Hemorrhage after major pancreatic resection: incidence, risk factors, management, and outcome

Abstract

Introduction: Hemorrhage is a rare, but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage (PPH) in a tertiary care center. Methods: A total of 414 patients underwent major pancreatic resections at our institution. PPH was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. Results: Some 47 patients (11.4%) developed PPH. Operative duration and postoperative pancreatic fistula (POPF) Grades B and C were significantly associated with severe PPH on multivariable logistic regression. Most patients with PPH Grade C (14 of 15 patients; 93.3%) presented with late hemorrhage (>24 hours). Nine patients (60%) had sentinel bleeds. Angiographic coiling/stenting was performed in 7 patients. Relaparotomy was undertaken in 6 patients. The mortality rate among patients with PPH Grade C was 2/15 (13.3%), and both fatalities occurred late as a consequence of eroded vessels in association with the pancreaticogastrostomy. Conclusion: Severe hemorrhagic complications after major pancreatic surgery usually occur late in the postoperative course. Sentinel bleed is an early warning sign. POPF is the most important risk factor for severe PPH and future strategies to reduce the incidence of POPF might also affect the incidence of bleeding episodes.