Haemostatic Efficacy of Topical Agents During Liver Resection: A Network Meta-Analysis of Randomised Trials
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SCIENTIFIC REVIEW
Haemostatic Efficacy of Topical Agents During Liver Resection: A Network Meta-Analysis of Randomised Trials Cameron I. Wells1 • Chathura B. B. Ratnayake1 • Keno Mentor2 • Gourab Sen2 • John S. Hammond2 • Jeremy J. French2 • Colin H. Wilson2 • Derek Manas2 • Steve White2 Sanjay Pandanaboyana2
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. Topical haemostatic agents are frequently used to control bleeding during hepatectomy, with multiple products currently available. However, it remains unknown which of these is most effective for achieving haemostasis and improving peri-operative outcomes. Methods A systematic review and random-effects Bayesian network meta-analysis of randomised trials investigating topical haemostatic agents in hepatic resection was performed. Interventions were analysed by grouping into similar products; fibrin patch, fibrin glue, collagen products, and control. Primary outcomes were the rate of haemostasis at 4 and 10 min. Results Twenty randomized controlled trials were included in the network meta-analysis, including a total of 3267 patients and 7 different interventions. Fibrin glue and fibrin patch were the most effective interventions for achieving haemostasis at both 4 and 10 min. There were no significant differences between haemostatic agents with respect to blood loss, transfusion requirements, bile leak, post-operative complications, reoperation, or mortality. Conclusions Amongst the haemostatic agents currently available, fibrin patch and fibrin glue are the most effective methods for reducing time to haemostasis during liver resection, but have no effect on other peri-operative outcomes. Topical haemostatic agents should not be used routinely, but may be a useful adjunct to achieve haemostasis when needed.
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05621-z) contains supplementary material, which is available to authorized users. & Sanjay Pandanaboyana [email protected] 1
Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
2
HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
Despite improvements in surgical and anaesthetic techniques in recent decades, hepatic resection is still associated with considerable morbidity [1, 2]. Hepatectomy carries a high risk of bleeding both intra- and post-operatively, and parenchymal bleeding may be difficult to control [3]. Operative blood loss and subsequent transfusion requirements impact on both short- and long-term outcomes following hepatic resection [4–6]. Considerable effort has been directed towards reducing bleeding, with multiple techniques including low central venous pressure, in-flow vascular occlusion, and various transection methods currently in use [3, 7, 8].
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World J Surg
Topical adjunctive haemostatic agents are frequently u
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