanaka H, Fukushima K, Srinivasan PK, Pawlowsky K, Koegel B, Hata K, Ku Y, Uemoto S, Tolba RH. Efficacy of the Novel Medical Adhesive, MAR-VIVO-107, in an Acute Porcine Liver Resection Model. Surg Innov 2017; 24:423-431. [PMID: 28715950 DOI: 10.1177/1553350617720993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Despite modern surgical techniques, insufficient hemostasis after liver trauma is still a major cause of morbidity and mortality after injury. Therefore, efficient hemostatic agents are indicated. In this study, we evaluated the hemostatic efficacy of a novel synthetic wound adhesive (MAR-VIVO-107) based on polyurethane/polyurea, compared with a widely used fibrin adhesive (Tisseel). MATERIALS AND METHODS Twelve German Landrace pigs were randomly assigned to 2 groups. The animals were operated under sterile conditions. A midline laparotomy was performed and the left liver lobe was isolated and resected, using a surgical scissor, in order to induce hepatic trauma. MAR-VIVO-107 or Tisseel was applied to the resected area. The animals were monitored for 60 minutes; thereafter, they were sacrificed under anesthesia. Blood and tissue samples were collected pre- and postresection for biochemical and hematological analyses. RESULTS MAR-VIVO-107 versus Tisseel (mean ± SD, P value)-postsurgical survival rate was 100% in both groups. Bleeding time was significantly higher in Tisseel compared with MAR-VIVO-107 (10.3 ± 5.0 vs 3.7 ± 1.5 minutes, P = .0124). In trend, blood loss was less in the MAR-VIVO-107 group (54.3 ± 34.9 vs 105.5 ± 65.8 g, P = .222). Aspartate transaminase levels were significantly lower in the MAR-VIVO-107 group when compared with the Tisseel group (39.0 ± 10.0 vs 72.4 ± 23.4 U/L, P = .0459). CONCLUSION The efficacy of MAR-VIVO-107 and comparable performance to the gold standard fibrin have been shown under pre-clinical conditions. MAR-VIVO-107 permits hemorrhage control within seconds, even in wet environment.
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Affiliation(s)
- Hirokazu Tanaka
- 1 RWTH-Aachen International University, Aachen, Germany.,2 Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Fukushima
- 1 RWTH-Aachen International University, Aachen, Germany.,3 Kobe University Hospital, Hyogo, Japan
| | | | | | | | - Koichiro Hata
- 2 Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yonson Ku
- 3 Kobe University Hospital, Hyogo, Japan
| | - Shinji Uemoto
- 2 Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - René H Tolba
- 1 RWTH-Aachen International University, Aachen, Germany
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Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Gharabaghi N, Kraus TW, Mehrabi A, Oweira H. Hemostatic efficiency of modern topical sealants: Comparative evaluation after liver resection and splenic laceration in a swine model. J Biomed Mater Res B Appl Biomater 2017. [DOI: 10.1002/jbm.b.33937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Lukas Konstantinidis
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Thomas W. Kraus
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Hani Oweira
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
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16
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Reflections on multiple strategies to reduce transfusion in cancer patients: A joint narrative. Transfus Apher Sci 2017; 56:322-329. [DOI: 10.1016/j.transci.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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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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Langer S, Schildhauer TA, Dudda M, Sauber J, Spindler N. Fibrin glue as a protective tool for microanastomoses in limb reconstructive surgery. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 4:Doc14. [PMID: 26759762 PMCID: PMC4709928 DOI: 10.3205/iprs000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Fibrin glue becomes a more and more routinely used tool for stabilization of microanastomoses and nerve repair. This paper summarizes the technical properties and advantages of its use in a wide variety of microsurgical contexts, and includes an exemplary limb reconstructive case. Patients and methods: A total of 131 patients who had undergone elective and emergency microsurgery mainly of the limbs were retrospectively analyzed, as was the use of free flaps. Results: The use of fibrin glue allows for proper positioning of anastomoses and repaired nerves. No torsion of the pedicle could be seen. The flap survival rated >94%. The fibrin glue could stay in place in >99%. In the rare case of revision, the fibrin glue could easily be removed without damaging the region of the microanastomosis. Conclusion: Fibrin glue should not be used to repair insufficient, i.e., leaking anastomoses, but it does protect the site of anastomosis from tissue and fluid pressure. It prevents the pedickle from torsion and its use facilitates relocation of the microanastomoses in cases of revision surgery.
