title: Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma.
abstract: OBJECTIVE
  To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery.
  
  
  METHODS
  Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008.
  
  
  RESULTS
  Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (± 20) days.
  
  
  CONCLUSIONS
  Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.
authors.affiliation: Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
authors.forename: Seong Yeob
authors.initials: SY
authors.lastname: Ryu
authors.forename: Dong Yi
authors.initials: DY
authors.lastname: Kim
authors.forename: Ho Kun
authors.initials: HK
authors.lastname: Kim
authors.forename: Mi Ran
authors.initials: MR
authors.lastname: Jeong
mesh_terms: D015992:Body Mass Index; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006489:Hemostatic Techniques; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*