Ann Hepatobiliary Pancreat Surg.  2016 Nov;20(4):197-200. 10.14701/ahbps.2016.20.4.197.

Fibrin glue-infiltrating hemostasis for intractable bleeding from the liver or spleen during liver transplantation

• Hwang S
• Jung DH
• Song GW
• Ha TY
• Jwa EK
• Lee SG

• KMID: 2362471
• DOI: http://doi.org/10.14701/ahbps.2016.20.4.197

Abstract

Portal hypertension induces congestion of the liver and spleen, thus any capsular or parenchymal injury to these organs can produce intractable bleeding which generally is not easily controlled. To cope with intractable bleeding such as being encountered during liver transplantation, we developed an infiltrating hemostasis technique as a conceptual shift from conventional application methods, in which fibrin glue is locally injected into the bleeding area on the liver or spleen. This technique, which uses a fibrin glue kit (2 ml kit; Greenplast, Green Cross, Seoul, Korea), consists of inserting the needle 0.5-1 cm deep at the bleeding point, forcefully injecting 1 ml of fibrin glue contained in the fibrin glue kit, and then slowly withdrawing the needle with continuous forceful injection of the remaining 1 ml of fibrin glue. We have successfully performed this procedure in 6 cases of living donor liver transplantation and in 2 cases of non-transplant resection of the cirrhotic livers with hepatocellular carcinoma. This technique was also successfully applied to one liver transplant recipient in which intractable bleeding occurred from a small laceration at the spleen. Our fibrin glue-infiltrating hemostasis would be indicated to intractable bleeding from the hepatic or splenic cut surface. In such a situation, it would be applicable as a second-line rescue method for hemostasis.

Keyword

Hemostasis; Fibrin glue; Bleeding; Liver transplantation

MeSH Terms

Carcinoma, Hepatocellular
Estrogens, Conjugated (USP)
Fibrin Tissue Adhesive
Fibrin*
Hemorrhage*
Hemostasis*
Humans
Hypertension, Portal
Lacerations
Liver Transplantation*
Liver*
Living Donors
Methods
Needles
Seoul
Spleen*
Transplant Recipients
Estrogens, Conjugated (USP)
Fibrin
Fibrin Tissue Adhesive

Figure

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  Fig. 1 Operative photographs of fibrin glue-infiltrating hemostasis procedure: (A) fibrin glue needle insertion into the liver parenchyma by 0.5-1 cm in depth; (B) slow withdrawal of the needle with continuation of injection; and (C) completion of hemostasis procedure.

• 

  Fig. 2 Photograph of the cross-section of the fibrin glue-injected liver parenchyma showing dispersed fibrin glue drops (arrows).

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  Fig. 3 A case of splenic laceration in a patient with portal hypertension. (A) fibrin glue-infiltrating hemostasis (arrow) was applied; and (B) shallow intrasplenic infiltration of fibrin glue drops (arrow) is barely visualized in a follow-up non-enhanced computed tomography taken at posttransplant 5 days.

Reference

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