Management Of Postoperative Hemorrhage After Pancreaticoduodenectomy And Role Of Endoscopic Therapy

Objective:Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic resection. This study analyzes the incidence, management, and outcomes of PPH, and evaluate the efficacy of endoscopic therapy.Methods:The subjects included381patients who underwent pancreaticoduodenectomy between June2010and August2012in the First Affiliated Hospital of Zhejiang University, School of Medicine. The clinical data was analyzed retrospectively.Results:Overall incidence of post-operative hemorrhage was4.46%(17/381). Hemorrhage-related mortality was23.53%(4/17). An association between hemorrhage and pancreatic fistula was observed. Early hemorrhage was seen in4patients (4/17,23.53%), occurring at an average of8.5hours postoperatively(1to16hours), these patients all underwent reoperation, allowing management of bleeding source in3of4patients(75%). Late hemorrhage(13/17) occurred at an average of11.5days postoperatively(2to35days), and intraluminal hemorrhage was seen in46.15%(6/13), treated surgically, and management was required in4of6patients (66.67%). Patients with extraluminal hemorrhage (7/13) all underwent endoscopic examination and treatment. Endoscopy allowed management of bleeding in4patients with gastrointestinal anastomotic bleeding(4/4,100%). Conclusion:Pancreatic fistulae was significantly associated with a higher risk of postoperative hemorrhage. In early hemorrhage, reoperation should be considered as the first-line treatment. And management of delayed hemorrhage should be guided by location (intra-vs extraluminal). Endoscopic approach for the management of gastrointestinal hemorrhage after pancreatectomy is feasible.