Characterization and Management of Postoperative Hemorrhage Following Upper Retroperitoneal Laparoscopic Surgery

Abstract

Surgical paradigms may change in the era of laparoscopic surgery. We evaluated a conservative nonsurgical approach to postoperative hemorrhage following laparoscopic upper retroperitoneal surgery as opposed to the more traditional strategy of reexploring the surgical site. In 911 laparoscopic procedures performed in 8 years we retrospectively identified risk factors and characterized treatment for postoperative hemorrhage. We considered postoperative hemorrhage to be present when postoperative transfusion was required that could not be accounted for by operative blood loss or another definable cause outside of the surgical field. Red blood cell transfusion was required after 53 procedures (5.8%), of which 34 (3.7%) were done for postoperative hemorrhage. Postoperative hemorrhage occurred only after nephrectomy in 3.3% of cases, after partial nephrectomy in 9.9% and after adrenalectomy in 5.4%. Multivariate analysis revealed a significant association of postoperative hemorrhage with patient age and American Society of Anesthesiologists score (preoperative factors), operative time and splenic injury (intraoperative factors), and gastrointestinal complications and prolonged hospitalization (postoperative factors). Postoperative hemorrhage increased mean hospitalization from 2.5 to 6.4 days. No significant differences in post-hospital recovery were associated with postoperative hemorrhage. Only 4 of the 34 patients (12%) required surgical management of postoperative hemorrhage. All other cases were conservatively managed. Outcome after surgical and conservative management did not differ except postoperative renal complications tended to be more common in the former cases (50% vs 7%). Most patients with hemorrhage following laparoscopic upper retroperitoneal surgery can be treated with conservative nonsurgical interventions.