Hemostasis in liver surgery: Indonesian Society of Digestive Surgeons (IKABDI) consensus statements

Abstract

Liver resection is a complex operation with bleeding control as one of the most crucial factors. It is essential to determine the amount of bleeding to predict the mortality and morbidity after liver surgery. With technology and scientific development, liver resection can use open or laparoscopic surgical techniques supported by various energy devices and medical management. However, the main goal is to remove the tumor with adequate negative margins and good flow. Indonesian Society of Digestive Surgeons agreed to have an agreement using the Modified Delphi method consisting of twenty digestive surgeons. The consensus was established for hemostasis management choices as surgical and medical strategies in liver surgery. The surgical strategies recommendation include performing anatomical resection in primary hepatic tumor and non-anatomical resection for liver metastases; using of Glissonean Pedicle approach as an inflow control option; doing routine intermittent pringle maneuvers; prohibiting total vascular exclusion; and making a statement that no particular energy device preferred for transecting the liver parenchyma. For medical strategies, consensus recommends limiting the transfusion of PRC or any other blood components, antifibrinolytic's role as hemostatic agents, and using fibrin sealant and matrix coagulant sheets for hemostatic agents in liver surgery. These recommendations reflect current knowledge and can be reviewed if new findings are discovered. Hopefully, this consensus can be a valuable guide for surgeons, especially those practicing in Indonesia, to provide low mortality and morbidity in liver resection.