Modern principles of diagnosis and treatment of post–pancreatic resection bleeding

Abstract

Objective. To improve the results of treatment of patients with post–pancreatic resection bleeding.
 Materials and methods. The results of treatment of 827 patients who underwent radical resection of the pancreas for malignant tumours in the period from 2010 to 2021 were analysed. The patients were divided into two groups: the main group – 449 patients who were treated at the clinic from 2016 to 2021, and the control group – 378 patients who were treated in the clinic from 2010 to 2015. Postpancreatectomy bleeding occurred in 27 (6.0%) patients in the main group who were treated according to the developed diagnostic and therapeutic algorithm with the maximum use of endovascular techniques, and in 20 (5.3%) patients in the control group who received standard treatment.
 Results. X–ray endovascular bleeding control was performed in 14 (51.9%) of 27 patients in the main group: X–ray endovascular occlusion – in 9, by means of stent graft placement – in 5. In 3 (11.1%) patients of the main group, the source of bleeding was not detected during angiography, and they underwent laparotomy with subsequent bleeding control. Complications after X–ray endovascular occlusion occurred in 1 (11.1%) patient, and there were no complications after stent graft placement. Open surgical interventions were performed in 13 (48.1%) patients. One (3.7%) patient died after laparotomy with bleeding control due to the development of further purulent–septic complications. In the control group, X–ray endovascular bleeding control was performed in 3 (15%) patients, and relaparotomy with bleeding control in 17 (85%) patients. 6 (30%) patients died after open reoperative interventions.
 Conclusions. Endovascular techniques for stopping post–pancreatic transplantation bleeding are highly effective and safe with favourable technical and clinical results. They are advisable as the first step in the treatment of postpancreatic surgery bleeding with stent grafts in case of bleeding from the great vessels.