Could the topical application of tranexamic acid preserve the balance between surgical field hemostasis and a systemic anticoagulation state in sleeve gastrectomy patients? A prospective randomized study

Background: Tranexamic acid (TXA) is an effective, cheap antifibrinolytic medication. The parenteral route could beassociated with acute neurological and visual side effects, with some concern about the possible long-held belief ofthromboembolic events. The topical TXA is used in many surgical specialties to produce the same effect but not to inducethe aforementioned adverse effects. The topical TXA has not been tried previously in bariatric surgery, and there is scarceconflicting data regarding the parenteral TXA.Objectives: In this study, we aimed to compare the effects of intravenous and topical TXA on reducing staple linebleeding (SLB) and postlaparoscopic sleeve gastrectomy (LSG) bleeding and unveil the possible adverse effects linkedto both routes.Patients and Methods: This prospective randomized controlled study has been conducted at Ain Shams Universityhospitals, Cairo, Egypt, on 81 patients who underwent LSG from October 2022 to March 2023. Patients of either sex aged18–65 years and are candidates for LSG, were enrolled. Exclusion criteria included allergy to TXA, heavy sweet-eaters,bleeding disorders, and those unfit for general anesthesia. The patients were randomized into two groups: group A (given1 g intravenous TXA at the start of dissection) and group B had topical TXA (after stapling).Results: Eighty-one patients underwent LSG with a mean age of 34.2±11.3 years. Forty-two patients were included ingroup A, and 39 were enrolled in group B. Both groups were comparable in terms of baseline characteristics. The topicalroute significantly decreased SLB (P=0.013) and postoperative bleeding (P=0.024) compared to the parenteral route.Two patients in group A developed acute gastrointestinal tract and visual adverse effects. There were no cases of leakageor thromboembolic in either group.Conclusion: The topical route significantly decreased both SLB and postoperative bleeding, with a high safety profilecompared to the parenteral route.