Impact of modern topical sealants on histopathological changes after hepatectomy: an experimental porcine study

Background:

Despite remarkable developments in perioperative patient's care, surgical techniques, and surgical instruments, the risk of complications following liver resection such as bile leakage and hemorrhage is still high. Sealants are used frequently with the intention of reducing these complications. To our knowledge, detailed postoperative histopathological changes of sealants on liver surface after hepatectomy have not been studied so far. Accordingly, we aimed to assess and provide dependable evidence-based data to determine the impact of different sealant materials on histopathological changes after liver resection in an experimental study

Methods:

Twenty-seven landrace pigs (weight: 32.6 ± 4.2 kg) underwent left hemihepatectomy and were randomized in control group (n = 9) with no sealant and treatment groups (each n = 9), in which resection surfaces were covered with collagen-based sealant and fibrinogen-based sealant. After postoperative day 5, the tissue samples were examined and graded by and indipendent pathologist using a semi-quantitive scale for degree of hepatocellular regeneration, necrosis, fibrin production, associated inflammation, demarcation, intraparenchymal bleeding, granulation tissue formation, microabscess, bacterial colonization, and parenchymal inflammation.

Results:

There were no significant differences regarding preoperative cardiocirculatory parameters between three groups. Relative and absolute bleeding times were significantly lower in collagen-based sealant group (both p < 0.01). Hepatocellular necrosis occurred more in fibrinogen-based sealant group and less in collagen-based sealant group (p = 0.01). As expected, the rate of bacterial colonization and inflammation was significantly lower in control group (both p < 0.01). However, increased hepatocellular regeneration potential was seen in sealant groups, which was significantly higher in collagen-based sealant group.

Conclusion:

The usage of sealants after hepatectomy is safe and is not associated with major morbidities. Sealants significantly decreased bleeding after hepatectomy. Furthermore, collagen-based sealant increases the rate of posthepatectomy regeneration. Future randomized clinical studies should be performed to establish indications of using sealants in clinical setting.