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/l (range 42-85) versus 82 g/l (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 1 week postoperatively; 100 g/l (range 87-104) and 102 g/l (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.