title: Exploration for hemorrhage following laparoscopic renal surgery: intraoperative findings.
abstract: OBJECTIVE
  Bleeding after surgery is a rare but potentially life threatening complication. We reviewed operative and postoperative clinical features in patients who required surgical exploration secondary to hemorrhage following laparoscopic renal procedures.
  
  
  METHODS
  We retrospectively reviewed the records of patients undergoing laparoscopic renal surgery between January 1996 and September 2004. Nine of 1,123 patients (0.8%) underwent early exploration for bleeding within 5 days of surgery.
  
  
  RESULTS
  Two groups were identified. Group 1 consisted of 4 patients who underwent early exploration at less than 10 hours after surgery and had arterial bleeding. Group 2 consisted of 5 patients who underwent exploration a mean 38 hours after surgery and in whom no bleeding source was identified. Group 1 patients had pronounced hypotension with systolic blood pressure 70 to 79 mmHg and hematocrit decreases (mean 10.5%) in a short time course before repeat exploration (mean 4.5 hours). Arterial bleeding was identified in the hilum and adrenal bed. Group 2 patients demonstrated a decrease in hematocrit from an initial mean of 28.3% to 22.5% with tachycardia and mild hypotension (systolic blood pressure 90 to 99 mmHg). On exploration group 2 patients had diffuse oozing. Mean hospital stay in group 1 was 8 days (range 4 to 9) vs 12 (range 6 to 24) in group 2.
  
  
  CONCLUSIONS
  Early hemodynamic instability after laparoscopic renal surgery is likely to indicate a discrete arterial bleeding source from the hilum or adrenal bed, requiring surgical control. In patients who underwent exploration after a delayed bleeding presentation no discrete source was found intraoperatively. Therefore, it is unclear whether these patients benefited from surgical exploration.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri 63110, USA. Bhayanis@msnotes.wustl.edu
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Richard E
authors.initials: RE
authors.lastname: Link
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D000368:Aged; D003949:Diagnostic Techniques, Surgical; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies