Experience with the Use of a Fibrin Sealant (Tissucol) in Liver Surgery

Abstract

We present our experience with the use of a fibrin sealant (Tissucol, Immuno, Vienna) applied to the raw surface of the liver after resection. During a 4-year period, 102 hepatic resections were performed in 100 patients. Hepatic tumors, particularly hepatocellular carcinoma in cirrhotic liver, were the main indication, followed by metastasic lesions from colorectal cancer. Almost half of the patients submitted to hepatic resection had liver cirrhosis and therefore had an increased risk of postoperative liver failure, coagulopathy and hemorrhage. Tissucol was applied after hepatic parenchymal division and hemostasis of the blood vessels and bile ducts had been achieved using ligatures and electrocautery. A collagen felt was also placed on the raw surface in 20% of cases.

Postoperative mortality (9.8%) and morbidity was low, considering the high percentage of cirrhotic patients. Liver failure was the principal cause of death. In conclusion, a very careful surgical technique and the application of Tissucol to seal off the raw surface of the liver avoided in most cases the complications of oozing and biliary leakage, which would lead to hemorrhage, abscess, sepsis, and consequently liver failure.