Algorithm for the management of late post-resectional haemorrhage

Diagnosis and Management of Haemorrhagic Complications Following Hepatopancreatobiliary Surgery

Anitha Balakrishnan, Sirke Rinkoff, Petra Goldsmith, Simon J F Harper, Neville V Jamieson, Emmanuel L Huguet, Asif Jah, Raaj K Praseedom

Abstract


Context Post-operative haemorrhage is a known complication of hepatopancreatobiliary surgery. Prompt treatment minimizes mortality and morbidity; however, there is currently little uniformity in the management of this complication. Objective The total numbers of pancreatectomies or liver resections were identified using hospital episode statistic data. Methods Patients who experienced post-operative bleeding were identified with keyword searches of all discharge letters, imaging reports and the theatre-coding database for the period between January 2005 and December 2011. Treatment modalities for control of haemorrhage as well as morbidity, mortality, length of stay and survival were examined. Results Thirty-four of the 768 pancreatic and liver resections performed experienced post-operative haemorrhage. More patients bled following pancreatectomies (6.1%) compared to hepatectomies (2.5%). Bleeding was controlled using endoscopic, interventional radiological or surgical methods; re-laparotomy provided definitive management in the majority of patients. Post-pancreatectomy haemorrhage was associated with significantly increased mortality (P=0.004). Length of stay was increased following haemorrhage post-pancreatectomy or hepatectomy (P<0.05). Conclusions Our study highlights the substantial increase in mortality and length of stay following post-pancreatectomy and post-hepatectomy haemorrhage. Re-laparotomy was frequently required for control of bleeding. Our proposed management algorithm based on the timing and site of bleeding may standardize treatment in this heterogeneous group.

Image: Algorithm for the management of late post-resectional haemorrhage.


Keywords


Aneurysm, False; Haemorrhage; Hepatectomy; Pancreaticoduodenectomy

Full Text:

HTML PDF

References


Teh SH, Diggs BS, Deveney CW, Sheppard BC. Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 2009; 144:713–21. [PMID: 19687374]

Nathan H, Segev DL, Mayo SC, Choti MA, Cameron AM, Wolfgang CL, et al. National trends in surgical procedures for hepatocellular carcinoma: 1998-2008. Cancer 2012; 118:1838–44. [PMID: 22009384]

Dimick JB, Wainess RM, Cowan JA, Upchurch GR, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004; 199:31–8. [PMID: 15217626]

Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 2007; 204:356–64. [PMID: 17324768]

Ziegler KM, Nakeeb A, Pitt HA, Schmidt CM, Bishop SN, Moreno J, et al. Pancreatic surgery: evolution at a high-volume center. Surgery 2010; 148:702-709. [PMID: 20797743]

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006; 10: 1199–210–discussion1210–1. [PMID 17114007]

Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240:698–708–discussion708–10. [PMID 15383797]

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236:397–406. [PMID 12368667]

Tien Y-W, Lee P-H, Yang C-Y, Ho M-C, Chiu Y-F. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 2005; 201:554–9. [PMID 16183493]

van Berge Henegouwen MI, Allema JH, van Gulik TM, Verbeek PC, Obertop H, Gouma DJ. Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg 1995; 82:1527–31. [PMID 8535810]

Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226:248-60. [PMID 9339931]

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191:38–46. [PMID 10898182]

Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg 2006; 243:373–9. [PMID 16495703]

Trede M, Schwall G. The complications of pancreatectomy. Ann Surg 1988; 207:39–47. [PMID 3276272]

Yekebas EF, Wolfram L, Cataldegirmen G, Habermann CR, Bogoevski D, Koenig AM, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246:269–80. [PMID 17667506]

de Castro SMM, Kuhlmann KFD, Busch ORC, van Delden OM, Laméris JS, van Gulik TM, et al. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 2005; 241:85–91. [PMID 15621995]

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage [PPH]: an International Study Group of Pancreatic Surgery [ISGPS] definition. Surgery 2007; 142:20–5. [PMID 17629996]

Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery [ISGLS]. HPB [Oxford] 2011; 13:528–35. [PMID 21762295]

Correa-Gallego C, Brennan MF, D'Angelica MI, DeMatteo RP, Fong Y, Kingham TP, et al. Contemporary experience with postpancreatectomy hemorrhage: results of 1,122 patients resected between 2006 and 2011. J Am Coll Surg 2012; 215:616–21. [PMID 22921325] 20. Grützmann R, Rückert F, Hippe-Davies N, Distler M, Saeger H-D. Evaluation of the International Study Group of Pancreatic Surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery 2012; 151:612–20. [PMID 22088819]

Darnis B, Lebeau R, Chopin-Laly X, Adham M. Postpancreatectomy hemorrhage [PPH]: predictors and management from a prospective database. Langenbecks Arch Surg 2013; 398:441–8. [PMID 23435636]

Roulin D, Cerantola Y, Demartines N, Schäfer M. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg 2011; 15:1055–62. [PMID 21267670]

Cho JY, Suh K-S, Kwon CH, Yi N-J, Lee HH, Park JW, et al. Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy. Liver Transpl 2006; 12:201–6. [PMID 16447201]

Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy. The 'sentinel bleed'. Arch Surg 1991; 126:1037–40. [PMID 1863209]

Wei H-K, Wang S-E, Shyr Y-M, Tseng H-S, Tsai W-C, Chen T-H, et al. Risk factors for post-pancreaticoduodenectomy bleeding and finding an innovative approach to treatment. Dig Surg 2009; 26:297–305. [19602889]

Balachandran P, Sikora SS, Raghavendra Rao RV, Kumar A, Saxena R, Kapoor VK. Haemorrhagic complications of pancreaticoduodenectomy. ANZ J Surg 2004; 74:945–50. [PMID 15550080]

Otah E, Cushin BJ, Rozenblit GN, Neff R, Otah KE, Cooperman AM. Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg 2002; 137:55–9. [PMID 11772216]




DOI: http://dx.doi.org/10.6092/1590-8577/2996

NBN: http://nbn.depositolegale.it/urn%3Anbn%3Ait%3Aunina-14167

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 1590-8577 | JOP is published by CAB - Center for Libraries at "Federico II" University of Naples using Open Journal System