title: The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses.
abstract: Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004-2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications.
authors: Dept. of Urology, Sheba Medical Center, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe.
authors: Yasmin
authors: Y
authors: Abu-Ghanem
authors: Dept. of Urology, Sheba Medical Center, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe.
authors: Zohar
authors: Z
authors: Dotan
authors: Dept. of Urology, Sheba Medical Center, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe.
authors: Issac
authors: I
authors: Kaver
authors: Dept. of Urology, Sheba Medical Center, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe.
authors: Dorit E
authors: DE
authors: Zilberman
authors: Dept. of Urology, Sheba Medical Center, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe.
authors: Jacob
authors: J
authors: Ramon
mesh_terms: D000368:Aged; D002483:Cellulose, Oxidized / Q000008:administration & dosage*; D005260:Female; D006487:Hemostasis / Q000187:drug effects; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D013537:Sutures / Q000009:adverse effects
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel