Systematic review of delayed postoperative hemorrhage after pancreatic resection.
BACKGROUND
This review assesses the presentation, management, and outcome of delayed postpancreatectomy hemorrhage (PPH) and suggests a novel algorithm as possible standard of care.


METHODS
An electronic search of Medline and Embase databases from January 1990 to February 2010 was undertaken. A random-effect meta-analysis for success rate and mortality of laparotomy vs. interventional radiology after delayed PPH was performed.


RESULTS
Fifteen studies comprising of 248 patients with delayed PPH were included. Its incidence was of 3.3%. A sentinel bleed heralding a delayed PPH was observed in 45% of cases. Pancreatic leaks or intraabdominal abscesses were found in 62%. Interventional radiology was attempted in 41%, and laparotomy was undertaken in 49%. On meta-analysis comparing laparotomy vs. interventional radiology, no significant difference could be found in terms of complete hemostasis (76% vs. 80%; P = 0.35). A statistically significant difference favored interventional radiology vs. laparotomy in term of mortality (22% vs. 47%; P = 0.02).


CONCLUSIONS
Proper management of postoperative complications, such as pancreatic leak and intraabdominal abscess, minimizes the risk of delayed PPH. Sentinel bleeding needs to be thoroughly investigated. If a pseudoaneurysm is detected, it has to be treated by interventional angiography, in order to prevent a further delayed PPH. Early angiography and embolization or stenting is safe and should be the procedure of choice. Surgery remains a therapeutic option if no interventional radiology is available, or patients cannot be resuscitated for an interventional treatment.
Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Didier
D
Roulin
Yannick
Y
Cerantola
Nicolas
N
Demartines
Markus
M
Schäfer
D000465:Algorithms; D004621:Embolization, Therapeutic; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D015607:Stents
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