BACKGROUND: Bleeding is common after liver resection and establishing hemostasis with sutures or argon beam coagulation can be difficult. In our laboratory, concentrated albumin applied to the liver surface before argon beam coagulation improves sealing of the resected surface of the liver, including closure of blood vessels and ducts not generally seen with standard argon beam coagulation. METHODS: Domestic swine underwent heparinization, then laparotomy and wedge resection of the left medial segment of the liver, using finger fracture technique. Blood vessels and ducts 5 mm or greater were ligated. For achieving hemostasis, the animals were randomized to either a control group using argon beam coagulation alone (n = 15) or an albumin group using argon beam coagulation with concentrated 38% albumin (n = 13). After initial hemostasis, the resected liver surfaces were packed for 3 minutes. Repeated applications of argon beam coagulation with or without albumin were performed as needed, followed by 3 minutes of repacking, until complete hemostasis was achieved. Liver functions and blood counts were examined 4 days postoperatively. RESULTS: The albumin group was less likely to require repeat applications of argon beam coagulation than control animals (mean 0.5 versus 1.5 times, P = 0.006). The total time of argon beam coagulation was significantly shorter in the albumin group (mean 90 versus 154 seconds, P = 0.001). CONCLUSIONS: Adding albumin to the liver surface substantially increases the durability of the repaired surface and reduces the time needed to achieve stable hemostasis when compared with standard argon beam coagulation. Further investigations using this technique are warranted.
BACKGROUND: Bleeding is common after liver resection and establishing hemostasis with sutures or argon beam coagulation can be difficult. In our laboratory, concentrated albumin applied to the liver surface before argon beam coagulation improves sealing of the resected surface of the liver, including closure of blood vessels and ducts not generally seen with standard argon beam coagulation. METHODS: Domestic swine underwent heparinization, then laparotomy and wedge resection of the left medial segment of the liver, using finger fracture technique. Blood vessels and ducts 5 mm or greater were ligated. For achieving hemostasis, the animals were randomized to either a control group using argon beam coagulation alone (n = 15) or an albumin group using argon beam coagulation with concentrated 38% albumin (n = 13). After initial hemostasis, the resected liver surfaces were packed for 3 minutes. Repeated applications of argon beam coagulation with or without albumin were performed as needed, followed by 3 minutes of repacking, until complete hemostasis was achieved. Liver functions and blood counts were examined 4 days postoperatively. RESULTS: The albumin group was less likely to require repeat applications of argon beam coagulation than control animals (mean 0.5 versus 1.5 times, P = 0.006). The total time of argon beam coagulation was significantly shorter in the albumin group (mean 90 versus 154 seconds, P = 0.001). CONCLUSIONS: Adding albumin to the liver surface substantially increases the durability of the repaired surface and reduces the time needed to achieve stable hemostasis when compared with standard argon beam coagulation. Further investigations using this technique are warranted.
Authors: Genevieve R Mueller; Ronald F Wolf; Paul D Hansen; Kenton W Gregory; Scott A Prahl Journal: J Gastrointest Surg Date: 2010-07-07 Impact factor: 3.452