Comparison of absorbable materials for surgical haemostasis

Area of Science:

• Surgical Innovation
• Biomaterials Science
• Hepatobiliary Surgery

Background:

• Effective hemostasis is critical in liver surgery to minimize blood loss and complications.
• New hemostatic materials are continuously developed to improve surgical outcomes.
• Standard surgical gauze and oxidized cellulose are common hemostatic agents with varying efficacy.

Purpose of the Study:

• To compare the hemostatic efficacy of two novel materials, porcine collagen and calcium alginate, against conventional agents.
• To evaluate the speed of hemostasis, absorption rates, and tissue reaction of tested materials in a rabbit liver laceration model.

Main Methods:

• A standardized liver laceration model was created in 42 New Zealand White rabbits.
• Rabbits were randomized to receive treatment with surgical gauze, oxidized cellulose (Surgicel), porcine collagen (Medistat), or calcium alginate (Kaltostat).
• Blood loss and time to hemostasis were recorded; animals were observed for absorption and adhesion formation post-procedure.

Main Results:

• Calcium alginate achieved hemostasis in under 3 minutes in all subjects, significantly faster than porcine collagen (5.7 min), oxidized cellulose (12.5 min), and gauze (>15 min).
• Oxidized cellulose and calcium alginate were fully absorbed within 3 months, resulting in fibrous scarring.
• Porcine collagen elicited a significant foreign body reaction, leading to intestinal obstruction in 5 of 12 animals within 3 months.

Conclusions:

• Calcium alginate is a highly effective hemostatic agent for liver lacerations, offering rapid bleeding control and favorable absorption profiles.
• Porcine collagen demonstrated significant adverse effects, including intestinal obstruction, highlighting potential risks associated with its use.
• Both calcium alginate and oxidized cellulose show promise as absorbable hemostatic agents with acceptable tissue integration.