Abstract / Summary
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. Conclusions: Bio-based adhesives show substantial preclinical hemostatic effects in liver models, but these findings should not be interpreted as established clinical benefit. Adequately powered multicenter RCTs with standardized outcome assessment are required.