Role of fibrin sealants in liver surgery

Background: Fibrin sealants are widely used in liver surgery. The aim of this article is to review the literature on evidence of hemostatic and biliostatic capacities of different fibrin sealants in liver surgery. Methods: In PubMed, a literature search was done with the search terms 'fibrin sealant' or 'fibrin glue' combined with 'liver resection' or 'bile leakage'. Thirteen comparative fibrin sealant studies were selected. Results: In general, these studies have shown a reduced time to hemostasis when fibrin sealants were used. So far, only a few studies have been published that have focused on postoperative resection surface-related complications. There is no strong evidence that fibrin sealants reduce the incidence of bile leakage after liver resection. Important new evidence shows that bile contains profibrinolytic activity that causes lysis of the clot formed by the fibrin sealant at least in vitro. Conclusions: Fibrin sealants can be effective as an adjunct to achieve hemostasis during liver resections. However, considering lack of evidence on the efficacy of fibrin sealants in reducing postoperative resection surface-related complications, routine use of fibrin sealants in liver surgery cannot be recommended.