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Invited Critique
March 2002

A Polymeric Sealant Inhibits Anastomotic Suture Hole Bleeding More Rapidly Than Gelfoam/Thrombin—Invited Critique

Arch Surg. 2002;137(3):332. doi:10.1001/archsurg.137.3.332

The authors are to be commended on a well-conducted study. Bleeding is a continual concern for all surgeons; however, vascular PTFE graft suture hole bleeding is usually not a significant clinical problem. This is exemplified nicely in this study since the benefit of the polymeric sealant was just a 3-minute time saving. The use of proper technique can affect suture hole bleeding significantly. During the placement of PTFE grafts, the operating surgeon must be careful while placing the sutures and meticulously follow the curve of the needle as the needle is withdrawn from the graft. This maneuver alone can reduce bleeding from suture holes. The authors studied extremity revascularization and hemodialysis access procedures but a more appropriate study would have involved intra-abdominal vascular procedures where postoperative bleeding can be more problematic. One scenario in which there may be a clear benefit of the polymeric sealant is when any blood loss is critical; for example, in the anemic Jehovah's Witness who is refusing blood transfusion. Word from the laboratory is that polymeric sealant is excellent in stopping bleeding from a ruptured liver in an animal model, although the delivery system is cumbersome and needs some work.