Page 33 - Journal of Laparoscopic Surgery - WALS Journal

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The Effect of TXA on Blood Loss during Laparoscopic Sleeve Gastrectomy
intravenously during induction. The second group Postoperative Blood Loss
included the remaining 25 patients in whom TXA was Drain was kept for all patients who underwent lapa-
not given and was considered as control group. Injection roscopic sleeve gastrectomy. Most of the drains were
TXA was administered in a dose of 10 mg/kg as bolus removed within 72 hours. The fluid collected in the post-
injection (treatment group) given intravenously over operative drains was measured. In the treatment group,
5 minutes. The heart rate, respiratory rate, and blood 20 patients out of 25 patients had blood drain below 100 ml
pressure were checked and charted intraoperatively and on 1st postoperative day. In the control group, 16 patients
postoperatively. out of 25 patients had drained blood more than 100 ml
A single brand of TXA from a reputed firm was on the 1st postoperative day (Table 3).
used in all cases in order to minimize the brand-related
bias and for standardization. Intraoperative blood loss Table 3: Postoperative blood loss
was calculated by galanometric method, weighing the 50–100 ml 100–150 ml 150–200 ml Total
sponges used and soiled by blood during surgery and Treatment group 20 2 3 25
measuring the amount of blood collected in suction Control group 2 16 7 25
apparatus used during the surgery. Postoperatively, the Total 22 18 10 50
drained fluid collected in the drain was measured till the
drain was removed. Change in Hemoglobin Level
The hemoglobin level was assessed postopera- In patients who had laparoscopic sleeve gastrectomy,
tively and was compared with preoperative hemoglobin 23 patients out of 25 patients in the treatment group had
level. The data were collected in an excel sheet. The preoperative and postoperative hemoglobin difference
patients were followed up till they were discharged of less than 1 mg/dl. In the control group, 18 patients
from the hospital and were followed up in outpatient out of 25 patients had preoperative and postoperative
department. hemoglobin difference of more than 1 mg/dl (Table 4).

Table 4: Measurement of hemoglobin level
RESULTS
Preoperative hemoglobin Treatment Control Total
There were 50 patients in our study of whom 25 Less than 1 23 2
(50%) patients who received TXA were in the treat- 1.1–2 2 18
ment group and remaining 25 (50%) patients who 2.1–3 0 3
did not receive the drug were in the control group More than 3 0 2
(Table 1). Total 25 25 50

Table 1: Distribution of patients DISCUSSION
Drug Total Percentage Reduction of bleeding during laparoscopic sleeve
Control 25 50 gastrectomy is a major benefit for the operating surgeon.
Treatment 25 50 Tranexamic acid inhibits plasminogen activity and
Total 50 100 fibrinolysis and thereby reduces capillary ooze. It thus
There were 42 females and 8 males increases clot formation and decreases blood loss. The

added advantage is no postoperative alteration of patient’s
Intraoperative Blood Loss
coagulation profile and absence of major side effects.
In the treatment group, 20 patients out of 25 had blood A randomized controlled trial (RCT) was conducted
loss below 300 ml, and 2 patients had blood loss of more in 274 hospitals in 40 countries. This RCT named clinical
than 400 ml. In the control group, 5 patients out of 25 had randomization of an antifibrinolytic in significant
blood loss below 300 ml, and 20 patients had blood loss hemorrhage-2 (CRASH-2) assessed the efficacy and safety
of more than 400 ml (Table 2). of TXA by investigating 20,211 adult trauma patients
who had or were at risk of significant hemorrhage. In
Table 2: Intraoperative blood loss the trial, the injured patients were randomly separated
Less than 300– More than into two groups within 8 hours of injury. One group
300 ml 400 ml 400 ml Total received an initial dose of 1 gm of TXA and a second
Treatment 20 3 2 25 patients dose of 1 gm as infusion over 8 hours. The other group
Control 5 15 5 25 patients received a matching placebo. A total of 10,096 patients
Total 50 patients received TXA and 10,115 received placebo; of these

World Journal of Laparoscopic Surgery, January-April 2016;9(1):30-33 31