title: [Sealing of the hepatic resection area using hemostat devices does not improve results of adequate surgery].
abstract: OBJECTIVE
  In hepatic resections, there has been a high quality demand. The aim of this systematic clinical, prospective, unblinded unicenter observational study with two arms in an unselected patient cohort was to investigate whether hemostat device can significantly improve outcome in resective liver surgery, in particular, in high risk patients.
  
  
  METHODS
  All consecutive patients (mean age, 60.5 [range, 17 - 96] years) who underwent hepatic resection (ntotal = 770) were prospectively documented in a computer-based registry at a university hospital (tertiary center) over a time period of 10 years and retrospectively evaluated specifically with regard to the use (-/+; in daily practice and intraoperative decision-making) of hemostat device (Tissucol(®), n = 59/Tachocomb(®), n = 202/combination, n = 55) indicated (among others) by drainage volume, inflammatory parameters and rate of specific complications (nvalidated = 541 [100 %]).
  
  
  RESULTS
  Most frequently, (a-)/typical segmental resections were used: n = 192/90 (3-segment resection, only n = 38). 1) For the assignment of patients to the two different groups (-/+ hemostat device), weight loss and type of resection were found as significant factors (trend: ASA, cirrhosis), for the amount of drainage volume, ASA, sex, Karnofsky Performance Scale and also type of resections using independent distributed statistical tests (such as χ(2), U test [Mann/Whitney]; H test [Kruskal-Willis]; correlation coefficient by Spearman) - no impact: smoking, diabetes, BMI, ethanol. 2) Not taking into account these parameters, the use of hemostat device was characterized by an increased drainage volume (negative control < Tissucol = Tachocomb < combination). 3) Using multifactorial analysis of variance, it was found even under correction by the factors with significant impact elucidated in the single test that the application of hemostat device onto the hepatic resection area resulted unexpectedly rather in an increase than a decrease of the drainage volume but 4) under accompanying more pronounced increase of the white blood cell count (leucocytosis). 5) General and specific complications such as postoperative bleeding, biliary fistula and subhepatic abscess were not further lowered in a significant manner using hemostat device.
  
  
  CONCLUSIONS
  Adequate surgery in the operative management of hepatic resection area cannot further be improved or optimized using hemostat device. In this context, drainage volume may not be considered a sufficient rather an orienting parameter. However, there is an inflammatory response detectable most likely indicated by a(n un-)specific effusion and increase of white blood cell count, which can be interpreted as a) being characteristic for the problematic group of patients, in whom hemostat device was decided to be useful and was finally used in daily prectice, or b) reactive inflammation to foreign material.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Petersen
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St Josefs Krankenhaus, Salzkotten, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Steinert
authors.affiliation: Klinik für Allgemein- & Viszeralchirurgie, AMEOS Klinikum, Haldensleben, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Jannasch
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Venerito
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, Klinikum Magdeburg gGmbH, Magdeburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Meissner
authors.affiliation: Institut für Biometrie und Medizinische Informatik, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kropf
authors.affiliation: Klinik für Viszeral- & Gefäßchirurgie, HELIOS Klinikum, Aue, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Albrecht
authors.affiliation: AN-Institut für Qualitätssicherung in der Operativen Medizin, Otto-von-Guericke-Universität, Magdeburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lippert
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation* / Q000706:statistics & numerical data*; D006498:Hepatectomy / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D065506:Vascular Closure Devices / Q000706:statistics & numerical data*; D055815:Young Adult