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Affiliation(s)
- Stefan Langer
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Thomas A Schildhauer
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Marcel Dudda
- Department of Trauma, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Jeannine Sauber
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Nick Spindler
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
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Pathak S, Hakeem A, Pike T, Toogood GJ, Simpson M, Prasad KR, Miskovic D. Anaesthetic and pharmacological techniques to decrease blood loss in liver surgery: a systematic review. ANZ J Surg 2015; 85:923-30. [PMID: 26074283 DOI: 10.1111/ans.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is increasing evidence that perioperative blood loss and blood transfusions are associated with poorer short- and long-term outcomes in patients undergoing hepatectomy. The aim of this study was to systematically review the literature for non-surgical measures to decrease intraoperative blood loss during liver surgery. METHODS The literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google Scholar databases. The primary outcome measures were perioperative blood loss and transfusion requirements. A secondary outcome measure was development of ischaemia-reperfusion injury. RESULTS Seventeen studies met the inclusion criteria and included 1573 patients. All were randomized controlled studies. In eight studies (n = 894), pharmacological methods, and in another nine studies (n = 679), anaesthetic methods to decrease blood loss were investigated. Anti-fibrinolytic drugs, acute normovolaemic haemodilution, autologous blood donation and use of inhalational anaesthetic agent may affect blood loss and post-operative hepatic function. CONCLUSIONS There is potential for use of non-surgical techniques to decrease perioperative bleeding. However, on the basis of this review alone, due to heterogeneity of randomized trials conducted, no particular strategy can be recommended. Future studies should be conducted looking at pathways to decrease bleeding in liver surgery.
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Affiliation(s)
- Samir Pathak
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Abdul Hakeem
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Thomas Pike
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Giles J Toogood
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Matthew Simpson
- Department of Anaesthesia, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - K Raj Prasad
- Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Danilo Miskovic
- John Goligher Colorectal Unit, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK
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Safety and Hemostatic Effectiveness of the Fibrin Pad for Severe Soft-Tissue Bleeding During Abdominal, Retroperitoneal, Pelvic, and Thoracic (Non-cardiac) Surgery: A Randomized, Controlled, Superiority Trial. World J Surg 2015; 39:2663-9. [DOI: 10.1007/s00268-015-3106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yang YL, Zhang C, Zhang HW, Wu P, Ma YF, Lin MJ, Shi LJ, Li JY, Zhao M. Common bile duct injury by fibrin glue: Report of a rare complication. World J Gastroenterol 2015; 21:2854-2857. [PMID: 25759561 PMCID: PMC4351243 DOI: 10.3748/wjg.v21.i9.2854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/30/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Fibrin glue is widely used in clinical practice and plays an important role in reducing postoperative complications. We report a case of a 65-year-old man, whose common bile duct was injured by fibrin glue, with a history of failed laparoscopic cholecystectomy and open operation for uncontrolled laparoscopic bleeding. In view of the persistent liver dysfunction, xanthochromia and skin itching, the patient was admitted to us for further management. Ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) revealed multiple stones in the common bile duct, and liver function tests confirmed the presence of obstructive jaundice and liver damage. Endoscopic retrograde cholangiopancreatography was unsuccessfully performed to remove choledocholithiasis, but a small amount of tissue was removed and pathologically confirmed as calcified biliary mucosa. This was followed by open surgery for suspicious cholangiocarcinoma. There was no evidence of cholangiocarcinoma, but the common bile duct wall had a defect of 8 mm × 10 mm at Calot’s triangle. A hard, grid-like foreign body was removed, which proved to be solid fibrin glue. Subsequently, the residual choledocholithiasis was removed by a choledochoscopic procedure, and the common bile duct deletion was repaired by liver round ligament with T-tube drainage. Six months later, endoscopy was performed through the T-tube fistula and showed a well-repaired bile duct wall. Eight months later, MRCP confirmed no bile duct stenosis. A review of reported cases showed that fibrin glue is widely used in surgery, but it can also cause organ damage. Its mechanism may be related to discharge reactions.
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Abstract
Hepatobiliary surgery outcomes have significantly improved since the early 1970s. Surgical and anesthetic advances related to patient selection, alternative surgical management options, and reduction of operative blood loss have been important. Postoperative analgesic regimens are being modified to include intrathecal opiates and to embrace enhanced recovery regimens.
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Wyld L, Audisio RA, Poston GJ. The evolution of cancer surgery and future perspectives. Nat Rev Clin Oncol 2014; 12:115-24. [PMID: 25384943 DOI: 10.1038/nrclinonc.2014.191] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery is the oldest oncological discipline, dating back thousands of years. Prior to the advent of anaesthesia and antisepsis 150 years ago, only the brave, desperate, or ill-advised patient underwent surgery because cure rates were low, and morbidity and mortality high. However, since then, cancer surgery has flourished, driven by relentless technical innovation and research. Historically, the mantra of the cancer surgeon was that increasingly radical surgery would enhance cure rates. The past 50 years have seen a paradigm shift, with the realization that multimodal therapy, technological advances, and minimally invasive techniques can reduce the need for, or the detrimental effects of, radical surgery. Preservation of form, function, and quality of life, without compromising survival, is the new mantra. Today's surgeons, no longer the uneducated technicians of history, are highly trained medical professionals and together with oncologists, radiologists, scientists, anaesthetists and nurses, have made cancer surgeries routine, safe, and highly effective. This article will review the major advances that have underpinned this evolution.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2RX, UK
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, St Helens, Merseyside WA9 3DA, UK
| | - Graeme J Poston
- Department of Surgery, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK
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Kim G, Baik SK. Overview and recent trends of systematic reviews and meta-analyses in hepatology. Clin Mol Hepatol 2014; 20:137-50. [PMID: 25032179 PMCID: PMC4099328 DOI: 10.3350/cmh.2014.20.2.137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022] Open
Abstract
A systematic review (SR) is a research methodology that involves a comprehensive search for and analysis of relevant studies on a specific topic. A strict and objective research process is conducted that comprises a systematic and comprehensive literature search in accordance with predetermined inclusion/exclusion criteria, and an assessment of the risk of bias of the selected literature. SRs require a multidisciplinary approach that necessitates cooperation with clinical experts, methodologists, other experts, and statisticians. A meta-analysis (MA) is a statistical method of quantitatively synthesizing data, where possible, from the primary literature selected for the SR. Review articles differ from SRs in that they lack a systematic methodology such as a literature search, selection of studies according to strict criteria, assessment of risk bias, and synthesis of the study results. The importance of evidence-based medicine (EBM) in the decision-making for public policy has recently been increasing thanks to the realization that it should be based on scientific research data. SRs and MAs are essential for EBM strategy and evidence-based clinical practice guidelines. This review addresses the current trends in SRs and MAs in the field of hepatology via a search of recently published articles in the Cochrane Library and Ovid-MEDLINE.
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Affiliation(s)
- Gaeun Kim
- Department of Nursing, Keimyung University College of Nursing, Daegu, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Meddahi-Pellé A, Legrand A, Marcellan A, Louedec L, Letourneur D, Leibler L. Organ repair, hemostasis, and in vivo bonding of medical devices by aqueous solutions of nanoparticles. Angew Chem Int Ed Engl 2014; 53:6369-73. [PMID: 24740730 PMCID: PMC4320763 DOI: 10.1002/anie.201401043] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Indexed: 01/20/2023]
Abstract
Sutures are traumatic to soft connective tissues, such as liver or lungs. Polymer tissue adhesives require complex in vivo control of polymerization or cross-linking reactions and currently suffer from being toxic, weak, or inefficient within the wet conditions of the body. Herein, we demonstrate using Stöber silica or iron oxide nanoparticles that nanobridging, that is, adhesion by aqueous nanoparticle solutions, can be used in vivo in rats to achieve rapid and strong closure and healing of deep wounds in skin and liver. Nanoparticles were also used to fix polymer membranes to tissues even in the presence of blood flow, such as occurring after liver resection, yielding permanent hemostasis within a minute. Furthermore, medical devices and tissue engineering constructs were fixed to organs such as a beating heart. The simplicity, rapidity, and robustness of nanobridging bode well for clinical applications, surgery, and regenerative medicine.
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Affiliation(s)
- Anne Meddahi-Pellé
- Inserm U1148, LVTS; UniversitéParis 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
- UniversitéParis 13, Sorbonne Paris Cité, Paris (France)
| | - Aurélie Legrand
- Matière Molle et ChimieUMR 7167 CNRS - ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
| | - Alba Marcellan
- Matière Molle et ChimieUMR 7167 CNRS - ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
- Université Pierre et Marie Curie, Sorbonne UniversitésParis (France)
| | - Liliane Louedec
- Inserm U1148, LVTS; UniversitéParis 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
| | - Didier Letourneur
- Inserm U1148, LVTS; UniversitéParis 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
| | - Ludwik Leibler
- Matière Molle et ChimieUMR 7167 CNRS - ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
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Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal. Langenbecks Arch Surg 2014; 399:825-35. [PMID: 24880346 DOI: 10.1007/s00423-014-1215-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fibrin sealants and topical hemostatic agents have been used extensively in hepatobiliary and pancreatic (HPB) surgery to promote coagulation and clot formation decreasing the need for allogeneic blood transfusion and to act as tissue sealants, ideally preventing biliary, enteric, and pancreatic leaks. RESULTS Current literature has demonstrated some favorable outcomes using many different products for application in the field of HPB surgery. However, critical findings exist demonstrating lack of reproducible efficacy or benefit. In all, many clinical trials have demonstrated effectiveness of fibrin sealants and other agents at reducing the need for intraoperative and postoperative blood transfusion. Ability to effectively seal tissues providing biliostatic effect or preventing postoperative fistula formation remains debated as definitive evidence is lacking. CONCLUSIONS In the following invited review, we discuss current literature describing the use of topical agents and fibrin sealants in liver and pancreas surgery. We summarize major contemporary clinical trials and their findings regarding the use of these agents in HPB surgery and provide evidence from the preclinical literature as to the translation of these products into the clinical arena.
