Risk Factors of Massive Bleeding Related to Pancreatic Leak after Pancreaticoduodenectomy

Tien, Yu‐Wen; Lee, Po‐Huang; Yang, Ching-Yao; Ho, Ming‐Chih; Chiu, Yen‐Feng

doi:10.1016/j.jamcollsurg.2005.05.007

Cited by 128 publications

(122 citation statements)

References 27 publications

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“…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

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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.

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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

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“…In a clinical study performed in Japan, it was stated that the risk of aneurysm development due to erosion is four times higher in patients without omental flap applications and that flaps are effective in preventing the formation of aneurysms (17). However, in the literature, in series with low numbers of cases, the use of omental flap is described as a protective and useful procedure, whereas in meta-analyses and Cochrane studies, the use of omental flap is not described as useful (12,20,21).…”

Section: Discussionmentioning

confidence: 99%

Postoperative hemorrhage complications after the Whipple procedure

Dılek

Özşay²,

Acar³

et al. 2018

Turk J Surg

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Introduction:The Whipple operation is an essential surgical technique; however, its high morbidity (30% to 60%) and mortality (5%) rates are problems that should be addressed. The incidence of postoperative hemorrhage is 5% to 16% in the literature. In this study, the data and results in our clinic regarding postoperative hemorrhage complications were evaluated. Material and Methods:The files of 185 patients who underwent the Whipple operation in our hospital in the last five years were evaluated retrospectively, and we attempted to determine the causes of hemorrhage. It was found that 13 (7%) patients experienced hemorrhage, and six of them were found to have died. In six of these cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed on a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following cessation of the drug.Discussion: Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple surgeries. Results:In addition to known methods, angiography and embolization are emerging as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, the determination and elimination of independent risk factors, such as jaundice, that affect fistula formation and bleeding in the perioperative period is important for prevention Keywords: Complication, hemorrhage, pancreas, treatment, Whipple operation INTRODUCTIONThe Whipple operation is an essential surgical technique for periampullary tumors; however, its high morbidity (30% to 60%) and mortality (5%) rates are problems that should be addressed (1-3). Pancreatic fistulas (2% to 62%) are among the most common complications after the Whipple procedure (1, 4). The incidence of postoperative hemorrhage is 5% to 20.2% in the literature. Mortality due to hemorrhage is reported as 15% to 58% (1, 5-7). Hemorrhages may arise from the suture lines in the early period; here, we evaluate the data and results from our clinic regarding postoperative hemorrhage problems in cases who developed infections and fistula in the days following surgery. MATERIAL AND METHODSThe files of 185 patients who underwent the Whipple operation in our hospital in the last five years (2011 to 2015) were evaluated retrospectively; we also attempted to determine the causes of hemorrhage. As a routine procedure, all patients signed consent forms containing information about the routine procedures and complications. Cases who had hemorrhoids, anal fiss...

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“…Factors subscribed to these results have been represented by improved perioperative and critical care management, heightened patient selection and background, radiologic interventional drainage procedures for asymptomatic postoperative fluid collections and technical improvements in operative and reconstruction techniques (5). Perioperative morbidity rates still remains high despite progress, with incidence between 30% and 50% (6)(7)(8)(9), with most commonplace complications represented by fistula of the pancreaticoenteric anastomosis, delayed gastric emptying, anastomotic leakage, intraabdominal abscess and intraperitoneal or gastrointestinal hemorrhage (10,11). Hemorrhage following pancreaticoduodenectomy has a reported incidence from 1% to 8%, being responsible for 11% to 38% of procedure related mortality (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Perioperative morbidity rates still remains high despite progress, with incidence between 30% and 50% (6)(7)(8)(9), with most commonplace complications represented by fistula of the pancreaticoenteric anastomosis, delayed gastric emptying, anastomotic leakage, intraabdominal abscess and intraperitoneal or gastrointestinal hemorrhage (10,11). Hemorrhage following pancreaticoduodenectomy has a reported incidence from 1% to 8%, being responsible for 11% to 38% of procedure related mortality (6,7). Therefore, the clinical outcome and connotations of postoperative bleeding related to the pancreaticoduodenectomy is of substantive concern (12).…”

Section: Introductionmentioning

confidence: 99%

Intraluminal Postpancreatoduodenectomy Hemorrhage - Last 5 Years Experience

Valcea¹,

Beuran²,

Vartic³

2017

chr

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RezumatIntroducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii după duodenopancreatectomia cefalică. Scop: Studiul prezentat în acest articol analizează cazurile de hemoragie intralumenală de la nivelul anastomozei gastrojejunale mecanice secundară duodenopancreatectomiei cefalice. Material şi metodă: În perioada ianuarie 2012 -ianuarie 2017, 84 de rezecţii cefalo-pancreatice consecutive au fost efectuate de aceeaşi echipă chirurgicală. Procedeul preferat de reconstrucţie a fost Whipple (76 pacienţi). Anastomoza gastrojejunală a fost efectuată mecanic la toţi pacienţii, folosindu-se staplerul Panther liniar tip GIA. Clasificarea propusă de ISGPS a fost folosită pentru evaluarea severităţii hemoragiei. Rezultate: Din cei 84 de pacienţi, un număr de 7 cazuri de hemoragie intralumenală (8,33 %) a fost observat, în medie în ziua 4 postoperator. Relaparotomia a fost inevitabila în două cazuri. Trei pacienţi din subgrupul cu hemoragie intralumenală postpancreatectomie au decedat. În lotul studiat nu au fost înregistrate cazuri de hemoragie de la nivelul anastomozelor pancreatico-jejunală sau hepatico-jejunală. Concluzii: Anastomoza mecanică poate ridica controverse, sângerarea severă necesitând relaparotomie de urgenţă şi fiind corelată cu rate mari de mortalitate. Hemoragia intralumenală postduodenopancreatectomie rămâne o complicaţie importantă, al cărei management depinde de multipli factori şi care poate avea potenţial devastator.Cuvinte cheie: hemoragie, duodenopancreatectomie, management, mortalitate AbstractBackground: One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage. Aim: This study undertook an analysis of the cases that presented intraluminal bleeding of mechanical gastrojejunal anastomosis following pancreatico-

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Risk Factors of Massive Bleeding Related to Pancreatic Leak after Pancreaticoduodenectomy

Cited by 128 publications

References 27 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

Postoperative hemorrhage complications after the Whipple procedure

Intraluminal Postpancreatoduodenectomy Hemorrhage - Last 5 Years Experience

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