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

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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.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand

    Cameron I. Wells & Chathura B. B. Ratnayake

  2. HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK

    Keno Mentor, Gourab Sen, John S. Hammond, Jeremy J. French, Colin H. Wilson, Derek Manas, Steve White & Sanjay Pandanaboyana

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  1. Cameron I. Wells
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  2. Chathura B. B. Ratnayake
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Correspondence to Sanjay Pandanaboyana.

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Wells, C.I., Ratnayake, C.B.B., Mentor, K. et al. Haemostatic Efficacy of Topical Agents During Liver Resection: A Network Meta-Analysis of Randomised Trials. World J Surg 44, 3461–3469 (2020). https://doi.org/10.1007/s00268-020-05621-z

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