A prospective study of the efficacy of clinical application of a new carrier-bound fibrin sealant after liver resection.
OBJECTIVE
To examine the effectiveness of fibrin sealants as supportive treatment to improve hemostasis and decrease the incidence of bile leakage and intra-abdominal collections.


METHODS
Prospective, controlled, quasiexperimental study.


METHODS
Tertiary referral center, University Hospital Reina Sofía.


METHODS
A total of 115 patients (58 in the control group and 57 in the collagen sponge group) scheduled for conventional hepatectomies.


METHODS
Patients were distributed into groups for major and minor hepatectomies with or without application of a carrier-bound collagen sponge on the raw surface of the liver.


METHODS
The main outcome measures were postoperative mortality, incidence and severity of postoperative surgical complications, and length of hospital stay. The secondary outcome measures were postoperative drainage output volume, transfusion requirements, and changes in biochemical parameters (hemoglobin, bilirubin, alanine aminotransferase, and platelet levels).


RESULTS
The fibrin sealant after major liver resection was effective for decreasing drainage volume (mean [SD] volume, 1124.7 [842.8] mL in the control group and 691.2 [499.5] mL in the collagen sponge group; P = .007) with a higher volume of output by drain each postoperative day in the control patients (P = .003); postoperative blood transfusion requirements (18.9% vs 7.0%, respectively; P = .04); moderate to severe postoperative complications (21% vs 8%, respectively; P = .03); and mean (SD) hospital stay (12.6 [6.7] vs 9.6 [5.1] days, respectively; P = .03).


CONCLUSIONS
The use of a new carrier-bound collagen sponge after major liver resection may be recommended because of its clinical and cost-savings effectiveness.
Briceño
Javier
J
Unit of Hepatobiliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital Reina Sofía, Córdoba, Spain.
Naranjo
Alvaro
A
Ciria
Ruben
R
Díaz-Nieto
Rafael
R
Sánchez-Hidalgo
Juan-Manuel
JM
Luque
Antonio
A
Rufián
Sebastián
S
López-Cillero
Pedro
P
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D004322:Drainage; D004337:Drug Carriers; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D013917:Thrombin / Q000627:therapeutic use*; D016896:Treatment Outcome
D004337:Drug Carriers; D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin