|
1
|
Tominaga H, Kawamura I, Tokumoto H, Tawaratsumida H, Ogura T, Kuroshima T, Ijiri K, Taniguchi N. Fibrin glue-coated collagen matrix is superior to fibrin glue-coated polyglycolic acid for preventing cerebral spinal fluid leakage after spinal durotomy. Sci Rep 2024; 14:23613. [PMID: 39384868 PMCID: PMC11479623 DOI: 10.1038/s41598-024-75085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 10/01/2024] [Indexed: 10/11/2024] Open
Abstract
After surgery for intradural lesions, dural reconstruction is essential for preventing cerebrospinal fluid (CSF) leakage, which can cause serious complications. However, there is currently no established intraoperative procedure. While hydrophobic polyglycolic acid (PGA) sheets and fibrin glue are effective for dural reconstruction, the usefulness of hydrophilic artificial dura mater made of a porous collagen matrix has also been reported. This study aimed to compare the ability of a fibrin-coated porous collagen matrix and a fibrin-coated PGA sheet to prevent CSF leakage during spinal surgery. This study included 319 patients who underwent surgery for intradural lesions requiring dural reconstruction. Patients in the PGA sheet group (group P) and the porous collagen matrix group (group C) were compared. The median age was 60 years. A total of 319 patients were included, with 219 in Group P and 100 in Group C. CSF leakage occurred in 11 patients (5.0%) in Group P and 0 patients in Group C (P < 0.05). This is the first report showing the superiority of a porous collagen matrix sheet over a PGA sheet in preventing CSF leakage during spinal surgery. The porous collagen matrix is hydrophilic and may be more effective against CSF leakage than hydrophobic PGA sheets.
Collapse
Affiliation(s)
- Hiroyuki Tominaga
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Ichiro Kawamura
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroki Tawaratsumida
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takuma Ogura
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Tomoki Kuroshima
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kosei Ijiri
- Kirishima Orthopedic Surgery, Kirishima, Japan
| | - Noboru Taniguchi
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| |
Collapse
|
|
2
|
Korekawa K, Kunimitsu A. Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases. Clin J Gastroenterol 2024; 17:626-632. [PMID: 38678154 DOI: 10.1007/s12328-024-01975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Polyglycolic acid sheets and fibrin glue are routinely used in surgical procedures. Their usefulness in gastrointestinal endoscopy is mainly to prevent complications (bleeding, delayed perforation, stenosis, etc.) associated with procedures such as endoscopic submucosal dissection and endoscopic mucosal resection, with most reports on iatrogenic and secondary conditions. However, there are few reports on primary gastrointestinal diseases. Herein, we report three cases of gastrointestinal bleeding that were successfully treated with endoscopic hemostasis by sealing the lesions with polyglycolic acid sheets and fibrin glue. Case 1 was of an 83-year-old woman with a rare duodenal perforation that was treated with omental plugging who experienced subsequent bleeding from the greater omentum. Case 2 was of a 73-year-old woman with an acute hemorrhagic rectal ulcer that was difficult to treat even after performing standard endoscopic hemostasis techniques; however, surgery was avoided by sealing. Case 3 was that of an 89-year-old woman with a stercoral ulcer, treated curatively using a combination of sealing and argon plasma coagulation right from presentation based on the lessons learned from Cases 1 and 2. Endoscopic hemostasis using a polyglycolic acid sheet and fibrin glue may be a new treatment option for gastrointestinal bleeding particularly in refractory or rare causes.
Collapse
Affiliation(s)
- Kai Korekawa
- Department of Gastroenterology, Hachinohe City Hospital, Hachinohe, Aomori, 031-0011, Japan.
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Atsushi Kunimitsu
- Department of Gastroenterology, Hachinohe City Hospital, Hachinohe, Aomori, 031-0011, Japan
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
|
3
|
Khurana D, Suresh A, Nayak R, Shetty M, Sarda RK, Knowles JC, Kim HW, Singh RK, Singh BN. Biosubstitutes for dural closure: Unveiling research, application, and future prospects of dura mater alternatives. J Tissue Eng 2024; 15:20417314241228118. [PMID: 38343772 PMCID: PMC10858672 DOI: 10.1177/20417314241228118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/09/2024] [Indexed: 01/04/2025] Open
Abstract
The dura mater, as the crucial outermost protective layer of the meninges, plays a vital role in safeguarding the underlying brain tissue. Neurosurgeons face significant challenges in dealing with trauma or large defects in the dura mater, as they must address the potential complications, such as wound infections, pseudomeningocele formation, cerebrospinal fluid leakage, and cerebral herniation. Therefore, the development of dural substitutes for repairing or reconstructing the damaged dura mater holds clinical significance. In this review we highlight the progress in the development of dural substitutes, encompassing autologous, allogeneic, and xenogeneic replacements, as well as the polymeric-based dural substitutes fabricated through various scaffolding techniques. In particular, we explore the development of composite materials that exhibit improved physical and biological properties for advanced dural substitutes. Furthermore, we address the challenges and prospects associated with developing clinically relevant alternatives to the dura mater.
Collapse
Affiliation(s)
- Dolphee Khurana
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ankitha Suresh
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manjunath Shetty
- Division of Pharmacology, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rohit Kumar Sarda
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Jonathan C Knowles
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, UK
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Republic of Korea
| | - Hae-Won Kim
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Republic of Korea
- Institute of Tissue Regeneration Engineering, Dankook University, Cheonan, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Dankook University, Cheonan, Republic of Korea
| | - Rajendra K Singh
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Republic of Korea
- Institute of Tissue Regeneration Engineering, Dankook University, Cheonan, Republic of Korea
| | - Bhisham Narayan Singh
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
|
4
|
Izumi K, Yortchan W, Aizawa Y, Kobayashi R, Hoshikawa E, Ling Y, Suzuki A. Recent trends and perspectives in reconstruction and regeneration of intra/extra-oral wounds using tissue-engineered oral mucosa equivalents. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:365-374. [PMID: 37954029 PMCID: PMC10632115 DOI: 10.1016/j.jdsr.2023.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Many conditions, including cancer, trauma, and congenital anomalies, can damage the oral mucosa. Multiple cultures of oral mucosal cells have been used for biocompatibility tests and oral biology studies. In recent decades, the clinical translation of tissue-engineered products has progressed significantly in developing tangible therapies and inspiring advancements in medical science. However, the reconstruction of an intraoral mucosa defect remains a significant challenge. Despite the drawbacks of donor-site morbidity and limited tissue supply, the use of autologous oral mucosa remains the gold standard for oral mucosa reconstruction and repair. Tissue engineering offers a promising solution for repairing and reconstructing oral mucosa tissues. Cell- and scaffold-based tissue engineering approaches have been employed to treat various soft tissue defects, suggesting the potential clinical use of tissue-engineered oral mucosa (TEOMs). In this review, we first cover the recent trends in the reconstruction and regeneration of extra-/intra-oral wounds using TEOMs. Next, we describe the current status and challenges of TEOMs. Finally, future strategic approaches and potential technologies to support the advancement of TEOMs for clinical use are discussed.
Collapse
Affiliation(s)
- Kenji Izumi
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Witsanu Yortchan
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - Yuka Aizawa
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Ryota Kobayashi
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Emi Hoshikawa
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
- Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Yiwei Ling
- Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ayako Suzuki
- Division of Biomimetics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| |
Collapse
|
|
5
|
Elkomos BE, Elkomos PE, Salem AA, Adly PB. The outcome of bioabsorbable staple line reinforcement versus standard stapler for distal pancreatectomy: A systematic review and meta-analysis. J Minim Access Surg 2022; 18:338-345. [PMID: 35708377 PMCID: PMC9306122 DOI: 10.4103/jmas.jmas_47_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Aim In the era of minimally invasive procedures and as a way to decrease the incidence of post-operative pancreatic fistula (POPF), the use of staplers for distal pancreatectomy (DP) has increased dramatically. Our aim was to investigate whether reinforced staplers decrease the incidence of clinically relevant PF after DP compared with staplers without reinforcement. Methods PubMed, Scopus, Web of Science and Cochrane Library were searched for eligible studies from inception to 1 November 2021, and a systematic review and a meta-analysis were done to detect the outcomes after using reinforced staplers versus standard stapler for DP. Results Seven studies with a total of 681 patients were included. The overall incidence of POPF and the incidence of Grade A POPF after DP are similar for the two groups (overall POPF, risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.71-1.01, P = 0.06; I2 = 38% and Grade A POPF, RR = 1.15, 95% CI = 0.78-1.69, P = 0.47; I2 = 49%). However, the incidence of clinically significant POPF (Grades B and C) is significantly lower in DP with reinforced staplers than DP with bare staplers (Grades B and C, RR = 0.45, 95% CI = 0.29-0.71, P = 0.0005; I2 = 17%). Nevertheless, the time of the operation, the blood loss during surgical procedure, the hospital stay after the surgery and the thickness of the pancreas are similar for both techniques. Conclusion Although staple line reinforcement after DP failed to prevent biochemical PF, it significantly reduced the rate of clinically relevant POPF in comparison to standard stapling.
Collapse
Affiliation(s)
- Beshoy Effat Elkomos
- Department of General Surgery, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt
| | | | - Amir Ali Salem
- Department of General Surgery, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt
| | - Philobater Bhgat Adly
- Department of General Surgery, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt
| |
Collapse
|
|
6
|
Thoracoscopic Repair of Adult-Onset Congenital Tracheoesophageal Fistula Using a Polyglycolic Acid Sheet-Buttressed Stapler. Medicina (B Aires) 2022; 58:medicina58070843. [PMID: 35888562 PMCID: PMC9320588 DOI: 10.3390/medicina58070843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Congenital tracheoesophageal fistula (TEF) without esophageal atresia is usually diagnosed and treated in the neonatal period. It is uncommon to occur in adulthood. Conventional treatment of adult-onset TEF involves repair by either cervicotomy or thoracotomy. We reported the case of a 31-year-old male patient with clinical and radiographic evidence of congenital H-type TEF. Although this fistula was located at the level of the second thoracic vertebra, the repair of the anomaly was performed successfully using a thoracoscopic approach with the novel use of a polyglycolic acid sheet reinforcement.
Collapse
|
|
7
|
Choi SI, Park JY. Large anastomotic leak: endoscopic treatment using combined fibrin glue and polyglycolic acid (PGA) sheets. BMJ Case Rep 2021; 14:e240188. [PMID: 34446509 PMCID: PMC8395350 DOI: 10.1136/bcr-2020-240188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/03/2022] Open
Abstract
Anastomotic leak after gastrectomy is a major complication and various endoscopic methods have been suggested. However, the treatment of large-sized leaks remains a challenge. Here, we present a case of a large anastomotic leak successfully treated endoscopically using a combination of fibrin glue and polyglycolic acid (PGA) sheets. A 68-year-old man who underwent laparoscopic total gastrectomy and oesophagojejunal anastomosis presented with abdominal pain and fever. In the endoscopic examination, two fistulas were observed at the anastomosis site. One was small (0.6 cm) while the other measured 2.5 cm. For the large leak, endoscopic treatment using endoclip and detachable snare was attempted, but failed. Subsequently, fibrin glue was injected into the large fistula through an endoscope. After 28 days, the size of the fistula was reduced and PGA sheets were inserted into the remaining fistula. After about 4 weeks, leaks were observed to be completely healed.
Collapse
Affiliation(s)
- Soo In Choi
- Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Seoul, Korea (the Republic of)
| | - Ji Young Park
- Internal Medicine, Inje University Sanggye Paik Hospital, Nowon-gu, Seoul, Korea (the Republic of)
| |
Collapse
|
|
8
|
Abstract
During operations, surgical mesh is commonly fixed on tissues through fasteners such as sutures and staples. Attributes of surgical mesh include biocompatibility, flexibility, strength, and permeability, but sutures and staples may cause stress concentration and tissue damage. Here, we show that the functions of surgical mesh can be significantly broadened by developing a family of materials called hydrogel-mesh composites (HMCs). The HMCs retain all the attributes of surgical mesh and add one more: adhesion to tissues. We fabricate an HMC by soaking a surgical mesh with a precursor, and upon cure, the precursor forms a polymer network of a hydrogel, in macrotopological entanglement with the fibers of the surgical mesh. In a surgery, the HMC is pressed onto a tissue, and the polymers in the hydrogel form covalent bonds with the tissue. To demonstrate the concept, we use a poly(N-isopropylacrylamide) (PNIPAAm)/chitosan hydrogel and a polyethylene terephthalate (PET) surgical mesh. In the presence a bioconjugation agent, the chitosan and the tissue form covalent bonds, and the adhesion energy reaches above 100 J⋅m-2 At body temperature, PNIPAAm becomes hydrophobic, so that the hydrogel does not swell and the adhesion is stable. Compared with sutured surgical mesh, the HMC distributes force over a large area. In vitro experiments are conducted to study the application of HMCs to wound closure, especially on tissues under high mechanical stress. The performance of HMCs on dynamic living tissues is further investigated in the surgery of a sheep.
Collapse
|
|
9
|
Patrone R, Granata V, Belli A, Palaia R, Albino V, Piccirillo M, Fusco R, Tatangelo F, Nasti G, Avallone A, Izzo F. The safety and efficacy of Glubran 2 as biliostatic agent in liver resection. Infect Agent Cancer 2021; 16:19. [PMID: 33726798 PMCID: PMC7968309 DOI: 10.1186/s13027-021-00358-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Biloma, an encapsulated collection of bile outside the biliary tree, supported by a predominantly iatrogenic biliary fistula, and bile likeage are two of the most important surgical complications after liver resection. We, hypothesized to conduct a project aimed to prevent, or reduce, the formation of biloma or biliary fistula applying on the hepatic resection area the cyanoacrylate glue (Glubran2). Methods We searched in our surgical database all patients underwent liver resection for mCRC from January 2013 to December 2018 and we found a total of 510 patients. 205 patients for Group A (study population: included patients in which we have used Glubran2 during surgical procedure) and 113 patients for Group B (control group), were enrolled. Results In both Groups no patients died during hospitalization and the 30-day mortality was 0 %. During follow-up in Group A, a biliary fistula was found in 2 patients (1 %) versus 3 patients in the Group B (2,6 %). In patients enrolled in Group A no adverse event were reported relate to the use of Glubran2. Conclusions It is possible to affirm that the use of Glubran2 as biliostatic agent after liver resection is useful to prevent bile leakage complication and biloma formation and its use demonstrated to be safe and feasible during liver surgery.
Collapse
Affiliation(s)
- Renato Patrone
- PhD ICTH, University Federico II, Via Sergio Pansinin 5, 80131, Naples, Italy
| | - Vincenza Granata
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy. .,Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Andrea Belli
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Raffaele Palaia
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Vittorio Albino
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Mauro Piccirillo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Roberta Fusco
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Fabiana Tatangelo
- Department of Support to Cancer Pathways Diagnostics Area, Pathology and Cytopathology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Guglielmo Nasti
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Antonio Avallone
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Francesco Izzo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| |
Collapse
|
|
10
|
Clinical impact of intraoperative bile leakage during laparoscopic liver resection. Surg Endosc 2020; 35:4134-4142. [PMID: 32780232 DOI: 10.1007/s00464-020-07880-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the increasing number of laparoscopic liver resection (LLR) procedures, postoperative bile leakage (POBL) remains a major complication. We occasionally experienced intraoperative bile leakage (IOBL) during LLR and managed it within the restrictions of laparoscopic surgery. However, there have been no reports about IOBL in LLR. We therefore investigated the impact of IOBL on postoperative outcomes and its predictive factors. METHODS We reviewed 137 patients who underwent LLR from April 2016 to March 2019 at our institute and assigned them to IOBL-positive or IOBL-negative groups. We compared clinicopathological characteristics and perioperative outcomes. Patients were further divided into four groups according to IOBL pattern, and the frequency of POBL in each was calculated. Predictors of IOBL were identified using multivariate logistic regression analysis. RESULTS There were 30 and 107 patients in the IOBL-positive and IOBL-negative groups, respectively. In the IOBL-positive group, operative time and postoperative hospital stays were significantly longer (P < 0.001). The frequency of POBL was significantly higher in the IOBL-positive group (P = 0.006). The IOBL-positive group was divided into two subgroups: IOBL from the transected parenchyma (IOBL-TP, n = 18) and from the main Glissonean pedicle (IOBL-mGP, n = 12). The IOBL-negative group was divided into two subgroups: bile staining in the mGP (BS-mGP, n = 9) and no change (NC, n = 98). POBL occurred in 11% (n = 2/18) of patients with IOBL-TP, 25% (n = 3/12) of those with IOBL-mGP, 11% (n = 1/9) of those with BS-mGP, and 1% (n = 1/98) of those with NC. Age, diabetes mellitus, indocyanine green retention rate, and Glissonean approach were predictors of IOBL (P < 0.05). CONCLUSIONS IOBL was relatively common during LLR and resulted in a higher incidence of POBL. Depending on the predictive factors, IOBL must be promptly identified and appropriately managed.
Collapse
|
|
11
|
Sakaguchi H, Takao T, Takegawa Y, Koga Y, Yamanaka K, Sagata M, Tanaka S, Morita Y, Toyonaga T, Kodama Y. Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs. Clin Endosc 2020; 54:64-72. [PMID: 32668527 PMCID: PMC7939780 DOI: 10.5946/ce.2020.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.
Collapse
Affiliation(s)
- Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshitatsu Takao
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Yuki Koga
- KM Biologics Co., Ltd., Kumamoto, Japan
| | | | | | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Toyonaga
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
|
12
|
Wang J, Zhao JP, Wang JJ, Chai SS, Zhang YX, Zhang ZG, Xiang S, Chen XP, Zhang WG. The impact of bile leakage on long-term prognosis in primary liver cancers after hepatectomy: A propensity-score-matched study. Asian J Surg 2020; 43:603-612. [PMID: 31611103 DOI: 10.1016/j.asjsur.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/16/2019] [Accepted: 08/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The impact of bile leakage (BL) on the long-term prognosis in patients with primary liver cancers after hepatectomy remains unclear. METHODS One thousand nine hundred and seventy-one consecutive patients with primary liver cancers who underwent curative hepatectomy were enrolled. 75 patients encountered BL, including 34 long-time BL (LTBL) and 41 short-time BL (STBL) according to 4-weeks demarcation. Variables associated with BL were identified using multiple logistic regression analysis. 75 patients without BL were enrolled into the Non-BL group using a one-to-one propensity score matched analysis before assessing the impact of BL on the long-term prognosis. The levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in the serum and drain fluid were detected and compared. RESULTS The tumor size, type of liver cancer, operation time, blood loss and blood transfusion were independent risk factors for BL. The long-term survival showed no difference between the patients with and without BL (p > 0.05), while the LTBL was a significant predictor of poor long-term prognosis (p < 0.001). Compared with the patients without BL, the patients with BL had a higher level of IL-6 from postoperative day (POD) 1 to POD 60, and a higher level of CRP from POD 7 to POD 60. By POD 60, the levels of IL-6 and CRP hadn't restored to the normal level in the LTBL group. CONCLUSIONS The LTBL has a negative impact on the long-term prognosis of patients with primary liver cancers after hepatectomy, in which the inflammatory responses may play a pivotal role.
Collapse
Affiliation(s)
- Jian Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Hepatopancreatobiliary Surgery Treatment Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jian-Ping Zhao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Jing Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song-Shan Chai
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Xin Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhan-Guo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Xiang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Wan-Guang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
|
13
|
Al-Saeedi M, Fonouni H, Kashfi A, Ghamarnejad O, Majlesara A, Gharabaghi N, Stahlheber O, Kraus TW, Mehrabi A, Kulu Y. Mechanical strength of biliary defect closure after topical sealing: Comparison of four sealants in a porcine model. Asian J Surg 2019; 42:723-730. [PMID: 30600147 DOI: 10.1016/j.asjsur.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE Biliary leakage is a potential complication of liver resection and is still a concern. The aim of the present study was to evaluate the effectiveness of four routinely used sealants in preventing bile leakage under pressure from an induced perforation of the gallbladder in a porcine model. METHODS Forty Landrace pigs were randomly assigned to one of five groups. These included a control group (n = 8) and one group each for the sealants TachoSil®, TissuCol Duo®, Coseal®, and FloSeal® (n = 8 per group). In the control group, the perforation was left unsealed. To evaluate the biliostatic potential of the sealants, we measured the pressure that was needed to induce leakage (mmHg) and the gallbladder volume (cc) at the time of leakage in each group. RESULTS A significantly higher mean pressure was required to induce leakage in the sealant groups compared with the control group. However, the biliostatic effects were heterogeneous among the sealant groups. Sealants with the highest to lowest effectiveness were TachoSil, Coseal, TissuCol, and FloSeal. The mean gallbladder volume at the time of leakage also varied between sealant groups. CONCLUSION Biliostatic properties are markedly improved by the use of modern sealants compared with using no sealant. However, the advantages and disadvantages of using sealants should be carefully considered in each clinical situation. The effectiveness of the sealants should be evaluated in chronic and clinical studies.
Collapse
Affiliation(s)
- Mohammad Al-Saeedi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Thomas W Kraus
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
| |
Collapse
|
|
14
|
Nakano Y, Takao T, Morita Y, Sakaguchi H, Tanaka S, Ishida T, Toyonaga T, Umegaki E, Kodama Y. Endoscopic plombage with polyglycolic acid sheets and fibrin glue for gastrointestinal fistulas. Surg Endosc 2018; 33:1795-1801. [PMID: 30251142 DOI: 10.1007/s00464-018-6454-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND STUDY AIMS Gastrointestinal (GI) fistulas arise as adverse events of GI surgery and endoscopic treatment as well as secondary to underlying diseases, such as ulceration and pancreatitis. Until a decade ago, they were mainly treated surgically or conservatively. Bioabsorbable polyglycolic acid (PGA) sheets and fibrin glue, which are commonly used in surgical procedures, have also recently been used in endoscopic procedures for the closure of GI defects. However, there have only been few case reports about successful experiences with this approach. There have not been any case-series studies investigating the strengths and weaknesses of such PGA sheet-based treatment. In this study, we evaluated the clinical effectiveness of using PGA sheets to close GI fistulas. PATIENTS AND METHODS Cases in which patients underwent endoscopic filling with PGA sheets and fibrin glue for GI fistulas at Kobe University Hospital between January 2013 and April 2018 were retrospectively reviewed. RESULTS A total of 10 cases were enrolled. They included fistulas due to leakage after GI surgery, aortoesophageal/bronchoesophageal fistulas caused by chemoradiotherapy, or severe acute pancreatitis. The fistulas were successfully closed in 7 cases (70%). The unsuccessful cases involved a fistula due to leakage after surgical esophagectomy and bronchoesophageal fistulas due to chemoradiotherapy or severe acute pancreatitis. Unsuccessful treatment was related to fistula epithelization. CONCLUSION Endoscopic plombage with PGA sheets and fibrin glue could be a promising therapeutic option for GI fistulas.
Collapse
Affiliation(s)
- Yoshiko Nakano
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Toshitatsu Takao
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Tsukasa Ishida
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | | | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| |
Collapse
|
|
15
|
Watanabe K, Hikichi T, Nakamura J, Hashimoto M, Takagi T, Suzuki R, Sugimoto M, Konno N, Takasumi M, Sato Y, Irie H, Kimura T, Kenjo A, Marubashi S, Obara K, Ohira H. Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor. Case Rep Gastroenterol 2018; 12:679-685. [PMID: 30631252 PMCID: PMC6323404 DOI: 10.1159/000494918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022] Open
Abstract
We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.
Collapse
Affiliation(s)
- Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
|
16
|
Seehawong U, Morita Y, Nakano Y, Iwasaki T, Krutsri C, Sakaguchi H, Sako T, Takao T, Tanaka S, Toyonaga T, Umegaki E, Kodama Y. Successful treatment of an esophageal perforation that occurred during endoscopic submucosal dissection for esophageal cancer using polyglycolic acid sheets and fibrin glue. Clin J Gastroenterol 2018; 12:29-33. [PMID: 30171487 DOI: 10.1007/s12328-018-0900-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/23/2018] [Indexed: 02/08/2023]
Abstract
A 74-year-old female, who was diagnosed with superficial esophageal cancer, underwent endoscopic submucosal dissection (ESD) at another hospital, but a perforation occurred during the procedure. The perforation was closed with endoscopic clips, and the ESD was halted. The patient was referred to our hospital, and ESD was retried. There was severe fibrosis around the lesion, and injections into the submucosal layer were difficult. In addition, it was not possible to identify the submucosal layer, and making an oral-side incision caused a large perforation along the incision line. As continuing the submucosal dissection with an endoknife was considered difficult, the lesion was finally resected with hybrid ESD using a snare. The perforation was closed using polyglycolic acid (PGA) sheets and fibrin glue. Endoscopy performed 6 days later showed that the defect had been closed, and no contrast leakage was detected. Follow-up endoscopy conducted 3 months after the ESD showed ulcer healing at the dissection site and scar formation, but no residual tumor or esophageal stricture was noted. Our experience suggests that the use of PGA sheets with fibrin glue is a feasible, safe, and effective way of treating large esophageal perforations during ESD.
Collapse
Affiliation(s)
- Umaporn Seehawong
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Yoshiko Nakano
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Takehiro Iwasaki
- Department of Gastroenterology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Chonlada Krutsri
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Tomoya Sako
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Toshitatsu Takao
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | | | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| |
Collapse
|
|
17
|
Loreto-Brand M, Fernández-Pérez A, Varela-Ponte R, Varo-Pérez E. Resolución de colección biliar gigante por fistulización espontánea al colon. RADIOLOGIA 2018; 60:351-354. [DOI: 10.1016/j.rx.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022]
|
|
18
|
Kawata N, Ono H, Takizawa K, Kakushima N, Tanaka M, Igarashi K, Yoshida M, Kishida Y, Iwai T, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H. Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents. Gastric Cancer 2018; 21:696-702. [PMID: 29357012 DOI: 10.1007/s10120-018-0791-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking antithrombotic agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued antithrombotic agents. METHODS One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued antithrombotic agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared. RESULTS No significant differences were seen in the number and type of antithrombotic agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06-0.89). No adverse events were associated with the use of PGA sheets and fibrin glue. CONCLUSIONS The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.
Collapse
Affiliation(s)
- Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Kimihiro Igarashi
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Tomohiro Iwai
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan
| |
Collapse
|
|
19
|
Okuyama K, Yanamoto S, Naruse T, Sakamoto Y, Rokutanda S, Ohba S, Asahina I, Umeda M. Clinical complications in the application of polyglycolic acid sheets with fibrin glue after resection of mucosal lesions in oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:541-546. [PMID: 29402730 DOI: 10.1016/j.oooo.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/03/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Covering open wounds with a polyglycolic acid (PGA) sheet using fibrin glue after resection of oral mucosal lesions is reportedly useful. We focused on clinical complications of this procedure: development of marked granuloma-like neoplasm (GLN) and abnormal postoperative bleeding (APB) on the resected region. STUDY DESIGN The characteristics of 100 cases with PGA sheet application after the resection of oral mucosal lesion were examined retrospectively by the medical records and/or oral photographs at our department between 2010 and 2016. RESULTS Our retrospective analysis identified included 8 cases of GLN development and 7 cases of APB. There was a significantly higher risk of GLN development when the PGA sheet was applied to the raw surface of the tongue. There were no immediate APBs, but 4 APBs occurred several hours after surgery. All APB cases involved the tongue. CONCLUSIONS Both GLNs and APBs are minor complications. Although all cases of GLNs did not involve the recurrence of a tumor, follow-up with incisional or excisional biopsy should be performed. APB in the oral cavity induced by the PGA sheet peeling due to fluctuating adhesive force of the PGA sheets and fibrin glue can sometimes induce life-threatening events.
Collapse
Affiliation(s)
- Kohei Okuyama
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomofumi Naruse
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuki Sakamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Satoshi Rokutanda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
|
20
|
Abstract
STUDY DESIGN Basic science. OBJECTIVE This study aimed to compare the techniques of surgical repair of dural tear using bioabsorbable material and fibrin glue. SUMMARY OF BACKGROUND DATA Cerebrospinal fluid (CSF) leakage caused by dural tear can often be difficult to manage even after repair when the same materials are used in a similar manner. METHODS Burst pressure was measured for repaired porcine dura with holes of different diameters using spray of combined fibrinogen and thrombin solution (fibrin spray) alone as a control and the 5-mm hole following different methods using fibrinogen and thrombin solutions plus polyglactin 910 sheet (PGS). For group 1, fibrinogen was applied on the dura followed by PGS and thrombin. For group 2, thrombin was followed by PGS and fibrinogen. For group 3, fibrinogen was followed by PGS and fibrin spray. For group 4, thrombin was followed by PGS and fibrin spray. Microscopic observation was conducted for each specimen. RESULTS Repair using fibrin spray alone was successful for the 0.3-mm diameter pinhole (breakdown pressure: 27.8 ± 8.6 mmHg), but was not able to cover the 2.7- and 5-mm holes. For a 5-mm diameter hole, the breakdown pressure was 54.4 ± 38.8 mmHg in group 1, 26.3 ± 19.4 mmHg in group 2, 147.7 ± 65.0 mmHg in group 3, and 35.5 ± 23.4 mmHg in group 4 (P < 0.001). There was little fibrin glue in the burst layer between the dural surface and PGS with thrombin on the dural surface (group 2 and group 4). CONCLUSION Suppression of excessive CSF leakage could be successful by performing several cycles of the group 1 method (fibrinogen was applied on the dura followed by PGS and thrombin), followed by the group 3 method (fibrinogen was applied on the dura followed by PGS and fibrin spray), with thrombin solution wash each time. LEVEL OF EVIDENCE 4.
Collapse
|
|
21
|
Inokuchi S, Rokutanda S, Yanamoto S, Naruse T, Sakamoto Y, Umeda M. Experimental study and clinical application of polyglycolic acid sheet with fibrin glue for oral soft tissue surgery. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
22
|
Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Gharabaghi N, Kraus TW, Mehrabi A, Oweira H. Hemostatic efficiency of modern topical sealants: Comparative evaluation after liver resection and splenic laceration in a swine model. J Biomed Mater Res B Appl Biomater 2017. [DOI: 10.1002/jbm.b.33937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Lukas Konstantinidis
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Thomas W. Kraus
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Hani Oweira
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| |
Collapse
|
|
23
|
Matsuzuka T, Suzuki M, Ikeda M, Sato K, Fujimoto J, Hosaka R, Tanji Y, Soeda S, Murono S. A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor. Auris Nasus Larynx 2017. [PMID: 28624427 DOI: 10.1016/j.anl.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job. Under local anesthesia, resection was performed, and PGA sheet grafting were used to shield the skin defect. After resection, she was relieved from pain, and could stay home without daily wound treatment. One and half months after resection, the wound was almost epithelialized. The PGA sheets consist of soft, elastic, nonwoven fabric made of PGA. In recent years, PGA sheet grafting has been widely used in the reconstruction and was chosen to shield the skin defect for this case. PGA sheet grafting after resection of cervical skin tumor can be an acceptable method for palliative care to relieve pain, bleeding, offensive smell, and ugly appearance.
Collapse
Affiliation(s)
- Takashi Matsuzuka
- Department of Otolaryngology, Fukushima Medical University, Japan; Palliative Care Center, Fukushima Medical University Hospital, Japan.
| | - Masahiro Suzuki
- Department of Otolaryngology, Fukushima Medical University, Japan
| | - Masakazu Ikeda
- Department of Otolaryngology, Fukushima Medical University, Japan
| | - Kaoru Sato
- Palliative Care Center, Fukushima Medical University Hospital, Japan
| | - Junko Fujimoto
- Palliative Care Center, Fukushima Medical University Hospital, Japan
| | - Rumi Hosaka
- Palliative Care Center, Fukushima Medical University Hospital, Japan
| | - Yuko Tanji
- Palliative Care Center, Fukushima Medical University Hospital, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Japan
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Japan
| |
Collapse
|
|
24
|
Mochizuki Y, Tomioka H, Tushima F, Shimamoto H, Hirai H, Oikawa Y, Harada H. Clinical evaluation of coverage of open wounds: Polyglycolic acid sheet with fibrin glue spray vs split thickness skin. Ann Maxillofac Surg 2017; 6:228-234. [PMID: 28299263 PMCID: PMC5343633 DOI: 10.4103/2231-0746.200346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: This study aimed to evaluate the coverage of oral wounds using either a polyglycolic acid (PGA) sheet or split-thickness skin grafting (STSG). Materials and Methods: A total of 119 cases of wound coverage using a PGA sheet and fibrin glue spray as well as 132 cases of wound coverage cases using STSG were reviewed retrospectively. The site of the excision area, perioperative conditions, and postoperative functional problems were evaluated. Results: The PGA group had significantly shorter operation time, earlier start of oral intake, and shorter hospitalization than the STSG group. If the PGA sheet over the wound with exposed bone could be protected by a surgical sprint, oral food intake could be started on the day after surgery at the earliest. When the size of the wound in the buccal excisional area was classified into two groups (<6 or ≥6 cm2), mouth opening in the STSG group was significantly larger at 3 months postoperatively. When the size of the wound in the tongue and floor of mouth was classified into two groups (<12 or ≥12 cm2), the STSG group had a significantly higher score in postoperative speech intelligibility. Conclusion: Selection of a PGA sheet or STSG based on the consideration of defect size, tumor location, patients’ local and general condition and tolerance for surgery could reduce the patients’ postsurgical dysfunctional problems.
Collapse
Affiliation(s)
- Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Fumihiko Tushima
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yuu Oikawa
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| |
Collapse
|
|
25
|
Ishii T, Hatano E, Furuyama H, Manaka D, Terajima H, Uemoto S. Preventive Measures for Postoperative Bile Leakage After Central Hepatectomy: A Multicenter, Prospective, Observational Study of 101 Patients. World J Surg 2017; 40:1720-8. [PMID: 26902629 DOI: 10.1007/s00268-016-3453-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND There are no conclusive measures for preventing postoperative bile leakage (POBL). METHODS First, 310 patients who underwent hepatectomy were analyzed retrospectively to clarify risk factors for POBL. Then, focusing on operations at high risk of POBL, patients who underwent central hepatectomy were recruited prospectively among 18 institutions, to evaluate various preventive measures for avoiding POBL. The primary endpoint was the frequency of POBL. RESULTS The retrospective analysis revealed central hepatectomy and repeated hepatectomy to be independent risk factors for POBL. One hundred and one patients undergoing central hepatectomy were enrolled in the prospective study. POBL developed in 13 patients (12.9 %). Intraoperative bile leakage was recognized in 42 of the 101 patients (41.6 %), and 10 of the 42 patients developed POBL (23.8 %). Primary closure of the site of bile leakage and/or biliary drainage tube placement was preferable for preventing POBL in the patients with intraoperative bile leakage. Although 59 patients (58.4 %) did not show intraoperative bile leakage, three patients (5.1 %) developed POBL. In the group without intraoperative bile leakage, treatment with fibrin glue with a polyglycolic acid (PGA) sheet or collagen sheet coated with a fibrinogen and thrombin layer (CSFT) had good results. CONCLUSIONS Primary closure of the site of bile leakage and/or placement of biliary drainage tubes may be recommended in cases involving intraoperative bile leakage. Treatment with fibrin glue with a PGA sheet and/or CSFT might have preventive effects in patients without intraoperative bile leakage.
Collapse
Affiliation(s)
- Takamichi Ishii
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan.
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan.
| | | | - Dai Manaka
- Department of Surgery, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Hiroaki Terajima
- Department of Gastroenterological Surgery and Oncology, Kitano Hospital, Osaka, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
|
26
|
Hayashibe A, Ogino N. Clinical study for pancreatic fistula after distal pancreatectomy with mesh reinforcement. Asian J Surg 2016; 41:236-240. [PMID: 27964997 DOI: 10.1016/j.asjsur.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The purpose of this cohort study was to determine whether distal pancreatectomy with mesh reinforcement can reduce postoperative pancreatic fistula (POPF) rates compared with bare stapler. METHODS In total, 51 patients underwent stapled distal pancreatectomy. Out of these, 22 patients (no mesh group) underwent distal pancreatectomy with bare stapler and 29 patients (mesh group) underwent distal pancreatectomy with mesh reinforced stapler. The risk factor for clinically relevant POPF (grades B and C) after distal pancreatectomy was also evaluated. RESULTS Clinical characteristics were almost similar in both the groups. The days of the mean hospital stay and drainage tube insertion in the mesh group were significantly fewer than those in the no mesh group. The mean level of amylase in the discharge fluid in the mesh group was also significantly lower than that the in no mesh group. The rate of clinically relevant POPF (grades B and C ) in the mesh group was significantly lower than that in the no mesh group (p=0.016). Univariate analyses of risk factors for POPF (grades B and C) revealed that only mesh reinforcement was associated with POPF (grades B and C). Moreover, on multivariate analyses of POPF risk factors with p value<0.2 in univariate analyses by logistic regression, mesh reinforcement was regarded as a significant factor for POPF(grades B and C). CONCLUSIONS The distal pancreatectomy with mesh reinforced stapler was thought to be favorable for the prevention of clinically relevant POPF (grades B and C).
Collapse
Affiliation(s)
- Akira Hayashibe
- Department of Surgery, Osakafu Saiseikai Tondabayashi Hospital, Osaka, Japan.
| | - Nobuo Ogino
- Department of Surgery, Osakafu Saiseikai Tondabayashi Hospital, Osaka, Japan
| |
Collapse
|
|
27
|
Hiroyuki T, Kohki Y, Hiroe M, Tsunehito H, Rie A, Shota T, Hiroko T, Yuki O, Takagi T, Kengo T, Takashi T, Hideyuki K, Hideki T, Akeo H. A basic study of the effect of the shielding method with polyglycolic acid fabric and fibrin glue after endoscopic submucosal dissection. Endosc Int Open 2016; 4:E1298-E1304. [PMID: 27995192 PMCID: PMC5161138 DOI: 10.1055/s-0042-118208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and study aims: Recently, the shielding method with polyglycolic acid (PGA) fabric and fibrin glue (P-F method) has been reported to prevent serious complications after endoscopic submucosal dissection (ESD). However, the effectiveness and mechanism to prevent complications by this method remain unclear and the corresponding basic research has not been fully conducted. Methods and results: We examined the effectiveness and mechanism of the P-F method, using a surgical ESD model of canine stomach and in vitro experiments. In the model experiment treated by P-F method or no treatment (control), ulcer perforation or penetration occurred only in the control group, but not in the P-F group. Microscopically, the P-F group showed less damages of the ulcer lesion than that of the control group, showing thicker granulation tissues including PGA fibers on the third day and excellent mucosal regeneration on the fourteenth day. In vitro culture experiments showed that fibroblasts proliferated at a significantly higher rate on PGA than on fibrin or a complex thereof. However, under hydrochloric acid treatment, fibroblasts were protected by fibrin, followed by the complex of both, and PGA. Conclusion: The P-F method exhibited a protective effect against gastric juice by fibrin glue to reduce tissue damages and a scaffold function of PGA fabric to induce better granulation formation at the earlier phase, resulting in excellent long-term tissue repair, on ulcer lesion following ESD, although the results were based on basic experiments.
Collapse
Affiliation(s)
- Tsujimoto Hiroyuki
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan,Corresponding author Hiroyuki
Tsujimoto, MD, PhD Division of Medical Life
SystemDepartment of Life and Medical
ScienceDoshisha
University1-3
Tatara-MiyakodaniKyotanabe, Kyoto
610-0321Japan+81-774-65-6887
| | - Yamanaka Kohki
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Miyamoto Hiroe
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Horii Tsunehito
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Abe Rie
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Tanaka Shota
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Torii Hiroko
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Ozamoto Yuki
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Toshitaka Takagi
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| | - Takimoto Kengo
- Department of Gastroenterology, Takeda
Central Hospital, Kyoto, Japan
| | - Torii Takashi
- Department of Gastroenterology, Kyoto
Prefectural University of Medicine, Kyoto, Japan
| | - Konishi Hideyuki
- Department of Gastroenterology, Kyoto
Prefectural University of Medicine, Kyoto, Japan
| | | | - Hagiwara Akeo
- Division of Medical Life System, Department
of Medical Life System, Doshisha University, Kyotanabe, Kyoto,
Japan
| |
Collapse
|
|
28
|
Koshinuma S, Murakami S, Noi M, Murakami T, Mukaisho KI, Sugihara H, Yamamoto G. Comparison of the wound healing efficacy of polyglycolic acid sheets with fibrin glue and gelatin sponge dressings in a rat cranial periosteal defect model. Exp Anim 2016; 65:473-483. [PMID: 27384972 PMCID: PMC5111851 DOI: 10.1538/expanim.16-0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/15/2016] [Indexed: 01/28/2023] Open
Abstract
Oral surgical procedures occasionally require removal of the periosteum due to lesions, and these raw bone surfaces are prone not only to infection but also to scar formation during secondary healing. The objective of this study was to identify successful methods for reconstruction using periosteal defect dressings. We created 1-cm2 defects in the skin and cranial periosteum of 10-week-old male Wistar rats under isoflurane anesthesia. The animals were assigned to three defect treatment groups: (1) polyglycolic acid sheets with fibrin glue dressing (PGA-FG), (2) Spongel® gelatin sponge dressing (GS), and (3) open wound (control). Postoperative wound healing was histologically evaluated at 2, 4, and 6 weeks. The moist conditions maintained by the GS and PGA-FG treatments protected the bone surface from the destructive effects of drying and infection. Complete wound healing was observed in the GS group but not for all animals in the PGA-FG and control groups. Histologically, osteoblast proliferation on bone surfaces and complete epithelialization with adnexa were observed in the GS group at 6 weeks after surgery. In contrast, PGA sheets that had not been absorbed inhibited osteoblast proliferation and delayed wound healing in the PGA-FG group. Wound surface dressings maintain a moist environment that promotes wound healing, but PGA materials may not be suitable for cases involving exposed periosteum or bone surfaces due to the observed scar formation and foreign-body reaction.
Collapse
Affiliation(s)
- Shinya Koshinuma
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | | | | | | | | | | | | |
Collapse
|
|
29
|
Masuda S, Fujibayashi S, Otsuki B, Kimura H, Neo M, Matsuda S. The dural repair using the combination of polyglycolic acid mesh and fibrin glue and postoperative management in spine surgery. J Orthop Sci 2016; 21:586-90. [PMID: 27519623 DOI: 10.1016/j.jos.2016.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Accidental dural tears are iatrogenic complications during spine surgery. However, there is no established intraoperative method or postoperative management in this situation. To examine the efficacy of the intraoperative method of dural repair, which consists of using the combination of a polyglycolic acid (PGA) mesh and fibrin glue, and the postoperative management of accidental dural tear or intended durotomy. METHODS Seventy-five patients (34 males and 41 females; age range, 16-80 years; mean age, 57.1 years) underwent dural repair intraoperatively from December 2007 to January 2015 at our institution. We repaired dural tears using suture or nonpenetrating titanium clips, followed by reinforcement with a PGA mesh and fibrin glue intraoperatively. In all cases, epidural drains were placed in the wound, then taken off suction and maintained on gravity only. Postoperatively, patients were kept on flat bedrest until the drain was removed, and were allowed to elevate the head and ambulate as early as possible. Medical records were reviewed retrospectively. RESULTS Only one patient with persistent cerebrospinal fluid (CSF) leakage underwent reoperation for dural repair 4 days after the initial operation. Another patient had irrigation and debridement for superficial surgical-site infection. The remaining patients had good clinical course without reoperation. CONCLUSIONS Our method of dural repair (i.e., the combination of a PGA mesh with fibrin glue) and postoperative management appear to be effective and safe in this situation. Only one patient out of 75 (1.3%) required reoperation for dural repair.
Collapse
Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| |
Collapse
|
|
30
|
Brustia R, Granger B, Scatton O. An update on topical haemostatic agents in liver surgery: systematic review and meta analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:609-621. [PMID: 27580747 DOI: 10.1002/jhbp.389] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/29/2016] [Indexed: 12/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Raffaele Brustia
- Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France.,Université Pierre et Marie Curie, Paris, France
| | - Benjamin Granger
- Department of Biostatistics, Public Health and Medical Information, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, Pitié Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l' Hôpital, Paris, 75013, France. .,Université Pierre et Marie Curie, Paris, France.
| |
Collapse
|
|
31
|
Fujihara S, Mori H, Kobara H, Nishiyama N, Matsunaga T, Ayaki M, Yachida T, Masaki T. Management of a large mucosal defect after duodenal endoscopic resection. World J Gastroenterol 2016; 22:6595-6609. [PMID: 27547003 PMCID: PMC4970484 DOI: 10.3748/wjg.v22.i29.6595] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.
Collapse
|
|
32
|
Influence of anti-adhesive agent on incidence of bile leakage after liver resection: A prospective cohort study. Int J Surg 2016; 31:40-6. [PMID: 27260310 DOI: 10.1016/j.ijsu.2016.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/12/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anti-adhesive agents are increasingly used to reduce the incidence of postoperative adhesions following abdominal surgery. Bile leakage after liver resection remains a major cause of postoperative morbidity. The aim of this study was to examine the effect of anti-adhesive agent on bile leakage after liver resection. MATERIALS AND METHODS 77 patients were enrolled to receive an anti-adhesive agent (study group) during liver resection between May 2012 and August 2013. The study group was compared to a match-paired control group. Clinical data were collected including bilirubin concentration in serum and drain fluid and bile leakage rate. In addition, a separate analysis was performed between patients with and without postoperative bile leakage. RESULTS There was no difference in bile leakage rate or hospital stay between the study group (n = 77) and control group (n = 77). Of the total number of patients (n = 154), there were 29 patients with postoperative bile leak and 125 patients without bile leak. On univariate analysis, patients without history of hepatitis were significantly associated with bile leakage. In addition, liver resection with broader cut surface area was associated with bile leakage. Application of anti-adhesive agent was not associated with bile leakage. On multivariate analysis, resection with broader cut surface area (OR = 2.788, p = 0.026) and patients without history of hepatitis (OR = 5.153, p = 0.039) were significantly associated with bile leakage. CONCLUSIONS Larger area of cut-surface and patients without history of hepatitis were significant risk factors for bile leakage. The use of anti-adhesive agent was not associated with increased risk of bile leakage.
Collapse
|
|
33
|
Paik HJ, Lee SH, Choi CI, Kim DH, Jeon TY, Kim DH, Jeon UB, Choi CW, Hwang SH. Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management. Ann Surg Treat Res 2016; 90:157-63. [PMID: 26942159 PMCID: PMC4773460 DOI: 10.4174/astr.2016.90.3.157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/05/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management. Methods We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013. Results A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99–9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50–11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61–28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30–11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45–21.71) as predictors of this complication. Conclusion Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.
Collapse
Affiliation(s)
- Hyun-June Paik
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang-In Choi
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae-Hwan Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae-Yong Jeon
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Dong-Heon Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Ung-Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol-Woong Choi
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
|
34
|
Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2016. [PMID: 26897031 DOI: 10.1007/s00423-016-1382-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results. METHODS A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil(®) to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals. RESULTS Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil(®). A sensitivity analysis of only randomised controlled trials confirmed the results. CONCLUSIONS The application of Tachosil(®) to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.
Collapse
|
|
35
|
Hüttner FJ, Mihaljevic AL, Hackert T, Ulrich A, Büchler MW, Diener MK. Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2016; 401:151-9. [PMID: 26897031 DOI: 10.1007/s00423-016-1382-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/08/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results. METHODS A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil(®) to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals. RESULTS Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil(®). A sensitivity analysis of only randomised controlled trials confirmed the results. CONCLUSIONS The application of Tachosil(®) to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.
Collapse
Affiliation(s)
- Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
|
36
|
Kobayashi S, Takeda Y, Nakahira S, Tsujie M, Shimizu J, Miyamoto A, Eguchi H, Nagano H, Doki Y, Mori M. Fibrin Sealant with Polyglycolic Acid Felt vs Fibrinogen-Based Collagen Fleece at the Liver Cut Surface for Prevention of Postoperative Bile Leakage and Hemorrhage: A Prospective, Randomized, Controlled Study. J Am Coll Surg 2015; 222:59-64. [PMID: 26597705 DOI: 10.1016/j.jamcollsurg.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The incidence of postoperative biliary leakage and hemorrhage is low, but these factors remain important in liver surgery, and this study's objective was to explore the efficacy of fibrin sealant (FS) with polyglycolic acid (PGA) vs fibrinogen-based collagen fleece (CF) at the liver cut surface. Fibrinogen-based collagen fleece is generally used for hemostasis; PGA-FS has reduced biliary leakage in several retrospective studies. STUDY DESIGN We designed a multicenter, randomized, controlled trial. The primary outcome was the rate of biliary leakage and hemorrhage. Secondary outcomes included morbidities and effusion at the liver cut surface at 3 months post-surgery. Biliary leakage was diagnosed when the drain/serum bilirubin ratio was >5. Hemorrhage was diagnosed when relaparotomy or transfusion was needed. RESULTS Of 786 patients from 11 institutions enrolled from 2009 to 2014, a total of 391 were randomly assigned to PGA-FS and 395 to CF. Regarding primary outcomes, rates of biliary leakage were 4.1% with PGA-FS and 5.1% with CF, and rates of hemorrhage were 1.0% in each group; groups did not differ significantly. For secondary outcomes, morbidity rates were 18.7% in the PGA-FS group and 24.6% in the CF group (p = 0.0450). Effusion at the cut liver surface was less with PGA-FS (22.2%) than with CF (32.9%) (p = 0.0142). Regarding morbidity, infection around the liver, jaundice, and abdominal paracentesis were less in the PGA-FS group. CONCLUSIONS Compared with CF, PGA-FS did not reduce biliary leakage and hemorrhage. Surgical site infection around the liver, effusion at the liver cut surface, and abdominal paracentesis were less in the PGA-FS group.
Collapse
Affiliation(s)
- Shogo Kobayashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Surgery, Osaka University Hospital, Osaka, Japan.
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Osaka, Japan
| | - Shin Nakahira
- Department of Surgery, Kansai Rosai Hospital, Osaka, Japan
| | - Masanori Tsujie
- Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Hiroaki Nagano
- Department of Surgery, Osaka University Hospital, Osaka, Japan
| | - Yuichiro Doki
- Department of Surgery, Osaka University Hospital, Osaka, Japan
| | - Masaki Mori
- Department of Surgery, Osaka University Hospital, Osaka, Japan
| |
Collapse
|
|
37
|
Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue. Langenbecks Arch Surg 2015; 400:843-8. [PMID: 26345639 DOI: 10.1007/s00423-015-1339-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/31/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Pancreatic fistula (PF) remains an obstacle to safe distal pancreatectomy (DP). A thick pancreatic parenchyma is a major risk factor for PF. In this paper, we elucidate the feasibility of the new closure method using soft coagulation and polyglycolic acid felt with fibrin glue. METHODS In 2009-2013, 96 patients underwent DP with a novel closure method for pancreatic stump that utilized soft coagulation and polyglycolic acid felt with fibrin glue. We evaluated amylase levels in drainage fluid on postoperative days (POD) 1 and 3 and the incidence of postoperative PF according to International Study Group of Pancreatic Fistula (ISGPF) definitions. RESULTS Drain amylase levels on POD1 and POD3 were 275 and 241 U/L, respectively, and ISGPF-defined Grade B/C PF rates were 16.7%. No clinical factors were significantly associated with PF. Average pancreatic parenchymal thicknesses were similar in PF-positive and PF-negative patients (10.4 ± 2.6 mm vs. 10.1 ± 2.2 mm, P = 0.639). There was no significant difference in the postoperative PF rate between patients with thick (≥12 mm) and thin (<12 mm) pancreas (11.1 vs. 18.8%, P = 0.544). CONCLUSION Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.
Collapse
|
|
38
|
Prevention of Polyglycolic Acid-Induced Peritoneal Adhesions Using Alginate in a Rat Model. BIOMED RESEARCH INTERNATIONAL 2015; 2015:403413. [PMID: 26078949 PMCID: PMC4454711 DOI: 10.1155/2015/403413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
Postoperative intra-abdominal or intrathoracic adhesions sometimes cause significant morbidity. We have designed three types of alginate-based treatments using strongly cross-linked (SL), weakly cross-linked (WL), and non-cross-linked (NL) alginate with calcium gluconate. In rat experiments, we compared the antiadhesive effects of the three types of alginate-based treatments, fibrin glue treatment (a standard treatment), and no treatment against adhesions caused by polyglycolic acid (PGA) mesh (PGA-induced adhesions). The antiadhesive materials were set on the PGA sheet fixed on the parietal peritoneum of the abdomen. Fifty-six days later, the adhesions were evaluated macroscopically by the adhesion scores and microscopically by hematoxylin-eosin staining and immunostaining. We also tested the fibroblast growth on the surface of the antiadhesive materials in vitro. The antiadhesive effects of WL and NL were superior to the no treatment and fibrin glue treatment. A microscopic evaluation confirmed that the PGA sheet was covered by a peritoneal layer constructed of well-differentiated mesothelial cells, and the inflammation was most improved in the NL and WL. The fibroblast growth was inhibited most on the surfaces of the NL and WL. These results suggest that either the WL or NL treatments are suitable for preventing PGA-induced adhesions compared to SL or the conventional treatment.
Collapse
|
|
39
|
Takao T, Takegawa Y, Shinya N, Tsudomi K, Oka S, Ono H. Tissue shielding with polyglycolic acid sheets and fibrin glue on ulcers induced by endoscopic submucosal dissection in a porcine model. Endosc Int Open 2015; 3:E146-51. [PMID: 26135658 PMCID: PMC4477022 DOI: 10.1055/s-0034-1391391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The safety and efficacy of the application of polyglycolic acid (PGA) sheets with fibrin glue to ulcers induced by endoscopic submucosal dissection (ESD) have not been established in the treatment of lesions of the gastrointestinal tract, in which the influence of digestive fluid and peristalsis may affect treatment, and there may also be a risk of infection. The aims of this study were to evaluate the healing process of ESD-induced ulcers in animals treated with the application of a PGA sheet with fibrin glue and to verify experimentally the safety of this treatment procedure. MATERIALS AND METHODS Gastric ESD was performed in nine pigs under general anesthesia. Two ulcer sites were prepared in each pig; one ulcer was treated by applying a PGA sheet with fibrin glue (treated ulcer site), while the other ulcer was left untreated (control ulcer site). Three pigs were euthanized at week 1, three at week 4, and three at week 8 after ESD, and the ulcer sites were macroscopically and histopathologically evaluated. RESULTS Of the nine treated ulcer sites, seven ulcer sites, to which a PGA sheet had been applied without exposure to the mucosal fluid, showed no peeling of the sheet despite the influence of peristalsis and gastric acid. Histopathologic examination revealed abundant, newly formed blood vessels in the treated ulcers and good granulation. In the treated ulcers, no excessive inflammation, necrosis, or infection was observed. CONCLUSIONS Our animal study experimentally demonstrated that this treatment technique can be safely applied to ESD-induced ulcers.
Collapse
Affiliation(s)
- Toshitatsu Takao
- Endoscopy Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan,Corresponding author Toshitatsu Takao, MD Endoscopy Division, Shizuoka Cancer Center Hospital1007 Shimonagakubo, Nagaizumi-cho Shizuoka 411-8777 Japan+81-55-989-5783
| | - Yoshitaka Takegawa
- Chemo-sero-therapeutic Research Institute (Kaketsuken), Kumamoto-shi, Japan
| | - Noriko Shinya
- Chemo-sero-therapeutic Research Institute (Kaketsuken), Kumamoto-shi, Japan
| | - Kimihiro Tsudomi
- Chemo-sero-therapeutic Research Institute (Kaketsuken), Kumamoto-shi, Japan
| | - Shiro Oka
- Chemo-sero-therapeutic Research Institute (Kaketsuken), Kumamoto-shi, Japan
| | - Hiroyuki Ono
- Endoscopy Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| |
Collapse
|
|
40
|
Izzo F, Albino V, Palaia R, Piccirillo M, Tatangelo F, Granata V, Petrillo A, Lastoria S. Hepatocellular carcinoma: preclinical data on a dual-lumen catheter kit for fibrin sealant infusion following loco-regional treatments. Infect Agent Cancer 2014; 9:39. [PMID: 25489337 PMCID: PMC4258802 DOI: 10.1186/1750-9378-9-39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/04/2014] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Fibrin sealants are currently used in a variety of surgical and endoscopic settings to improve time to haemostasis, reduce blood loss and complications. However, the application of sealants (composed of two essential components: fibrinogen and thrombin) is not without difficulties. These sealants are normally applied to the resected area using dual-chamber delivery systems. Administration of these substances with different viscosities and diverse flow rates through a long catheter means that a certain amount of force needs to be applied and clot formation and clogging at the distal end of the catheter can occur. METHODS We designed a novel dual-lumen catheter to facilitate the optimal application of fibrin sealant after diagnostic and therapeutic percutaneous procedures and assessed the efficacy and tolerability of this dual-lumen kit when used in a model of hepatic fine needle aspiration (FNA) biopsy and radiofrequency ablation (RFA) in an in vivo, preclinical porcine study. RESULTS The experimental was performed on nine pigs (mean body weight 85 ± 7 kg) and with the exception of one pig, all animals survived in good conditions until the day of hepatectomy and euthanasia. The premature death of this animal was in the veterinarian's judgment caused by a common, non-infective disease. In all nine pigs, bleeding was stopped within 3 minutes of the application of the fibrin sealant and no cases of recurrent bleeding occurred. CONCLUSIONS The new dual aspect catheter increased ease of delivery of the sealant and FNA liver biopsy and RFA procedures were successfully and safely performed.
Collapse
Affiliation(s)
- Francesco Izzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Vittorio Albino
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Raffaele Palaia
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Fabiana Tatangelo
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Vincenza Granata
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Antonella Petrillo
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Secondo Lastoria
- Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| |
Collapse
|
|
41
|
Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal. Langenbecks Arch Surg 2014; 399:825-35. [PMID: 24880346 DOI: 10.1007/s00423-014-1215-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fibrin sealants and topical hemostatic agents have been used extensively in hepatobiliary and pancreatic (HPB) surgery to promote coagulation and clot formation decreasing the need for allogeneic blood transfusion and to act as tissue sealants, ideally preventing biliary, enteric, and pancreatic leaks. RESULTS Current literature has demonstrated some favorable outcomes using many different products for application in the field of HPB surgery. However, critical findings exist demonstrating lack of reproducible efficacy or benefit. In all, many clinical trials have demonstrated effectiveness of fibrin sealants and other agents at reducing the need for intraoperative and postoperative blood transfusion. Ability to effectively seal tissues providing biliostatic effect or preventing postoperative fistula formation remains debated as definitive evidence is lacking. CONCLUSIONS In the following invited review, we discuss current literature describing the use of topical agents and fibrin sealants in liver and pancreas surgery. We summarize major contemporary clinical trials and their findings regarding the use of these agents in HPB surgery and provide evidence from the preclinical literature as to the translation of these products into the clinical arena.
Collapse
|
|
42
|
Hanna EM, Martinie JB, Swan RZ, Iannitti DA. Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal. Langenbecks Arch Surg 2014. [PMID: 24880346 DOI: 10.1007/s00423-014-1215-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Fibrin sealants and topical hemostatic agents have been used extensively in hepatobiliary and pancreatic (HPB) surgery to promote coagulation and clot formation decreasing the need for allogeneic blood transfusion and to act as tissue sealants, ideally preventing biliary, enteric, and pancreatic leaks. RESULTS Current literature has demonstrated some favorable outcomes using many different products for application in the field of HPB surgery. However, critical findings exist demonstrating lack of reproducible efficacy or benefit. In all, many clinical trials have demonstrated effectiveness of fibrin sealants and other agents at reducing the need for intraoperative and postoperative blood transfusion. Ability to effectively seal tissues providing biliostatic effect or preventing postoperative fistula formation remains debated as definitive evidence is lacking. CONCLUSIONS In the following invited review, we discuss current literature describing the use of topical agents and fibrin sealants in liver and pancreas surgery. We summarize major contemporary clinical trials and their findings regarding the use of these agents in HPB surgery and provide evidence from the preclinical literature as to the translation of these products into the clinical arena.
Collapse
Affiliation(s)
- Erin M Hanna
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Moorehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA
| | | | | | | |
Collapse
|
|
43
|
Ding H, Yuan JQ, Zhou JH, Zheng XY, Ye P, Mao C, Chen Q. Systematic review and meta-analysis of application of fibrin sealant after liver resection. Curr Med Res Opin 2013; 29:387-94. [PMID: 23339601 DOI: 10.1185/03007995.2013.768216] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fibrin sealant (FS) has been increasingly used on the raw surface after liver resection but its clinical value has not been established to date. The aim of this study was to evaluate the efficacy and safety of the employment of FS after liver resection. METHODS PubMed, Cochrane Library, Embase, CNKI, CBM and VIP were searched for randomized trials comparing the effect of FS with no FS or any other intervention for patients undergoing liver resection. Primary outcomes included time to hemostasis, hemostatic success, amount of drainage and drainage duration. RESULTS Eleven randomized controlled trials were included. Meta-analysis suggested that the amount of drainage (standard mean difference -0.30; 95% confidence interval [CI] -0.82 to 0.23) and drainage duration (mean difference [MD] -0.46, 95% CI -0.61 to -1.53) were similar between FS group and no FS group. Compared with topical hemostatic agents, FS could significantly reduce time to hemostasis (MD -208.46, 95% CI -228.22 to -188.70) and increase hemostasis success rate (relative risk 1.35, 95% CI 1.17 to 1.57). Two trials compared FS with argon beam coagulation (ABC), which both suggested that FS could significantly decrease the time to hemostasis. CONCLUSIONS This study demonstrated a modest benefit of FS over no FS, topical hemostatic agents and ABC in controlling intraoperative bleeding from the raw liver surface after liver resection. But there is no evidence that FS is beneficial to patients in reducing amount of drainage and drainage duration.
Collapse
Affiliation(s)
- Hong Ding
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | | | | | | | | | | | | |
Collapse
|
|
44
|
Shinozaki T, Hayashi R, Ebihara M, Miyazaki M, Tomioka T. Mucosal defect repair with a polyglycolic acid sheet. Jpn J Clin Oncol 2012; 43:33-6. [PMID: 23225906 DOI: 10.1093/jjco/hys186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Early-stage oral or oropharyngeal carcinomas are often treated with surgical resection. Resulting wounds that are too large for primary closure can be covered with skin grafts or patches made from various biomaterials. Recently, polyglycolic acid sheets have been used for this purpose. METHODS We treated six patients with large wounds resulting from the resection of oral or oropharyngeal squamous cell carcinoma by grafting polyglycolic acid sheet patches. All patients were initially treated at the National Cancer Center East Hospital from March 2010 through July 2012. After mucosal resection, the wounds were covered with polyglycolic acid sheet patches attached with fibrin glue. Oral intake was started 4 days after surgery. RESULTS Mucosal resection was the initial treatment in seven patients (five with oral squamous cell carcinoma and two with oropharyngeal squamous cell carcinoma). The polyglycolic acid sheet patches became detached in two patients (on the day of surgery and on postoperative day 6), who then required large doses of analgesics. A patient who underwent tooth extraction also required large doses of analgesics. The other four patients required only small doses of analgesics. One patient had bleeding at the surgical site. No adverse effects were caused by the polyglycolic acid sheet patch or by fibrin glue. CONCLUSIONS Our study has shown that grafting of a polyglycolic acid sheet patch is effective and provides good pain control for patients with large, open wounds after mucosal resection of oral or oropharyngeal squamous cell carcinoma. We plan to evaluate tissue contraction and oral intake after polyglycolic acid patch grafting.
Collapse
Affiliation(s)
- Takeshi Shinozaki
- Division of Head and Neck Surgery National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
| | | | | | | | | |
Collapse
|
|
45
|
Zacharias T, Ferreira N. Carrier-bound fibrin sealant compared to oxidized cellulose application after liver resection. HPB (Oxford) 2012; 14:839-47. [PMID: 23134186 PMCID: PMC3521913 DOI: 10.1111/j.1477-2574.2012.00560.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/07/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the study was to compare the incidence of post-operative complications between those patients that received TachoSil to the transection surface of the liver vs. those that received Surgicel. METHODS Retrospective study of a prospective database in a tertiary hospital. Primary endpoints were overall complications. Secondary endpoints were liver surgery-specific composite endpoint, major complications and hospital stay. Uni- and multivariate analysis of predictive factors for complications and subgroup analysis were performed. RESULTS One hundred thirty-three liver resections were performed between 9 November 2007 and 2 November 2011: 64 with TachoSil and 69 with Surgicel application. Both groups were equivalent concerning demographic, clinical and major intra-operative data. No significant differences were observed in overall complication rate (62.5% vs. 62.3%), liver surgery-specific composite endpoint (12.5% vs. 18.8%), major complication rate (18.7% vs. 24.6%) and median hospital stay (13 vs. 10 days) for TachoSil and Surgicel application, respectively. Predictive factors for complications in multivariate analysis were: American Society of Anesthesiology Score ≥3 and duration of surgery >240 min. Subgroup analysis found a reduced complication rate with TachoSil for major hepatectomy. CONCLUSION The results of the present study suggest that the routine use of TachoSil after a liver resection does not reduce the overall complication rate compared with Surgicel application. However, TachoSil may be beneficial in a major hepatectomy.
Collapse
|
|
46
|
Simo KA, Hanna EM, Imagawa DK, Iannitti DA. Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil). ISRN SURGERY 2012. [PMID: 23029624 DOI: 10.5402/2012/729086.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.
Collapse
Affiliation(s)
- K A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | | | | | | |
Collapse
|
|
47
|
Grazi GL. Liver resections: complications and survival outcome. Expert Rev Pharmacoecon Outcomes Res 2012; 7:269-79. [PMID: 20528313 DOI: 10.1586/14737167.7.3.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Today, liver resection represents one of the most effective therapies in the treatment of defined liver diseases, particularly for hepatocellular carcinomas, liver metastases and tumors originating from the bile ducts. There have been a number of improvements in the technique but the use of kellyclasia associated with meticulous control of hemostasis and biliostasis appears to be more effective and efficient. The procedure is still burdened with some postoperative complications, the more characteristic of which are liver insufficiency, biliary leakage and ascites. Several neoplastic diseases, both primitive and secondary, can benefit from this therapy with substantial improvement of long-term survival, and a notable change in the natural history of the disease. For these situations, a consultation should always be performed by a surgeon experienced in hepatic surgery.
Collapse
Affiliation(s)
- Gian Luca Grazi
- Associate Professor of General Surgery, University of Bologna, Liver & Multi Organ Transplant Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy. ; www.liversurgery.info
| |
Collapse
|
|
48
|
Simo KA, Hanna EM, Imagawa DK, Iannitti DA. Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil). ISRN SURGERY 2012; 2012:729086. [PMID: 23029624 PMCID: PMC3458284 DOI: 10.5402/2012/729086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/24/2012] [Indexed: 12/15/2022]
Abstract
Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.
Collapse
Affiliation(s)
- K A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | | | | | | |
Collapse
|
|
49
|
Fibrin Sealant for Prevention of Resection Surface-Related Complications After Liver Resection. Ann Surg 2012; 256:229-34. [DOI: 10.1097/sla.0b013e3182602819] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
|
50
|
Kapoor S, Nundy S. Bile duct leaks from the intrahepatic biliary tree: a review of its etiology, incidence, and management. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:752932. [PMID: 22645406 PMCID: PMC3356893 DOI: 10.1155/2012/752932] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/06/2012] [Accepted: 02/19/2012] [Indexed: 12/20/2022]
Abstract
Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.
Collapse
Affiliation(s)
- Sorabh Kapoor
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi 110060, India
| | | |
Collapse
|