Fibrin Sealant in Paediatric Surgical Practice

Abstract

In 1987, we described the use of fibrin sealant for ensuring perfect haemostasis of the raw hepatic surface in reduced-size or partial paediatric liver transplantation. The success of our experimental and clinical studies led to new and wider surgical applications for this product. In liver transplantation, fibrin sealant was used to ensure high-pressure vascular anastomoses and to seal the raw surface in the reduced-sized liver. In these cases we sought efficacy in haemostasis, sealing and safety. The success of this high-risk surgery permitted us to employ fibrin sealant in other cases, including hepatic and splenic ruptures, complete tracheal stenosis treated with pericardial graft and thoracic and abdominal tumours, particularly bilateral Wilms’ tumours, in which extensive tumourectomy must be performed in both kidneys and where the risk of urine and blood leakage is high. For all these indications the aim was the same: sealing. We have had no side effects or morbidity due to fibrin sealant. Thus, it was later applied in two cases of lymphangioma to avoid recurrence. At present, in rat models we are studying the possible use of fibrin sealant to prevent impending perforation provoked by neonatal necrotizing enterocolitis (NEC) and have applied it successfully in one clinical case. In this particular case, we used fibrin sealant by spray to avoid perforation and fixed the intestinal segments to prevent occlusive adhesions, and we used fibrin sealant without spray to apply a layer between the peripheral small intestine and the abdominal zip that was placed to control NEC evolution daily. It seems clear that new applications for fibrin sealant are emerging and our experience provides wider possibilities in paediatric surgery.