Effectiveness of Tranexamic Acid in Reducing Hidden Blood Loss During Laparoscopic Sleeve Gastrectomy: A Randomized Clinical Trial

<b>Background</b>: Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing bleeding across various surgical procedures. However, its role in bariatric surgery remains underexplored. This study aimed to evaluate the effectiveness of TXA in mitigating hidden blood loss following laparoscopic sleeve gastrectomy (SG). <b>Methods</b>: A single-center, single-blind, randomized, controlled trial was conducted at the University Clinical Center, Medical University of Gdańsk, Poland, between July 2022 and June 2023. A total of 238 patients undergoing SG were randomized to receive either TXA or no pharmacological intervention. The primary outcome was hemoglobin concentration in abdominal drainage post-surgery. Secondary outcomes included total blood loss, drainage volume, the need for blood transfusion, and postoperative complications. Statistical analyses were conducted using intention-to-treat and per-protocol strategies. <b>Results</b>: A statistically significant reduction in hemoglobin concentration in abdominal drainage samples was observed in the TXA group (<i>p</i> = 0.011). No significant differences were found in total blood loss, drainage volume, necessity for blood transfusions, or extended hospital stay between groups. <b>Conclusions</b>: While TXA administration may reduce the hidden blood loss effect, its general clinical significance appears questionable. Nonetheless, intraoperative TXA may be beneficial for a selected patient group with multiple preoperative disorders and risk factors. Further research is necessary to comprehensively assess the risks and benefits of TXA administration in bariatric surgery.