Journal of Functional Biomaterials
Bio-Based Hemostatic Adhesives, Sealants, and Local Hemostatic Agents for Liver Tissue: A Systematic Review with Meta-Analysis of Preclinical Data
By Roman Ishchenko, Maksim V. Solopov, Matvey Ilyashenko and 8 others.
Abstract
Background
Liver surgery carries a high risk of hemorrhage; bio-based adhesives and sealants are promising adjuncts, but hepatic evidence remains fragmented.
Methods
Following PRISMA 2020, we searched PubMed, Dimensions, Consensus, and SciSpace through February 2026. Forty-two studies were included (38 preclinical animal, 3 human clinical, and 1 veterinary RCT); 25 preclinical studies (67 pairwise comparisons) underwent random-effects meta-analysis using REML with HKSJ adjustment. Risk of bias was assessed with SYRCLE, RoB 2, and ROBINS-I; certainty of evidence was rated with an adapted GRADE framework.
Results
Versus standard hemostats, bioadhesives shortened time to hemostasis (MD = +56.05 s, 95% CI: 20.14 to 91.96; p = 0.0044) and reduced blood loss (RoM = 2.05, 95% CI: 1.48 to 2.86; p = 0.0002); versus untreated negative controls, effects were larger (MD = +419.53 s; RoM = 5.68). Heterogeneity was extreme (I2 = 96–99%), 95% prediction intervals included the null, and available clinical effect sizes were small and non-significant. Certainty of evidence was low to very low.