Late Postpancreatectomy Hemorrhage After Pancreaticoduodenectomy: Is It Possible to Recognize Risk Factors?
Context Post-pancreatectomy hemorrhage is one of the most common complications after pancreaticoduodenectomy. Objective To evaluate the late post-pancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery criteria and to recognize factors related to its onset. Methods A prospective study of 113 patients who underwent pancreaticoduodenectomy was conducted. Late post-pancreatectomy hemorrhage was defined according to the criteria of the International Study Group of Pancreatic Surgery. Demographic, clinical, surgical and pathological data were considered and related to late post-pancreatectomy hemorrhage. Results Thirty-one (27.4%) patients had a post-pancreatectomy hemorrhage. Twenty-five (22.1%) patients developed late post-pancreatectomy hemorrhage: 19 (16.8%) grade B, 6 (5.3%) grade C. Surgical re-operation was performed in 2 out of the 25 cases with late post-pancreatectomy hemorrhage (8.0%) grade C associated with postoperative pancreatic fistula. At univariate analysis, the only factor significantly related to late post-pancreatectomy hemorrhage was postoperative pancreatic fistula (P<0.001). Multivariate analysis underlined that the severity of postoperative pancreatic fistula (P<0.001) and pancreatic anastomosis (P=0.049) independently increased the risk of late hemorrhage. Conclusion In patients undergoing pancreaticoduodenectomy, the criteria introduced by International Study Group of Pancreatic Surgery to define late postpancreatectomy hemorrhage are related to a higher incidence of hemorrhage than previously detected because they considered also mild hemorrhage.
Simons JP, Shah SA, Ng SC et al. National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 2009;13:1798-1805
Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 2010;34:121-125.
Yekebas EF, Wolfram L, Cataldegirmen G et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg. 2007; 246(2):269-80.
Sato N, Yamaguchi K, Shimizu S et al. Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg. 1998;133:1099-102.
Balladur P, Christophe M, Tiret E et al. Bleeding of the pancreatic stump following pancreatoduodenectomy for cancer. Hepatogastroenterology 1996;43:268 -270.
Halloran CM, Ghaneh P, Bosonnet L et al. Complications of pancreatic cancer resection. Dig Surg. 2002;19:138 -146.
Wente MN, Veit JA, Bassi C et al. Postpancreatectomy hemorrhage (PPH). An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20-25.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213
Sidi A, Lobato EB, Cohen JA. The American Society of Anesthesiologists' Physical Status: Category V Revisited. J Clin Anesth 2000; 12:328-34.
Bassi C, Dervenis C, Butturini G et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13.
Peng S, Mou Y, Cai X, Peng C. Binding pancreaticojejunostomy is a new technique to minimize leakage. Am J Surg 2002;183:283-5.
Rajarathinam G, Kannan DG, Vimalraj V et al. Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity grading. HPB 2008;10(5):363-70.
Sanjay P, Fawzi A, Fulke JL et al. Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP. 2010;5;11(3):220-225.
Eckardt AJ, Klein F, Adler A, Veltzke-Schlieker W, Warnick P, Bahra M, Wiedenmann B, Neuhaus P, Neumann K, Glanemann M. Management and outcomes of haemorrhage after pancreatogastrostomy versus pancreatojejunostomy. Br J Surg 2011;98:1599-1607.
Choi SH, Moon HJ, Heo JS et al. Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 2004;199:186-191.
Yamashita Y, Taketomi A, Fukuzawa K et al. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg 2007;193:454-459.
Rumstadt B, Schwab M, Korth P. Haemorrhage after pancreatoduodenectomy. Ann Surg 1998;227:236-241.
Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy. The ‘sentinel bleed’. Arch Surg 1991;126:1037-40.
Copyright (c) 2014 Claudio Ricci, Riccardo Casadei, Salvatore Buscemi, Francesco Minni
This work is licensed under a Creative Commons Attribution 4.0 International License.As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.