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Sealing of the Hepatic Resection Area Using Hemostat Device Does Not Result in Further Improved Results of Adequate Surgery but in Induction of a Detectable Reactive Inflammatory Response Onto Foreign Material Indicated by an Enlarged Drainage Volume and Leucocytosis
Manuela Petersen1, Siegfried Kropf2, Ralf Steinert3, Olof Jannasch1, Marino Venerito4, Carl Meissner5, Meyer Frank*1
1Dept. of General, Abdominal & Vascular Surgery, University Hospital, Magdeburg, Germany; 2Inst. of Biometry and Medical Informatics, University Hospital of Magdeburg, Magdeburg, Germany; 3Dept. of General and Abdominal Surgery, St-Josefs Hospital, Salzkotten, Salzkotten, Germany; 4Dept. of Gastroenterology, Hepatology & Infectious Diseases, University Hospital, Magdeburg, Germany; 5Dept. of General and Abdominal Surgery, Municipal Hospital, Magdeburg, Germany
Introduction: In hepatic resections, there has been a high quality demand.
The aim of this systematic study was to investigate whether hemostat device can significantly improve outcome in resecting liver surgery, in particular, in high risk patients.
Methods: All consecutive patients (mean age, 60.5 [range, 17-96] years) who underwent hepatic resection (nTotal=770) were prospectively documented in a computer-based registry at a university hospital (tertiary center) over a time period of 10 years and retrospectively evaluated specifically with regard to the use (-/+) of hemostat device (Tissucol®, n=59 / Tachocomb®, n=202 / combination, n=55) indicated (among others) by drainage volume, inflammatory parameters and rate of specific complications (nValidated=541 [100 %]).
Results: Most frequently, (a-)/typical segmental resections were used: n=192/90 (3-segment resection, n=38 only).
1.) For the assignment of patients to the two different groups (-/+hemostat device), weight loss and type of resection were found as significant factors (trend: ASA, cirrhosis), for the amount of drainage volume, ASA, sex, Karnofsky Performance Scale and also type of resections using independent distributed statistical tests such as (χ2, U test [Mann/Whitney]; H test [Kruskal-Willis]; correlation coefficient by Spearman) - no impact: smoking, diabetes, BMI, ethanol.
2.) Not taking into account these parameters, the use of hemostat device was characterized by an increased drainage volume (negative control < Tissucol=Tachocomb < combination).
3.) Using multifactorial analysis of variance, it was found even under correction by the factors with significant impact elucidated in the single test that the application of hemostat device onto the hepatic resection area resulted unexpectedly rather in an increase than a decrease of the drainage volume but
4.) under accompanying more pronounced increase of the white blood cell count (leucocytosis).
5.) General and specific complications such as postoperative bleeding, biliary fistula and subhepatic abscess were not further lowered in a significant manner using hemostat device.
Conclusion: Adequate surgery in the operative management of hepatic resection area cannot further be improved or optimized using hemostat device. In this context, drainage volume may not be considered a sufficient rather an orienting parameter. However, there is an inflammatory response detectable most likely indicated by a(n un-)specific effusion and increase of white blood cell count, which can be interpreted as reactive inflammation to foreign material.
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