Staple line bleeding is a potential postoperative complication encountered following sleeve gastrectomy. Fibrin sealant is designed to mimic the terminal coagulation cascade to provide stable clot formation and minimize postoperative blood loss. The following investigates the effect of aerosolized fibrin sealant on post-operative bleeding rates in patients undergoing non-revisional laparoscopic sleeve gastrectomy (LSG).
Patients were prospectively consented for LSG at a high-volume bariatric surgery center. Patient records were reviewed by aerosolized fibrin sealant (FS) or no fibrin (NF) status. Demographic and perioperative information were collected for statistical analysis including PACU and postoperative hemoglobin levels with p <.05 determined as significant.
A total of 84 patients were studied, of which 46 (54.8%) received conventional LSG and 38 (45.2%) received LSG with aerosolized fibrin sealant. No significant differences were observed between cohorts by demographics including average age, BMI, and gender distribution. Groups demonstrated similar average PACU hemoglobin (FS 12.8 g/dL, NF 12.8 g/dL) and hemoglobin on postoperative day one (FS 12.4 g/dL, NF 12.3 g/dL). Postoperative peak systolic blood pressure, rates of blood transfusion, and frequency of concurrent hiatal hernia repair were not statistically different. Similar rates of anticoagulation use, toradol use, and frequency of postoperative nausea, was appreciated by both groups.
While a useful tool for control of intraoperatively identified bleeding, our findings suggest aerosolized fibrin sealant does not convey added benefit for minimizing postoperative blood loss following laparoscopic sleeve gastrectomy. These data are consistent with previously published reports on the utility of fibrin-based adhesives in hemostasis.