Topical hemostatic agents in liver surgery: do we need them?

Background: Worldwide, partial liver resections are increasingly performed for primary or secondary hepatic malignancies. There are various techniques to reduce blood loss during liver surgery. Several topical hemostatic agents have been developed to improve hemostasis of the resection surface and these agents are used more and more, even although the true effects remain unclear. Methods: The present literature about the use of topical hemostatic agents in liver surgery was reviewed. Futhermore we conducted a Dutch national survey tot explore the use of and belief in these agents in liver surgery. Results: The Dutch national survey among surgeons showed that topical hemostatic agents are frequently used not only to lower intraoperative blood loss or shorten time to hemostasis, but even more importantly, to reduce resection surface related complications such as bile leakage, postoperative hemorrhage and abscess formation. Although various topical hemostatic agents have been shown to reduce intraoperative time to hemostasis at the resection surface after liver resections, there is no scientific proof that these topical haemostatic agents really reduce resection surface related complications. Conclusion: This review highlights the need for more randomized clinical trials to investigate the efficacy of topical haemostatic agents in reducing resection surface related complications.