Colla di fibrina homemade e commerciale in chirurgia epatica

Background. Several studies showed the effectiveness of fibrin glue (FG) in reducing bleeding from cut surface in liver resection. This study compares the efficacy in reducing bleeding of a homemade FG, in comparison with a commercial product. Methods. Thirthy-four patients submitted to liver resection for carcinoma were enrolled. Fourteen of them received homemade FG, while the others the commercial product (Tissucol, Baxter). Homemade FG was obtained from allogeneic fresh frozen plasma by using the CryoSeal CS-1 system (Thermogenesis Corp.) device. Fibrinogen concentration in homemade FG was assessed according to the Clauss method. In all the patients the same amount of FG (5 mL) was sprayed on liver cut surface, at the end of the liver resection. Results. Mean fibrinogen concentration in homemade FG was 23.16±5.93mg/mL. In homemade group the baseline haematocrit (Hct) was 40.3±4.1%, in the Tissucol group 40.1±5.4% (p NS). The Hct in 5thpostoperative day was 35±4.1 in group treated with homemade FG, and 32.8±3.8 in pts receiving Tissucol (p<0.05). Blood loss in patients treated by Tissucol was superior to that observed in patients receiving homemade FG (527±251.6 vs 305.6±253.7mL, p<0.05). It has been observed that out of 14 patients treated with homemade FG, 2 (14.3%) received blood transfusion with a mean RBC volume of 500±141.4 mL, in Tissucol group 35% of the patients (p NS) have been transfused and received a mean RBC volume of 542±222.5mL (p NS). Conclusions. Despite the fibrinogen concentration in homemade FG was significantly lower than that reported to be present in Tissucol (75-115mg/mL), the use of homemade product was associated with a statistically significant reduction in blood loss