Effectiveness of tranexamic acid in reducing hidden blood loss during laparoscopic sleeve gastrectomy: a randomized clinical trial

Introduction: Obesity and its related metabolic complications are an increasing challenge for healthcare systems. Bariatric surgery is an effective treatment, but it is associated with potential adverse events, including postoperative bleeding. Enhanced Recovery After Bariatric Surgery (ERABS) protocols aim to reduce length of hospital stay, but they also reduce time for patients monitoring. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing bleeding in various surgeries, but its use in bariatric procedures remains under-researched. This study aims to evaluate the effectiveness of TXA in reducing postoperative bleeding following laparoscopic sleeve gastrectomy (SG). Material and methods: A single-center, single-blinded, 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 the haemoglobin concentration in abdominal drainage post-surgery. Secondary outcomes included total blood loss, drainage volume, need for blood transfusion, and postoperative complications. Statistical analysis was performed using intention-to-treat and per-protocol strategies. Results: A significant reduction in haemoglobin concentration in the drainage samples was observed in the TXA group (p=0.003). However, no significant differences were found in overall blood loss, drainage volume, necessity for blood transfusions or extended hospital stay between groups. Conclusion: TXA administration during SG reduces postoperative, abdominal bleeding as measured by haemoglobin concentration in abdominal drainage without affecting overall blood loss. These findings support further research into the routine use of TXA as part of the ERABS protocol in bariatric surgery. Further multicenter trials are needed to confirm the broader applicability and safety of TXA in this setting. Trial registration: ClinicalTrials.gov (blinded).