Andrea Bosca Robledo*, Ana Navio Seller, Mireia Navasquillo Tamarit, Javier Maupoey Ibanez, Raquel Jimenez Rosellon, Eva Maria Montalva Oron, Rafael Garcia Dominguez, David Calatayud Mizrahi and Rafael Lopez Andujar
Hepatobiliary Pancreatic Surgery and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, SpainFulltext PDF
The use of biological hemostatic and sealing agents over the edge of the liver resection has been increasing exponentially for over 30 years but without solid literature review. The aim of this study was to produce a meta-analysis including only prospective and randomized studies to know real effect using hemostatic sealants on the resection edge after elective hepatic resection, especially regarding biliary fistula and hematoma. A literature search of the Medline and EMBASE was carried out to find prospective and randomized trials related to the use of hemostatic sealant in the surface of the liver resection compared with not using products after the usual revision of hemostasis. Six studies were included involving a total of 1,002 patients in this meta-analysis. After analyzing the results, the risk of developing hematoma/abscess or biliary leak was not related to the use of sealants. Odds Ratio (OR): 1.19; 95% Confidence Interval (CI): 0.79 to 1.81; p=0.40 and OR: 1.02; 95% CI: 0.65 to 1.61; p=0.92 respectively. The use of sealants over the edge of the liver resection does not currently provide any benefit and its cost is not really justified.
Robledo AB, Seller AN, Tamarit MN, Ibanez JM, Rosellon RJ, Montalva Oron EM, et al. Is the Use of Sealing and Hemostatic Agents Justified in Hepatic Resections? Review and MetaAnalysis. Clin Surg. 2020; 5: 2979..