title: Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer.
abstract: BACKGROUND
  Postoperative anastomotic hemorrhage is a relatively rare complication, but it is lethal if not treated immediately.
  
  
  METHODS
  Of 1400 patients with gastric cancer who underwent gastrectomy between September 2002 and December 2007, postoperative anastomotic hemorrhage was observed in 6 patients. The surgical procedures, bleeding sites, methods of hemostasis, and clinical courses of these 6 patients were analyzed.
  
  
  RESULTS
  Of the 1400 patients, 878, 72, and 450 underwent distal, proximal, and total gastrectomy, respectively. The bleeding sites were as follows: transection line of the stomach using a linear stapler (n = 1); gastroduodenostomy using a circular stapler (n = 3); gastrojejunostomy by hand-suture (n = 1); and esophagojejunostomy using a circular stapler (n = 1). Five patients achieved complete hemostasis with endoscopic treatment. One patient underwent re-operation for anastomotic hemorrhage without endoscopic therapy. Two patients had delayed gastric emptying, and one patient developed an intraabdominal abscess after hemostatic treatment.
  
  
  CONCLUSIONS
  Postoperative anastomotic hemorrhage is an infrequent but potentially life-threatening complication. Endoscopy appears to be useful for both the confirmation of bleeding and therapeutic intervention.
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005763:Gastroenterostomy / Q000009:adverse effects; D016558:Hemostasis, Endoscopic; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012086:Reoperation; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors