title: Role of fibrin sealants in liver surgery.
abstract: BACKGROUND
  Fibrin sealants are widely used in liver surgery. The aim of this article is to review the literature on evidence of hemostatic and biliostatic capacities of different fibrin sealants in liver surgery.
  
  
  METHODS
  In PubMed, a literature search was done with the search terms 'fibrin sealant' or 'fibrin glue' combined with 'liver resection' or 'bile leakage'. Thirteen comparative fibrin sealant studies were selected.
  
  
  RESULTS
  In general, these studies have shown a reduced time to hemostasis when fibrin sealants were used. So far, only a few studies have been published that have focused on postoperative resection surface-related complications. There is no strong evidence that fibrin sealants reduce the incidence of bile leakage after liver resection. Important new evidence shows that bile contains profibrinolytic activity that causes lysis of the clot formed by the fibrin sealant at least in vitro.
  
  
  CONCLUSIONS
  Fibrin sealants can be effective as an adjunct to achieve hemostasis during liver resections. However, considering lack of evidence on the efficacy of fibrin sealants in reducing postoperative resection surface-related complications, routine use of fibrin sealants in liver surgery cannot be recommended.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.t.de.boer@umcg.nl
authors.forename: Marieke T
authors.initials: MT
authors.lastname: de Boer
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Boonstra
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D001652:Bile Ducts; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000601:surgery
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics