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Haemostatic Efficacy of Topical Agents During Liver Resection: A Network Meta-Analysis of Randomised Trials

Lookup NU author(s): Gourab Sen, John Hammond, Jeremy French, Professor Colin Wilson, Professor Derek Manas, Steven White, Sanjay PandanaboyanaORCiD


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© 2020, Société Internationale de Chirurgie. 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.

Publication metadata

Author(s): Wells CI, Ratnayake CBB, Mentor K, Sen G, Hammond JS, French JJ, Wilson CH, Manas D, White S, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: World Journal of Surgery

Year: 2020

Volume: 44

Pages: 3461-3469

Print publication date: 01/10/2020

Online publication date: 02/06/2020

Acceptance date: 02/04/2018

ISSN (print): 0364-2313

ISSN (electronic): 1432-2323

Publisher: Springer


DOI: 10.1007/s00268-020-05621-z