A cost‐effective analysis of fibrin sealants versus no sealant following open right hemihepatectomy for colorectal liver metastases

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Excerpt

Bile leak and haemorrhage remain common complications following liver resection and have a negative impact on post‐operative recovery in addition to the long‐term survival.1 A number of agents have been used with varying degrees of success to reduce these complications including oxidized cellulose,3 absorbable gelatin sponge,4 microfibrillar collagen5 and fibrin sealants.6 Among these topical agents, fibrin sealants are the most commonly used and have been shown to improve perioperative haemostasis and reduce the need for allogeneic blood transfusion in patients undergoing elective liver resection.7 However, several randomized controlled trials have compared the efficacy of fibrin sealants on the cut surface with no treatment with varied outcomes.9 Indeed, a recent meta‐analysis comparing fibrin sealant to no sealant has shown no perioperative advantage with regard to haemostatic and biliostatic efficacy.11 However, the use of fibrin sealants was shown to reduce the time to haemostasis.11 These results have clinical and financial implications as fibrin sealants are increasingly used in surgical practice, and global sales are rising annually.12 In this context, this study aimed to assess the cost‐effectiveness of fibrin sealant following right hemihepatectomy for colorectal liver metastases in comparison with no sealant in a large cohort of patients.
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