Total pancreatectomy for the treatment of grade C late post-pancreaticoduodenectomy hemorrhage 

Abstract

Objective: Late post-pancreatoduodenectomy hemorrhage (LPPH) is associated with a significant increase in perioperative mortality. It is of great significance to explore effective treatment methods for severe LPPH patients. Methods: Between 2014 and 2021, 224 pancreatoduodenectomies were performed, and 14 patients had a late hemorrhage (occurring >24 h postoperatively). The clinicopathological variables and treatments related to hemorrhage were investigated. Results: Out of the 14 LPPH patients, 6 had grade B hemorrhage and 8 had grade C hemorrhage. There were 11 cases of comorbid pancreatic fistula, 5 cases of biliary fistula, and 7 cases of abdominal infection. The median time to first hemorrhage after surgery was 9 days. Of the 6 grade B LPPH patients, 4 underwent conservative treatment, 1 underwent transarterial embolization (TAE), and 1 underwent local suturing at the bleeding site for hemostasis. Of the 8 grade C LPPH patients, One patient without pancreatic fistula and abdominal infection was given conservative treatment after no bleeding was found by digital subtraction angiography examination. The other 7 patients had comorbid pancreatic fistula, of which 5 had comorbid abdominal infection, 3 had comorbid biliary fistula, and all 7 patients underwent total pancreatectomy of the residual pancreas. Three of these patients simultaneously underwent endovascular treatment. All patients recovered and were discharged, with a mortality of 0%. Conclusion: Total pancreatectomy of the residual pancreas is safe and feasible in grade C LPPH patients with comorbid pancreatic fistula, biliary leakage, or abdominal infection.