Is the Use of Sealing and Hemostatic Agents Justified in Hepatic Resections? Review and Meta-analysis

The use of biological hemostatic and sealing agents over the edge of the liver resection has been increasing exponentially for over 30 years but without solid literature review. The aim of this study was to produce a meta-analysis including only prospective and randomized studies to know real effect using hemostatic sealants on the resection edge after elective hepatic resection, especially regarding biliary fistula and hematoma. A literature search of the Medline and EMBASE was carried out to find prospective and randomized trials related to the use of hemostatic sealant in the surface of the liver resection compared with not using products after the usual revision of hemostasis. Six studies were included involving a total of 1,002 patients in this meta-analysis. After analyzing the results, the risk of developing hematoma/abscess or biliary leak was not related to the use of sealants. Odds Ratio (OR): 1.19; 95% Confidence Interval (CI): 0.79 to 1.81; p=0.40 and OR: 1.02; 95% CI: 0.65 to 1.61; p=0.92 respectively. The use of sealants over the edge of the liver resection does not currently provide any benefit and its cost is not really justified. Andrea Boscà Robledo*, Ana Navío Seller, Mireia Navasquillo Tamarit, Javier Maupoey Ibáñez, Raquel Jiménez Rosellón, Eva María Montalvá Orón, Rafael García Domínguez, David Calatayud Mizrahi and Rafael López Andújar Hepatobiliary Pancreatic Surgery and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain