The Use of Infrared Sapphire Contact Coagulation and Fibrinogen Adhesive for Hemostasis After Partial Hepatectomy: A Comparative Study

Abstract

With conventional surgical technique, bleeding, biliary fistulae, parenchymal necrosis and secondary subphrenic abscesses represent major complications in the postoperative course following liver resection. Promising adjuvant methods for improvement of surgical hemostasis include a biological two-component fibrin sealant (FS) and, recently, the so-called infrared sapphire coagulation (ISC).

The purpose of the present study was to evaluate intra- and postoperative characteristics of both methods and to compare them with each other. Using a controlled animal model in 20 miniature pigs a standardized left-side hepatectomy was performed. Intraoperative control of bleeding was achieved either by FS or ISC. On postoperative day 12 hepatobiliary scanning (HBS) was done followed by second-look laparotomy including removal of the liver remnant for pathohistologic examination and for nuclear magnetic resonance spectroscopy (NMR).

Intraoperative comparison demonstrated that, in order to achieve preliminary hemostasis, necessary clamping time of the hepatoduodenal ligament (FS, 22.1±1.0min; ISC, 29.1±2.2min) as well as application time of each method during clamping (FS, 5.8 ± 0.6 min; ISC, 13.5 ± 1.2 min) was significantly less when using FS (P < 0.05). Time needed to achieve complete hemostasis after unclamping was comparable (FS, 6.4 ± 1.2 min; ISC, 6.2 ± 1.4 min). Concomitantly, intraoperative blood loss was less in the FS group (FS, 210 ±20 ml; ISC, 270 ±20 ml; P<0.05). In all animals, bleeding could be controlled sufficiently, and the postoperative course was uneventful. HBS excluded extravasation of bile in every case. On second-look laparotomy, a search for biliary fistula or formation of hematoma turned out to be negative. However, compared with FS, the ISC-treated group showed markedly more pronounced adhesions in the resection areas. Parenchymal necrosis was two to three times deeper when using ISC. On NMR, in all animals at a tissue depth of more than 2 cm, no more alterations than with normal tissue were detectable.

Fibrin sealant and ISC proved to be highly effective methods for control of hemostasis and for preventing biliary leakage in liver surgery. Compared with ISC, FS is faster and less aggressive towards tissue, thus significantly reducing ischemia and hemorrhage. However, since application of FS is still compromised by its high costs, combined use of both methods may be preferable.