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Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome.

Ansari, Daniel LU ; Tingstedt, Bobby LU ; Lindell, Gert LU ; Keussen, Inger LU ; Ansari, David LU and Andersson, Roland LU (2017) In Scandinavian Journal of Surgery2002-01-01+01:00 106(1). p.47-53
Abstract
Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancrea-tectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.

RESULTS: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C... (More)
Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancrea-tectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.

RESULTS: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy.

CONCLUSION: Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage. (Less)
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author
organization
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type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Surgery2002-01-01+01:00
volume
106
issue
1
pages
47 - 53
publisher
Finnish Surgical Society
external identifiers
  • pmid:26929287
  • scopus:85013243899
  • wos:000398818200006
ISSN
1799-7267
DOI
10.1177/1457496916631854
language
English
LU publication?
yes
id
40efc89c-619c-45c7-90c2-a391ab5ed086 (old id 8856737)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26929287?dopt=Abstract
date added to LUP
2016-03-15 10:16:18
date last changed
2018-03-18 03:23:25
@article{40efc89c-619c-45c7-90c2-a391ab5ed086,
  abstract     = {Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancrea-tectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.<br/><br>
RESULTS: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy.<br/><br>
CONCLUSION: Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.},
  author       = {Ansari, Daniel and Tingstedt, Bobby and Lindell, Gert and Keussen, Inger and Ansari, David and Andersson, Roland},
  issn         = {1799-7267},
  language     = {eng},
  number       = {1},
  pages        = {47--53},
  publisher    = {Finnish Surgical Society},
  series       = {Scandinavian Journal of Surgery2002-01-01+01:00},
  title        = {Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome.},
  url          = {http://dx.doi.org/10.1177/1457496916631854},
  volume       = {106},
  year         = {2017},
}