Surglcel (®) Reinforced Resection Lines in Left-sided Hepatectomy with Linear Stapling Device. An Experimental Study on Pigs

Fourteen pigs underwent left-sided hepatectomy. The resection was performed with a linear stapling device and the pigs were randomised to either Surgicel (®) reinforced resection lines or not. The median time required for resection was 25 min (range 17-30) in the Surgicel(®) reinforced group compared to 30 min (range 21-41) in the stapled group. This difference was, however, not statistically significant (p=0.053). The postoperative haemoglobin value was lower in the stapled group compared to the Surgicel(®) reinforced group 69 g/1 (range 42-85) versus 82 g/1 (range 78-90) (p=0.018). The estimated blood losses by weighing the compresses were 287 ml (range 166-379) for the stapled group and 204 ml (range 152-264) for the Surgicel(®) reinforced group (p=0.053). The median number of additional haemostatic sutures in the Surgicel(®) reinforced group was 7 (range 3-11) and in the stapled group 10 (range 5-15) (p=0.038). The haemoglobin value was similar in the two groups week postoperatively; 100 g/1 (range 87-104) and 102 g/1 (range 95-114), p=0.27, in the stapled group and the Surgicel(®) reinforced group, respectively. In the stapled group reinforced with the Surgicel(®) there was one postoperative death. In the solely stapled group there was no postoperative death (p=0.5). Four out of six pigs in the Surgicel(®) group had massive adhesions to the resection lines. One of these six pigs was sacrificed postoperatively as it was ill and had small bowel obstruction secondary to Surgicel(®) induced adhesions. On the other hand, no adhesions were seen in the solely stapled pigs (p=0.09). At this point, we can not recommend the use of Surgicel(®) to reinforce resection lines at stapled liver resection in the clinical situation, because of the high frequency of adhesions this material creates.