title: [Symptoms, Diagnostics, Treatment and Classification of 22 Patients with Postpancreatectomy Haemorrhage (PPH) in a Series of 400 Consecutive Pancreatic Head Resections and Pancreatectomies].
abstract: Introduction:Postpancreatectomy haemorrhage (PPH) is a dangerous complication after pancreatic resection.Patients and Methods:From 2006 to 2015, 400 consecutive pancreatic head resections and pancreatectomies were performed and prospectively documented. This study analysed incidence, treatment and outcome of patients with PPH.Results:Incidence of PPH was 5.5 % (n = 22). PPH occurred in a median of eight days after pancreatic surgery with an equal frequency of symptoms being caused by gastrointestinal bleeding (n = 11) and abdominal bleeding (n = 11). Postoperative pancreatic fistulas (POPF) were significantly more frequent in case of PPH (45 % POPF in case of PPH vs. 20 % POPF in case of no PPH, p < 0.01). PPH was more frequent after pancreatogastrostomy (8/70; 11 %) than after pancreatojejunostomy (11/281; 4 %; p = 0.01). The majority of bleedings after pancreatogastrostomy came from the intragastric cut surface of the pancreas. During the first week, relaparotomy was significantly more frequent (n = 5; 56 %) than in late PPH (n = 1; 8 %; p = 0.01). In late PPH, interventions (angiography; n = 7, endoscopy; n = 4) were more frequent. In 16 severe cases, surgical/interventional bleeding control (n = 12) or relevant transfusions of more than 3 units of packed red blood cells (n = 4) were performed. Compared with the whole group, mortality was significantly increased in case of PPH (13.6 % in case of PPH vs. 3.7 % in case of no PPH; p = 0.03).Conclusion:PPH is an episodic and potentially life-threatening complication with an increased mortality rate, which is frequently associated with impaired healing of the pancreatic anastomosis. Diagnostic investigation and treatment of PPH requires an experienced surgical centre with a close cooperation with endoscopy and (interventional) radiology.
authors: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors: H
authors: H
authors: Riediger
authors: Institut für Radiologie und Interventionelle Therapie, Humboldt-Klinikum, Berlin, Deutschland.
authors: K
authors: K
authors: Krüger
authors: Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland.
authors: F
authors: F
authors: Makowiec
authors: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors: U
authors: U
authors: Adam
authors: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors: C M
authors: CM
authors: Krueger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult