Risk factors for post-pancreaticoduodenectomy bleeding and finding an innovative approach to treatment.
BACKGROUND
This study is to determine the risk factors and outcome for post-pancreaticoduodenectomy bleeding, and to assess the roles of surgery and intravascular intervention in its management.


METHODS
Post-pancreaticoduodenectomy data of 628 patients were analyzed with regards to post-pancreaticoduodenectomy bleeding.


RESULTS
Post-pancreaticoduodenectomy bleeding occurred in 58 patients (9.2%) and led to death in 23 patients. Pancreatic leakage and intra-abdominal abscess were independent risk factors for both extraluminal and intraluminal post-pancreaticoduodenectomy bleeding. The most common source of bleeding was the gastroduodenal artery (n = 9, 24.3%), and 8 of these patients (88.9%) experienced gastroduodenal artery bleeding in late post-pancreaticoduodenectomy bleeding. Hemostasis for post-pancreaticoduodenectomy bleeding was achieved by surgery in 22 patients (78.6%) and intravascular intervention in 7 patients (58.3%). Transarterial embolization for gastroduodenal artery bleeding did not deteriorate liver function in most patients except for 1 who died of hepatic failure.


CONCLUSIONS
The placement of metallic clips on the gastroduodenal artery stump during a pancreaticoduodenectomy is helpful in identifying overlooked intermittent sentinel bleeding during angiography. Transarterial embolization for gastroduodenal artery bleeding could not guarantee against hepatic failure. The intravascular placement of a covered stent is the preferred procedure to avoid the complete interruption of arterial blood supply to the liver.
Wei
Hung-Kuang
HK
Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Wang
Shin-E
SE
Shyr
Yi-Ming
YM
Tseng
Hsiuo-Shan
HS
Tsai
Wan-Chen
WC
Chen
Tien-Hua
TH
Su
Cheng-Hsi
CH
Wu
Chew-Wun
CW
Lui
Wing-Yiu
WY
D018784:Abdominal Abscess / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013270:Stomach / Q000098:blood supply; D013529:Surgical Wound Dehiscence / Q000150:complications