title: Local venous thrombotic risk of an expanding haemostatic agent used during liver resection.
abstract: BACKGROUND
  For patients undergoing liver resection that leaves an empty intraparenchymal cavity, traditional topical agents might be inadequate to achieve additional hemostasis. A new hemostatic expanding topical foam (BioFoam(®)) has been designed to provide a mechanical seal. The objective of this study was to report our preliminary results regarding the safety and the efficacy using this foam.
  
  
  METHODS
  Between 2009 and 2011, BioFoam(®) was used to fill a three-dimensional defect following liver resection in 14 patients. The operative results and postoperative course of these patients were compared to those of 14 matched controls who underwent liver resection but did not receive BioFoam(®).
  
  
  RESULTS
  The two groups were similar in terms of demographics, indications for liver resection, type of surgical procedure, and type and duration of clamping. BioFoam(®) patients experienced significantly less operative blood loss (275 vs. 630 ml, p = 0.032) but similar operative transfusion rates (28.6 vs. 35.7 %, p = 0.686) compared to no-BioFoam(®) patients. The postoperative mortality was nil and no patient developed postoperative hemorrhage. While the two groups shared similar overall (64.3 vs. 57.1 %, p = 0.599) and major (28.6 vs. 14.3 %, p = 0.357) complications rates, BioFoam(®) patients experienced significantly higher major vascular thrombosis compared to no-BioFoam(®) patients (29 vs. 0 %, p = 0.04). In the BioFoam(®) group, major vascular thrombosis was associated with exposure of the vessel along the transection plane.
  
  
  CONCLUSIONS
  While the clinical benefit of BioFoam(®) in high-risk liver resections leaving a deep parenchymal defect remains to be proven, the associated risk of vascular thrombosis should preclude its use in contact with major veins.
authors.affiliation: Pôle des Maladies de l'Appareil Digestif (PMAD), Department of Hepato-Pancreato-Biliary Surgery, AP-HP, Beaujon Hospital, Clichy, France, fafatoubib@gmail.com.
authors.forename: Francois
authors.initials: F
authors.lastname: Cauchy
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D003432:Cross-Linking Reagents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects*; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D020100:Hydrogels / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020246:Venous Thrombosis / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D003432:Cross-Linking Reagents; D006490:Hemostatics; D020100:Hydrogels
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