Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology

Abstract

Background/Purpose Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage following pancreato-biliary surgery.

Management of Delayed Post-Pancreaticoduodenectomy Arterial Bleeding: Interventional Radiological Treatment First

“…Although the prevalence of surgical mortality of pancreaticoduodenectomy (PD) has recently fallen to acceptable levels (0–5%) [1,2,3,4,5,6,7,8,9,10], the prevalence of mortality can reach 11–60% [10,11,12,13,14,15] if postoperative arterial bleeding occurs. Post-PD arterial bleeding usually happens late (>5 days postoperatively).…”

Endovascular management of bleeding events after robotic pancreaticobiliary surgery

“…While prospective studies comparing bleeding complications between open, laparoscopic, and robotic surgeries are scarce in the literature, meta-analyses examining the postsurgical outcomes show similar rates of intra-operative complications, postoperative complications, and mortality between robotic and laparoscopic surgery (14). Furthermore, large series examining the incidence and nature of bleeding complications following major pancreatic surgery indicate that the typical bleeding site (hepatic and visceral arteries), type (caused by pseudoaneurysm), and timing (predominantly delayed) are similar between conventional surgical approaches to pancreatic resection and robotic pancreatic surgical interventions (15,16).…”

“…Delayed hemorrhage commonly arises from the hepatic artery or gastroduodenal artery stump due to the close proximity of these vessels to the surgical site (13). Other vessels, including the superior mesenteric artery and pancreaticoduodenal arteries, have been described as bleeding sources (6).…”

“…Postoperative hemorrhage is an uncommon complication of pancreaticobiliary surgery, but it may result in significant morbidity and mortality (3). With the rise of image-guided and catheter-based therapies, endovascular techniques have become an accepted treatment option for postoperative bleeding complications (5,6). While endovascular methods for addressing bleeding after pancreatic surgery have been described (7), there are limited data on the application of such approaches after minimally invasive robotic pancreaticobiliary surgery.…”

Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review

“…Interventional radiology (IR) provides a minimally invasive alternative for managing post-surgical complications [19,20]. Several different IR procedures, such as percutaneous drainage, aspiration of abscesses or fluid collections [4,5], percutaneous transhepatic biliary drainage [6], and arterial embolisation [21][22][23] have been introduced in clinical practice to treat post-surgical complications. IR procedures are an alternative approach to manage post-surgical complications less invasive than surgical re-intervention, and may lead to a reduction in hospital stay and re-operation rate [10,11].…”