title: An update on topical haemostatic agents in liver surgery: systematic review and meta analysis.
abstract: Mortality and morbidity in hepatic surgery are affected by blood loss and transfusion. Topical haemostatic agents (THA) are composed by a matrix and/or fibrin sealants, and their association known as "carrier-bound fibrin sealant" (CBFS): despite widely used for secondary haemostasis, the level of evidence remains low. To realize a meta-analysis on the results of CBFS on haemostasis and postoperative complications. Searches in PubMed, PubMed Central, Cochrane and Google Scholar using keywords: "topical_haemostasis" OR "haemostatic_agents" OR "sealant_patch" OR "fibrin_sealant" OR "collagen_sealant" AND "liver_surgery" OR "hepatic_surgery" OR "liver_transplantation". Randomized clinical trials, large retrospective cohort studies, case control studies evaluating THA on open/laparoscopic liver surgery and transplantation. From 1993 to 2016 were found 22 studies for qualitative synthesis and 13 for quantitative meta-analysis. The time to haemostasis was lower in the CBFS group (mean difference -2.33 min; P = 0.00001). The risk of receiving blood transfusion, developing collections and bile leak was not influenced by the use of CBFS (OR 0.75; P = 0.25), (OR 0.72; P = 0.52), (OR 0.74; P = 0.30) respectively. The use of CBFS in liver surgery significantly reduce the time to haemostasis, but does not decrease transfusion, postoperative collection and bile leak.
authors: Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France.|Université Pierre et Marie Curie, Paris, France.
authors: Raffaele
authors: R
authors: Brustia
authors: Department of Biostatistics, Public Health and Medical Information, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors: Benjamin
authors: B
authors: Granger
authors: Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France. olivier.scatton@aphp.fr.|Université Pierre et Marie Curie, Paris, France. olivier.scatton@aphp.fr.
authors: Olivier
authors: O
authors: Scatton
mesh_terms: D000287:Administration, Topical; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008099:Liver / Q000503:physiopathology / Q000601:surgery; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics
keywords: Bile leak; Blood loss; Liver surgery; Topical haemostatic agents