The use of Tachosil® as hemostatic sealant in nephron sparing surgery for Wilms tumor: Preliminary observations

Abstract Background TachoSil®, which is an absorbable collagen sponge coated with human fibrinogen and thrombin, has proven to enhance hemostasis and promote optimal wound healing in adults undergoing nephron sparing surgery (NSS). We report our preliminary experience using this hemostatic agent dur...

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Published in:Journal of pediatric surgery 2013-03, Vol.48 (3), p.689-694
Main Authors: Mele, Ermelinda, Ceccanti, Silvia, Schiavetti, Amalia, Bosco, Sandro, Masselli, Gabriele, Cozzi, Denis A
Format: Article
Language:English
Subjects:
Child, Preschool
Drug Combinations
Female
Fibrin sealant
Fibrinogen - therapeutic use
Hemostasis
Hemostatic agents
Hemostatics - therapeutic use
Humans
Infant
Kidney Neoplasms - surgery
Male
Nephrectomy - methods
Nephron sparing surgery
Nephrons
Organ Sparing Treatments
Pediatrics
Prospective Studies
Surgery
Surgical Sponges
Thrombin - therapeutic use
Wilms tumor
Wilms Tumor - surgery
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Summary:Abstract Background TachoSil®, which is an absorbable collagen sponge coated with human fibrinogen and thrombin, has proven to enhance hemostasis and promote optimal wound healing in adults undergoing nephron sparing surgery (NSS). We report our preliminary experience using this hemostatic agent during NSS in children. Methods Prospective analysis of 3 patients with Wilms tumor (synchronous bilateral in one) undergoing NSS at our institution over an 18-month period. Primary outcome measures were intraoperative bleeding control and surgery-related postoperative sequelae. Results Overall, 4 kidneys underwent 5 NSS procedures, which included 3 partial nephrectomies and multiple tumor excisions performed on another kidney at initial and second-look surgery. After control of major bleeding and suturing of the collecting system, which was entered during 2 of the 5 NSS procedures, TachoSil® was applied to the parenchymal surface of the kidney, achieving immediate hemostasis. All NSS procedures were performed without hilar clamping, drainage or stent placement. None of the patients required blood transfusion. Small perirenal fluid collections were documented postoperatively, and all spontaneously resolved within 4 weeks of surgery. Conclusion In children undergoing NSS, TachoSil® represents an effective and safe tool for control of mild to moderate bleeding, and also facilitates sealing and wound dressing.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2013.01.019