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Hanna EM, Martinie JB, Swan RZ, Iannitti DA. Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal. Langenbecks Arch Surg 2014. [PMID: 24880346 DOI: 10.1007/s00423-014-1215-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Fibrin sealants and topical hemostatic agents have been used extensively in hepatobiliary and pancreatic (HPB) surgery to promote coagulation and clot formation decreasing the need for allogeneic blood transfusion and to act as tissue sealants, ideally preventing biliary, enteric, and pancreatic leaks. RESULTS Current literature has demonstrated some favorable outcomes using many different products for application in the field of HPB surgery. However, critical findings exist demonstrating lack of reproducible efficacy or benefit. In all, many clinical trials have demonstrated effectiveness of fibrin sealants and other agents at reducing the need for intraoperative and postoperative blood transfusion. Ability to effectively seal tissues providing biliostatic effect or preventing postoperative fistula formation remains debated as definitive evidence is lacking. CONCLUSIONS In the following invited review, we discuss current literature describing the use of topical agents and fibrin sealants in liver and pancreas surgery. We summarize major contemporary clinical trials and their findings regarding the use of these agents in HPB surgery and provide evidence from the preclinical literature as to the translation of these products into the clinical arena.
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Affiliation(s)
- Erin M Hanna
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Moorehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA
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Meddahi‐Pellé A, Legrand A, Marcellan A, Louedec L, Letourneur D, Leibler L. Organ Repair, Hemostasis, and In Vivo Bonding of Medical Devices by Aqueous Solutions of Nanoparticles. Angew Chem Int Ed Engl 2014. [DOI: 10.1002/ange.201401043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anne Meddahi‐Pellé
- Inserm U1148, LVTS; Université Paris 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
- Université Paris 13, Sorbonne Paris Cité, Paris (France)
| | - Aurélie Legrand
- Matière Molle et Chimie, UMR 7167 CNRS ‐ ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
| | - Alba Marcellan
- Matière Molle et Chimie, UMR 7167 CNRS ‐ ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
- Université Pierre et Marie Curie, Sorbonne Universités, Paris (France)
| | - Liliane Louedec
- Inserm U1148, LVTS; Université Paris 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
| | - Didier Letourneur
- Inserm U1148, LVTS; Université Paris 7, Université Paris 13, Sorbonne Paris Cité, Hôpital Bichat, 46 rue rue H Huchard, 75018 Paris (France)
| | - Ludwik Leibler
- Matière Molle et Chimie, UMR 7167 CNRS ‐ ESPCI ParisTech, ESPCI, 10, rue Vauquelin, 75005 Paris (France)
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Abstract
INTRODUCTION Fibrin sealants (FS) have been approved for use in the United States since 1998. Since approval, they have been used in a wide variety of clinical settings and new products continue to be introduced. AREAS COVERED This review covers the literature supporting the USA FDA-approved indications for FS products produced by Baxter Corp. Literature review of PubMed, the Cochrane Library, FDA approval documents and product websites yielded information contained in this article. Mechanism of action, efficacy and safety of these products are covered. EXPERT OPINION FS are generally safe, popular and are used for a wide variety of off-label indications. Their use appears to be expanding rapidly. For many uses, including approved ones, large well-controlled trials are still needed. Additionally, cost-effectiveness data for these products would be a great benefit in guiding their future use.
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Affiliation(s)
- Samuel P Mandell
- Harborview Medical Center , 325 9th Avenue, Box 359796, Seattle, WA 98104-2499 , USA +1 206 744 3140 ; +1 206 744 2896 ;
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Amer AO, Wilson CH, White SA, Manas DM. Fibrin-based haemostatic agents for reducing blood loss in adult liver resection. Hippokratia 2013. [DOI: 10.1002/14651858.cd010872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aimen O Amer
- Institute of Cellular Medicine, Newcastle University; Newcastle upon Tyne Tyne and Wear UK NE7 7DN
| | - Colin H Wilson
- The Freeman Hospital; Institute of Transplantation; Freeman Road High Heaton Newcastle upon Tyne Tyne and Wear UK NE7 7DN
| | - Steven A White
- Institute of Cellular Medicine, Newcastle University; Newcastle upon Tyne Tyne and Wear UK NE7 7DN
| | - Derek M Manas
- The Freeman Hospital; Institute of Transplantation; Freeman Road High Heaton Newcastle upon Tyne Tyne and Wear UK NE7 7DN
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