Outcome of Post Pancreatectomy haemorrhage following pancreatecodudodenectomy at Tribhuvan University Teaching Hospital

Abstract

Introduction: Post Pancreatectomy hemorrhage (PPH) is a life-threatening complication following pancreatic resection. Method: This study analyzes the rate, management, and outcomes of PPH over 14-year period. Patients who developed PPH following PDs between 2004 and 2018 were identified from a prospective database. Postpancreatectomy hemorrhage was defined and categorized according to ISGPS 2007 definition. Demographics, operative and perioperative outcomes were analyzed using standard descriptive statistics. Result: Total number PDs in this period was 274. There were total 37(13.5%) cases who had PPH. Most of the time PPH was associated with POPF (78.3%, 29 of 37). Grade A, B and C PPH was present in 16.3%,40.5%,43.2% patients respectively. Of which 37.8% had intraluminal bleed and 62.2% had extra luminal bleed. Reexploration was done in 40.5%(15 of 37), Radiological intervention was done in 13.5%(5 of 37) and conservatively managed in 45.9% (17 of 37). There were total 13(35.1%)mortalities. Final diagnosis of most of the PPH patients was Ampullary carcinoma (78.3%, 29 of 34). On comparing the first decade and the time following the commencement of PDs at our centre, the incidence of PPH seems to be almost similar but mortality has decreased from 58.8% to 15.1%. This can be attributed to the increased experience of PDs, improvement of Post operative and critical care and a good support from Interventional Radiology. Conclusion: PPH although a less common complication than POPF, it carries a high mortality. Early Recognition and timely intervention can bring down mortality rates.