Therapeutic Reduction of Intraoperative Blood Loss by Terlipressin in Abdominal Surgery

Abstract

Aim. To determine the efficiency of selective vasoconstrictor terlipressin in blood loss reduction during large abdominal
surgery.
Material and Methods. Results of abdominal surgical operations in two comparable clinical groups (1st control group of 30 patients and 2nd research group of 38 patients) in aspect of intraoperative blood loss volume are analyzed. Patients underwent liver resection, pancreatic resection, biliodigestive reconstructive surgery and splenectomy for “huge” spleen. Intraoperative blood loss and some parameters of postoperative period were studied. Patients of the 2nd group received terlipressin (Remestyp®) 1000–3000 μg intravenously in addition to standard surgical procedures to reduce blood loss.
Results. An optimal algorithm of terlipressin (Remestyp®) administration for blood loss reduction during abdominal surgery was determined: 1000 μg for 30 minutes before intervention plus 500–1000 μg during operation and 1000 μg if duration of surgery is over than 4 hours. There is the most demonstrative reduction of blood loss in cases of repeated biliodigestive reconstructions and splenectomy for “huge” spleen – 484.2 ± 36.1 ml vs. 352.8 ± 22.5 ml (р < 0.01) and 560.4 ± 76.2 ml vs. 314.2 ± 38.8 ml (р < 0.01).
Conclusion. Surgical technique is most important factor for blood loss reduction in abdominal interventions. However sometimes intraoperative use of terlipressin is substantively effective. Selective vasoconstrictor-assisted upper abdominal surgery in patients with portal hypertension should be obligatory