Different
hemostatic methods are available for mild to moderate intraoperative
bleeding during open and laparoscopic abdomino-pelvic surgery, but topical hemostats have gained popularity. We sought to review evidence on the use of a
gelatin-
thrombin matrix (FloSeal®) in elective abdominal and pelvic surgery. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted. The primary endpoints were intraoperative
bleeding and number of transfusions. Secondary endpoints included
operative time, postoperative complications, re-operation for
bleeding, mortality, and duration of hospitalization. Of five controlled trials, only three were prospective, randomized-controlled studies. The first, in open
myomectomy, showed that
hemostatic matrix dramatically reduced intraoperative
bleeding and transfusion rates compared with conventional
hemostatic measures.
Hemostatic matrix also reduced postoperative stay. Similar results were obtained in a trial comparing
FloSeal versus infrared-
sapphire coagulator during open renal
tumor enucleation. In the third,
FloSeal was equally as effective as conventional
suture methods in preventing staple-line
bleeding after sleeve
gastrectomy. Data were not pooled because of the heterogeneity in design. There is insufficient evidence that
FloSeal provides better results than conventional hemostasis in abdominal and pelvic surgery, except for open
myomectomy. Well-designed randomized trials are needed to evaluate the use of
gelatin-
thrombin matrix in elective abdomino-pelvic surgery outcomes.