An update on topical haemostatic agents in liver surgery: systematic review and meta analysis

Raffaele Brustia (1) , Benjamin Granger (1) , Olivier Scatton (2)

1 CHU Pitié-Salpêtrière [AP-HP]
2 UMRS893 - Centre de Recherche Saint-Antoine

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.

Mots clés: Topical Haemostatic Agents; Liver surgery; blood loss; bile leak

Domaines: Chirurgie; Hépatologie et Gastroentérologie

Raffaele Brustia, Benjamin Granger, Olivier Scatton. An update on topical haemostatic agents in liver surgery: systematic review and meta analysis. Journal of Hepato-Biliary-Pancreatic Sciences, 2016, 23 (10), pp.609-621. ⟨10.1002/jhbp.389⟩. ⟨hal-02328923⟩