title: The use of Tachosil as hemostatic sealant in nephron sparing surgery for Wilms tumor: preliminary observations.
abstract: BACKGROUND
  TachoSil, which is an absorbable collagen sponge coated with human fibrinogen and thrombin, has proven to enhance hemostasis and promote optimal wound healing in adults undergoing nephron sparing surgery (NSS). We report our preliminary experience using this hemostatic agent during NSS in children.
  
  
  METHODS
  Prospective analysis of 3 patients with Wilms tumor (synchronous bilateral in one) undergoing NSS at our institution over an 18-month period. Primary outcome measures were intraoperative bleeding control and surgery-related postoperative sequelae.
  
  
  RESULTS
  Overall, 4 kidneys underwent 5 NSS procedures, which included 3 partial nephrectomies and multiple tumor excisions performed on another kidney at initial and second-look surgery. After control of major bleeding and suturing of the collecting system, which was entered during 2 of the 5 NSS procedures, TachoSil was applied to the parenchymal surface of the kidney, achieving immediate hemostasis. All NSS procedures were performed without hilar clamping, drainage or stent placement. None of the patients required blood transfusion. Small perirenal fluid collections were documented postoperatively, and all spontaneously resolved within 4 weeks of surgery.
  
  
  CONCLUSIONS
  In children undergoing NSS, TachoSil represents an effective and safe tool for control of mild to moderate bleeding, and also facilitates sealing and wound dressing.
authors.affiliation: Pediatric Surgery Unit, Department of Pediatrics, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy.
authors.forename: Ermelinda
authors.initials: E
authors.lastname: Mele
authors.forename: Silvia
authors.initials: S
authors.lastname: Ceccanti
authors.forename: Amalia
authors.initials: A
authors.lastname: Schiavetti
authors.forename: Sandro
authors.initials: S
authors.lastname: Bosco
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masselli
authors.forename: Denis A
authors.initials: DA
authors.lastname: Cozzi
mesh_terms: D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments; D011446:Prospective Studies; D015503:Surgical Sponges; D013917:Thrombin / Q000627:therapeutic use*; D009396:Wilms Tumor / Q000601:surgery*
chemical_list: D004338:Drug Combinations; D006490:Hemostatics; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin