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Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

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Abstract

Background

The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.

Methods

Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (n = 26), liver transplantation (n = 24) and other (n = 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.

Results

Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p = 0.14). Recurrence was similar after stenting and embolization (n = 4/18, 22% vs n = 8/26, 31%, p = 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n = 2/10, 20% vs. n = 11/16, 69%, p = 0.042).

Conclusion

IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.

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References

  1. Yekebas EF, Wolfram L, Cataldegirmen G et al (2007) Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 246:269–280

    Article  Google Scholar 

  2. Floortje van Oosten A, Smits FJ, van den Heuvel DAF et al (2019) Diagnosis and management of postpancreatectomy hemorrhage: a systematic review and meta-analysis. HPB 21:953–961

    Article  CAS  Google Scholar 

  3. de Castro SMM, Kuhlmann KFD, Busch ORC et al (2005) Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 241:85–91

    Article  Google Scholar 

  4. Boleslawski E, Bouras AF, Truant S et al (2013) Hepatic artery ligation for arterial rupture following liver transplantation: a reasonable option. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 13:1055–1062

    Article  CAS  Google Scholar 

  5. Yang J, Zhang X-H, Huang Y-H et al (2016) Diagnosis and treatment of abdominal arterial bleeding after radical gastrectomy: a retrospective analysis of 1875 consecutive resections for gastric cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract 20:510–520

    Article  Google Scholar 

  6. Khalsa BS, Imagawa DK, Chen JI et al (2015) Evolution in the treatment of delayed postpancreatectomy hemorrhage: surgery to interventional radiology. Pancreas 44:953–958

    Article  Google Scholar 

  7. Fujii Y, Shimada H, Endo I et al (2007) Management of massive arterial hemorrhage after pancreatobiliary surgery: does embolotherapy contribute to successful outcome? J Gastrointest Surg Off J Soc Surg Aliment Tract 11:432–438

    Article  Google Scholar 

  8. Zhang J, Zhu X, Chen H et al (2011) Management of delayed post-pancreaticoduodenectomy arterial bleeding: interventional radiological treatment first. Pancreatol Off J Int Assoc Pancreatol IAP Al 11:455–463

    Google Scholar 

  9. Hassold N, Wolfschmidt F, Dierks A et al (2016) Effectiveness and outcome of endovascular therapy for late-onset postpancreatectomy hemorrhage using covered stents and embolization. J Vasc Surg 64:1373–1383

    Article  Google Scholar 

  10. Asai K, Zaydfudim V, Truty M et al (2015) Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques. HPB 17:902–908

    Article  Google Scholar 

  11. Pottier E, Ronot M, Gaujoux S et al (2016) Endovascular management of delayed post-pancreatectomy haemorrhage. Eur Radiol 26:3456–3465

    Article  Google Scholar 

  12. Schäfer M, Heinrich S, Pfammatter T et al (2011) Management of delayed major visceral arterial bleeding after pancreatic surgery. HPB 13:132–138

    Article  Google Scholar 

  13. Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25

    Article  Google Scholar 

  14. Coccolini F, Stahel PF, Montori G et al (2017) Pelvic trauma: WSES classification and guidelines. World J Emerg Surg WJES 12:5

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  16. Yamashita Y, Taketomi A, Fukuzawa K et al (2007) Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg 193:454–459

    Article  Google Scholar 

  17. Chen J, Xu S, Zhao W et al (2015) Diagnostic and therapeutic strategies to manage post-pancreaticoduodenectomy hemorrhage. World J Surg 39:509–515

    Article  Google Scholar 

  18. Jilesen APJ, Tol JAMG, Busch ORC et al (2014) Emergency management in patients with late hemorrhage after pancreatoduodenectomy for a periampullary tumor. World J Surg 38:2438–2447

    Article  Google Scholar 

  19. Miura F, Asano T, Amano H et al (2009) Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology. J Hepatobiliary Pancreat Surg 16:56–63

    Article  Google Scholar 

  20. Chang Y-C, Liu K-L, Huang Y-C et al (2019) Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years. CVIR Endovasc 2:33

    Article  Google Scholar 

  21. Blanc T, Cortes A, Goere D et al (2007) Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated? Am J Surg 194:3–9

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France

    Emmanuel Devant, Edouard Girard, Julio Abba, Pierre-Yves Sage, Olivier Risse, Bertrand Trilling & Mircea Chirica

  2. Université Grenoble Alpes, CNRS, Grenoble, France

    Edouard Girard, Ivan Bricault & Bertrand Trilling

  3. Centre Hospitalier Universitaire Grenoble Alpes, Department of Radiology, Grenoble, France

    Julien Ghelfi, Christian Sengel & Ivan Bricault

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  1. Emmanuel Devant
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  2. Edouard Girard
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  3. Julio Abba
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  7. Olivier Risse
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Correspondence to Mircea Chirica.

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Devant, E., Girard, E., Abba, J. et al. Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes. World J Surg 45, 2432–2438 (2021). https://doi.org/10.1007/s00268-021-06116-1

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  • DOI: https://doi.org/10.1007/s00268-021-06116-1

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