Intra‐abdominal hemorrhage following 739 consecutive pancreaticoduodenectomy: Risk factors and treatments

Abstract

Background and Aim Post‐pancreaticoduodenectomy hemorrhage (PPH) is a potentially lethal complication. The objective of this study was to explore the risk factors of PPH and to evaluate the treatment options. Methods Clinical data of 739 consecutive patients undergoing pancreaticoduodenectomy between 2009 and 2017 were collected from a prospectively maintained database. Univariate and multivariate analysis was performed by logistic regression model to evaluate potential risk factors associated with early and late PPH. Results The morbidity of PPH was 8.7% (64/739), while the mortality was 12.5% (8/64). Twenty‐two (34.4%) patients developed PPH within postoperative day 1 (early PPH) whereas 42 (65.6%) patients after postoperative day 1 (late PPH). No significant risk factor was identified associated with early PPH, whereas pancreatic duct diameter < 0.4 cm, and intra‐abdominal complications, such as pancreatic fistula, intra‐abdominal abscess, and delayed gastric emptying, were independently correlated with late PPH. There were 10 (15.6%) grade A, 28 (43.8%) grade B, and 26 (40.6%) grade C bleedings. The bleeding sites were verified by endoscopy, angiography, and/or exploratory laparotomy in 23 of 54 (42.6%) patients with grade B or C hemorrhage. Seven out of nine (78%) patients with arterial bleeding were cured by angiography and embolization, while 10 of 11 (90.9%) patients with anastomotic, venous, or retroperitoneum bleeding were rescued by laparotomy. Ten patients with grade A and 22 patients with grade B or C hemorrhage were treated successfully by blood transfusion and hemostatic medications. Conclusions Hemorrhage following pancreaticoduodenectomy is a common and lethal complication. Treatment strategies should be tailored according to different etiologies.

Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage

“…Our study illustrated that ERBD is a significant risk factor contributing to POPF development. PPH is the most lethal complication of PD, related mortality being as high as 20% to 50% and its incidence ranging from 3% to 20% (29). In the present study, the incidence of PPH in the ENBD group was lower than in the ERBD group.…”

Nomogram based on albumin and neutrophil-to-lymphocyte ratio for predicting postoperative complications after pancreaticoduodenectomy

“…Previously, several risk factors for postoperative complications after PD have been identified, including age, sex, functional status and several abnormal laboratory results (4,5,(10)(11)(12). Most of the relevant researches merely focused on PF (5,11) and DGE (6,12).…”

“…In addition, since PD is one of the most complicate operations in general surgery, the prognosis may differ obviously for different surgeons because they are at different stages of the learning curve (13). For the related researches (4,5,10,12), the cases were performed by different surgeons and thus, there was bias influencing the accuracy of the predicting model.…”

Pancreatoduodenectomy within 2 weeks after endoscopic retrograde cholangio-pancreatography increases the risk of organ/space surgical site infections: a 5-year retrospective cohort study in a high-volume centre

“…Results from Wu et al Showed that ERBD was associated with an increased risk of intra-abdominal abscess (IAA) in patients undergoing PD (34). It's similar to SSI that Endoscopy, angiography, and/or exploratory laparotomy was associated with grade B or C hemorrhage (23 of 54, 42.6%) in post-PD patients (35). ERCP is a procedure that enables the physician to examine the pancreatic and bile ducts and it needs a small opening in the duodenum (ampulla) and a small plastic tube (cannula) is then passed through the endoscope and into this opening.…”