Gelatin-thrombin matrix for intraoperative hemostasis in abdomino-pelvic surgery: a systematic review

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.