Fibrin glue in renal and ureteral trauma.
Fibrin glue (FG) made with highly concentrated human fibrinogen and clotting factors was used to achieve hemostasis of fourteen renal injuries and to seal three ureteral anastomoses in 15 patients. The cause of injury included twelve gunshot wounds, four stab wounds, and one iatrogenic ureteral injury. The mean intraoperative blood loss was 1.6 +/- 1.1 L (SD), and patients received 4 +/- 5 units of blood perioperatively. Utilizing the described techniques, FG was effective in achieving hemostasis and sealing ureteral suture lines against leakage in all cases. There were no cases of renal infection, rebleeding, urinary fistulas, delayed rupture, stone formation, or urinary tract obstruction. Two patients underwent re-exploration for causes unrelated to their renal or ureteral injuries. The use of FG was associated with less reliance on suture redundancy to achieve parenchymal hemostasis and perform ureteral anastomoses. FG sealing of renal and ureteral injuries is a safe and effective technique for controlling hemorrhage and sealing anastomoses. It is effective in the management of both superficial and deep renal injuries.
Kram
H B
HB
Department of Surgery, King-Drew Medical Center, Los Angeles, California.
Ocampo
H P
HP
Yamaguchi
M P
MP
Nathan
R C
RC
Shoemaker
W C
WC
D000293:Adolescent; D000328:Adult; D007611:Aprotinin / Q000008:administration & dosage*; D004338:Drug Combinations / Q000008:administration & dosage; D005176:Factor XIII / Q000008:administration & dosage*; D005260:Female; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008722:Methods; D008875:Middle Aged; D011859:Radiography; D013917:Thrombin / Q000008:administration & dosage*; D014513:Ureter / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery
D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin