Hemorrhage After Pancreatoduodenectomy

Rumstadt, B.; Schwab, Michael; Korth, P; Samman, Mahmood; Trede, M.

doi:10.1097/00000658-199802000-00013

Cited by 190 publications

(222 citation statements)

References 31 publications

Supporting

Mentioning

204

Contrasting

Unclassified

Order By: Relevance

“…On the other hand, delayed bleeding occurs mainly due to erosion or pseudoaneurysm of major visceral arteries and has a higher mortality rate than those with suture-line bleeding [16] . Three major predisposing factors for delayed arterial bleeding after hepatobiliary pancreatic surgery have been suggested: (1) digestion of arterial walls due to activated pancreatic juice or infectious bile from anastomotic insufficiency, (2) arterial irritation by localized abscess in the intra-abdominal space, and (3) a mechanical injury of the artery during operation, particularly due to lymph node dissection for malignancy [1][2][3]14,17,18] . In the present study, lymphadenectomy around the hepatic artery was performed on all 9 patients.…”

Section: Discussionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

View full text Add to dashboard Cite

AIM:To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery. METHODS:We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS:The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION:When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may lead to an unfavorable outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

View full text Add to dashboard Cite

show abstract

“…Post surgical bleeding complications are reported in 5-16 % [8,[11][12][13][14][15] of patients following PD and are associated with high morbidity and mortality. A number of different definitions have been used by different authors.…”

Section: Post Pancreatectomy Haemorrhage (Pph)mentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

View full text Add to dashboard Cite

Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

show abstract

“…While operative mortality is <5 %, morbidity is still around 30 % [3]. Early bleed after pancreatic surgery will warrant emergency laparotomy after a failed conservative treatment [4].…”

Section: Discussionmentioning

confidence: 99%

Bleeding Complication after Pancreatic Surgery: Role of Harmonic Scalpel

et al. 2012

View full text Add to dashboard Cite

In this modern era of technological advancements, though many centers are contemplating complex surgical procedures on the pancreas, morbidity is still high and around 30-35 %. Post-operative bleeding complications are the most worrisome of all, which need vigilance by the operating team. Early recognition and prompt management using endoscopy, intervention radiology or urgent surgery, with a low threshold for relaparotomy is needed to avoid mortality. After successfully completing more than 500 Whipple's operations and over 300 Frey's procedures in the last 10 years, our bleeding complication, which is around 2 %, has substantially increased. This increase over the last couple of years is seen with usage of harmonic scalpel in pancreatic surgery. Here we report our recent encounter with bleeding in the post-operative period after Whipple's pancreaticoduodenectomy and Frey's procedure, where harmonic scalpel was used. We have recommended our suggestion to avoid this complication, by adopting a simple technique. We have achieved optimal results by applying this technique in our subsequent cases.

show abstract

Hemorrhage After Pancreatoduodenectomy

Cited by 190 publications

References 31 publications

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Pancreatoduodenectomy - Preventing Complications

Bleeding Complication after Pancreatic Surgery: Role of Harmonic Scalpel

Contact Info

Product

Resources

About