SS  Vol.6 No.6 , June 2015
Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot®) with Conventional Haemostatic Procedure after Thyroid Resection
Abstract: Background: Postoperative hemorrhage remains an uncommon but potentially life-threatening complication of thyroid surgery. The aim of this case-controlled study was to compare the effectiveness of PerClot® hemostatic agent with hemostasis by conventional technique (HCT) in thyroid surgery. Methods: The thyroid resection was performed from November 2009 to February 2010. Exclusion criteria were applied. There were 30 patients in the HCT group and 30 patients in the PerClot® group. The outcome parameters were postoperative bleeding, the drainage volume 24 hours postoperatively and adverse events according to PerClot®. Results: There was no post-operative hemorrhage in both groups. We found no significant difference between the control andPerClot® group with regard to total drainage volume after 24 h (51 ml ± 36.9 control group/53 ml ± 39.5 PerClot® group (p = 0.79)). There were no adverse events in the PerClot® group. Conclusions: Routine use of PerClot® hemostatic agent has no advantage over conventional hemostasis technique (HCT) in thyroid surgery. In addition, PerClot® is safe and well tolerated.
Cite this paper: Ahnen, T. , Ahnen, M. , Wirth, U. , Barisic, A. , Schardey, H. and Schopf, S. (2015) Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot&reg) with Conventional Haemostatic Procedure after Thyroid Resection. Surgical Science, 6, 239-246. doi: 10.4236/ss.2015.66037.

[1]   Musholt, T.J., Clerici, T., Dralle, H., Frilling, A., Goretzki, P.E. and Hermann, M.M. (2011) German Association of Endocrine Surgeons Practice Guidelines for the Surgical Treatment of Benign Thyroid Disease. Langenbeck’s Archives of Surgery, 396, 639-649.

[2]   Dralle, H. (2009) Chirurgische Arbeitsgemeinschaft Endokrinologie der Deutschen Gesellschaft für Allgemeinund Viszeralchirurgie und für die Deutsche Gesellschaft für Chirurgie. Identification of the Recurrent Laryngeal Nerve and Parathyroids in Thyroid Surgery. Chirurgie, 80, 352-363.

[3]   Roher, H.D., Goretzki, P.E., Hellmann, P. and Witte, J. (1999) Complications in Thyroid Surgery. Incidence and Therapy. Chirurgie, 70, 999-1010.

[4]   Thompson, N.W., Olsen, W.R. and Hoffman, G.L. (1973) The Continuing Development of the Technique of Thyroidectomy. Surgery, 73, 913-927.

[5]   Harding, J., Sebag, F., Sierra, M., Palazzo, F.F. and Henry, J.F. (2006) Thyroid Surgery: Postoperative Hematoma-Prevention and Treatment. Langenbeck’s Archives of Surgery, 391, 169-173.

[6]   Testini, M., Marzaioli, R., Lissidini, G., Lippolis, A., Logoluso, F., Gurrado, A., et al. (2009) The Effectiveness of FloSeal Matrix Hemostatic Agent in Thyroid Surgery: A Prospective, Randomized, Control Study. Langenbeck’s Archives of Surgery, 394, 837-842.

[7]   Guler, M., Maralcan, G., Kul, S., Baskonus, I. and Yilmaz, M. (2011) The Efficacy of Ankaferd Blood Stopper for the Management of Bleeding Following Total Thyroidectomy. Journal of Investigative Surgery, 24, 205-210.

[8]   Puzziello, A., Rosato, L., Innaro, N., Orlando, G., Avenia, N., Perigli, G., et al. (2014) Hypocalcemia Following Thyroid Surgery: Incidence and Risk Factors. A Longitudinal Multicenter Study Comprising 2631 Patients. Endocrine, 47, 537-542.

[9]   Promberger, R., Ott, J., Kober, F., Koppitsch, C., Seemann, R., Freissmuth, M., et al. (2012) Risk Factors for Postoperative Bleeding after Thyroid Surgery. British Journal of Surgery, 99, 373-379.

[10]   Campbell, M.J., McCoy, K.L., Shen, W.T., Carty, S.E., Lubitz, C.C., Moalem, J., et al. (2013) A Multi-Institutional International Study of Risk Factors for Hematoma after Thyroidectomy. Surgery, 154, 1283-1291.

[11]   Browder, I.W. and Litwin, M.S. (1986) Use of Absorbable Collagen for Hemostasis in General Surgical Patients. The American Surgeon, 52, 492-494.

[12]   Haas, S. (2006) The Use of a Surgical Patch Coated with Human Coagulation Factors in Surgical Routine: A Multicenter Postauthorization Surveillance. Clinical and Applied Thrombosis/Hemostasis, 12, 445-450.

[13]   Tae, W.K., Choi, S.Y., Jang, M.S., Lee, G.G., Nam, M.E., Son, Y.I., et al. (2012) Efficacy of Fibrin Sealant for Drainage Reduction in Total Thyroidectomy with Bilateral Central Neck Dissection. Otolaryngology—Head and Neck Surgery, 147, 654-660.

[14]   Amit, M., Binenbaum, Y., Cohen, J.T. and Gil, Z. (2013) Effectiveness of an Oxidized Cellulose Patch Hemostatic Agent in Thyroid Surgery: A Prospective, Randomized, Controlled Study. Journal of the American College of Surgeons, 217, 221-225.

[15]   Dionigi, G., Boni, L., Rovera, F. and Dionigi, R. (2007) Dissection and Hemostasis with Hydroxilated Polyvinyl Acetal Tampons in Open Thyroid Surgery. Annals of Surgical Innovation and Research, 1, 3.

[16]   Wang, Y., Xu, M., Dong, H., Liu, Y., Zhao, P., Niu, W., et al. (2012) Effects of PerClot® on the Healing of Full-Thickness Skin Wounds in Rats. Acta Histochemica, 114, 311-317.

[17]   Janczak, D., Ruciński, A., Rucińska, Z., Janczak, D., Dorobisz, K. and Chabowski, M. (2013) Modern Topical Hemostatic Agents—A Breakthrough in Vascular Surgery. Polimery w Medycynie, 43, 221-225.

[18]   Bergenfelz, A., Jansson, S., Kristoffersson, A., Martensson, H., Reihnér, E., Wallin, G., et al. (2008) Complications to Thyroid Surgery: Results as Reported in a Database from a Multicenter Audit Comprising 3,660 Patients. Langenbeck’s Archives of Surgery, 393, 667-673.

[19]   Cakabay, B., Sevinc, M.M., Gomceli, I., Yenidogan, E., Ulkü, A. and Koc, S. (2009) LigaSure versus Clamp-and-Tie in Thyroidectomy: A Single-Center Experience. Advances in Therapy, 26, 1035-1041.

[20]   Gentileschi, P., D’Ugo, S., Iaculli, E. and Gaspari, A.L. (2011) Harmonic FocusTM versus “Knot Tying” during Total Thyroidectomy: A Randomized Trial. Updates in Surgery, 63, 277-281.

[21]   Garas, G., Okabaysashi, K., Ashrafian, H., Shetty, K., Palazzo, F., Tolley, N.S., et al. (2013) Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies. Thyroid, 23, 1138-1150.

[22]   Wright, J.D., Ananth, C.V., Lewin, S.N., Burke, W.M., Siddiq, Z., Neugut, A.I., et al. (2014) Patterns of Use of Hemostatic Agents in Patients Undergoing Major Surgery. Journal of Surgical Research, 186, 458-466.

[23]   Rickenbacher, A., Breitenstein, S., Lesurtel, M. and Frilling, A. (2009) Efficacy of TachoSil a Fibrin-Based Haemostat in Different Fields of Surgery—A Systematic Review. Expert Opinion on Biological Therapy, 9, 897-907.

[24]   Maisano, F., Kjaergard, H.K., Bauernschmitt, R., Pavie, A., Rábago, G., Laskar, M., et al. (2009) TachoSil Surgical Patch versus Conventional Haemostatic Fleece Material for Control of Bleeding in Cardiovascular Surgery: A Randomized Controlled Trial. European Journal of Cardio-Thoracic Surgery, 36, 708-714.

[25]   Ujam, A., Awad, Z., Wong, G., Tatla, T. and Farrell, R. (2012) Safety Trial of Floseal® Haemostatic Agent in Head and Neck Surgery. Annals of the Royal College of Surgeons of England, 94, 336-339.

[26]   Tonante, A., Lo Schiavo, M.G., Bonanno, L., D’Alia, C., Taranto, F., Gagliano, E., et al. (2006) Haemorrhagic Complications in Thyroid Surgery. Control of Bleeding from Retroneural Vessels Using Collagen and Thrombin Gelatine Granules. Chirurgia Italiana, 58, 61-68.

[27]   Spencer, H.T., Hsu, J.T., Mc Donald, D.R. and Karlin, L.I. (2012) Intraoperative Anaphylaxis to Gelatin in Topical Hemostatic Agents during Anterior Spinal Fusion: A Case Report. The Spine Journal, 12, e1-e6.

[28]   Tublin, M.E., Alexander, J.M. and Ogilvie, J.B. (2010) Appearance of Absorbable Gelatin Compressed Sponge on Early Post-Thyroidectomy Neck Sonography: A Mimic of Locally Recurrent or Residual Thyroid Carcinoma. Journal of Ultrasound in Medicine, 29, 117-120.

[29]   Murat, F.J.L., Ereth, M.H., Dong, Y., Piedra, M.P. and Gettman, M.T. (2004) Evaluation of Microporous Polysaccharide Hemospheres as a Novel Hemostatic Agent in Open Partial Nephrectomy: Favorable Experimental Results in the Porcine Model. The Journal of Urology, 172, 1119-1122.

[30]   Anegg, U., Rychlik, R. and Smolle-Juttner, F. (2008) Do the Benefits of Shorter Hospital Stay Associated with the Use of Fleece-Bound Sealing Outweigh the Cost of the Materials? Interactive CardioVascular and Thoracic Surgery, 7, 292-296.