Late Hemorrhage Research Articles

Impact of Antithrombotic Agents on Postpancreatectomy Hemorrhage: Results from a Retrospective Multicenter Study

This retrospective multicenter study aimed to evaluate the risk of postpancreatectomy hemorrhage (PPH) in patients receiving antithrombotic agents (ATAs). PPH is the most severe complication after pancreatectomy. However, there is little known about the strength of the association between ATA use, PPH, and other clinical outcomes. Between 2007 and 2016, 1,297 patients underwent pancreatectomy at 2 surgical centers. ATA use included aspirin, clopidogrel, ticlopidine, warfarin, direct oral anticoagulants, and intravenous unfractionated heparin. The ATA group was composed of 144 patients who were taking ATAs before surgery. A total of 35 patients developed PPH. The patients in the ATA group showed higher frequency (8.3% vs 2.0%, p < 0.001) of PPH compared with the control group (n= 1,153). In multivariate analysis, ATA use was an independent adverse risk factor for PPH (odds ratio [OR] 3.58, 95% CI 1.29-9.91, p= 0.014). Stratification by preoperative ATA therapy revealed a significant risk of PPH Grade C in patients receiving combined AT therapy. The median onset of late hemorrhage (>24 hours post-surgery) in the ATA group was later than in the control group (17.5 vs 8.5 days, p= 0.032), and the incidence tended to be higher in patients who restarted ATAs postoperatively. History of ATA use is a significant risk factor for PPH, and postoperative resumption of ATAs appears to be associated with an increased risk of PPH. Patients receiving combined antithrombotic therapy may be at particularly high risk for PPH.

Percutaneous dilatational tracheostomy for saturating influx of COVID-19 patients: Experience of military ENT physicians deployed in Mulhouse, France

ObjectivesThe main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination. Material and methodsA single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy. ResultsEighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage). ConclusionThis study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.

Management of late hemorrhage after pancreatic surgery: treatment strategy and prognosis.

ObjectivePostpancreatectomy hemorrhage is a life-threatening complication. Hemorrhage occurring >24 hours after the index operation is defined as late hemorrhage. This study was performed to analyze the therapeutic management and prognostic factors of late hemorrhage after pancreatectomy.MethodsWe identified 87 patients with late hemorrhage among 2031 patients who underwent pancreatic surgery from January 2013 to December 2017. The patients’ demographic characteristics, perioperative treatment, hemorrhage details, and prognosis were retrospectively analyzed.ResultsOf the 87 patients, 53 were men. Bleeding occurred at a mean of 8.9 ± 6.0 days postoperatively. Extraluminal and intraluminal hemorrhage occurred in 58 and 29 patients, respectively. The primary intervention was successful in 66 patients, and 16 patients required a secondary intervention. The primary and total recovery rates were 72.4% and 89.7%, respectively. Of the 87 patients, 9 died. Male sex, hemorrhage on a later postoperative day, a significantly decreased hemoglobin level, and pancreatic fistula showed statistical significance as possible risk factors for mortality.ConclusionsMale sex, hemorrhage on a later postoperative day, a significantly decreased hemoglobin level, and pancreatic fistula are possible risk factors for mortality in patients with late hemorrhage after pancreatectomy. Hemorrhage is a dynamic process, and a secondary intervention may be necessary.

Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: A systematic review and meta-analysis.

To evaluate the latest evidence concerning the efficacy of conbercept on vitrectomy for proliferative diabetic retinopathy (PDR) and its efficacy compared to control and other antivascular endothelial growth factor. We performed a systematic literature search on topics that assess the role of conbercept in patients undergoing vitrectomy for PDR from inception to November 2019, using PubMed, EuropePMC, Cochrane Central Database, ProQuest, ScienceDirect, and Clinicaltrials.gov. Two researchers independently searched literature, extracted data, and evaluated the risk of bias. RevMan 5.3 and StataMP 16 software were used to perform data analysis. There were 699 cases (eyes) from eight studies. Baseline best-corrected visual acuity (BCVA) was better in the control group compared to conbercept group (mean difference [MD]=0.13, I2 =0%). A greater BCVA improvement was observed in the conbercept group after 1-month (MD=-0.27, I2 =1%), 3-month (MD=-0.28, I2 =0%), and 6-month (MD=-0.20, I2 =78%) follow-up. The need for endodiathermy (odds ratio [OR]=0.20, I2 =0%) and silicone oil tamponade use (OR=0.59, I2 =72%) and intraoperative bleeding (OR=0.11, I2 =33%) was lower in conbercept group. Postoperative early (OR=0.22, I2 =0%) and late (OR=0.47, I2 =0%) vitreous hemorrhage was lower in conbercept group. There was no significant difference in BCVA improvement and intraoperative outcome between conbercept and ranibizumab. Intravitreal conbercept was associated with a more significant BCVA improvement, better intraoperative outcome, and less postoperative vitreous hemorrhage compared to no conbercept.

Abstract WP59: Cerebral Blood Flow Increase After Endovascular Thrombectomy on Perfusion Weighted Image is Associated With Hemorrhagic Transformation

Introduction: The role of increased CBF after endovascular thrombectomy in post-ischemic hyperperfusion has not been studied in detail. We aimed to investigate the timing of CBF increases on PWI after thrombectomy in association with hemorrhagic transformation. Methods: We analyzed prospectively collected data in consecutive patients treated with endovascular thrombectomy. Inclusion criteria were: (1) patients with ICA or M1 occlusion, and (2) PWI and GRE obtained within 12 hours and 12-48 hours after thrombectomy. We compared each rCBF with early hemorrhage (within 12 hours after thrombectomy), late hemorrhage (12-48 hour) and non-hemorrhage in basal ganglia (BG) and MCA cortical or subcortical (CS) region. In each PWI dataset, ROIs were placed in two slice levels of the BG and three slice levels of the CS region. Results: Fifty-three patients met inclusion criteria. Early BG hemorrhages were noted in 13 patients, with 4 late BG hemorrhage, 8 early CS hemorrhage and 3 late CS hemorrhage. There were no significant differences on rCBF in PWI within 12 hours after thrombectomy between early hemorrhage, late hemorrhage and non-hemorrhage groups. In contrast, rCBF on 12-48 hours PWI in the BG region was significantly higher in the early BG hemorrhage than non-BG hemorrhage (lower BG slice 1.36 vs 1.01, p&lt;0.001, upper BG slice 1.33 vs 0.96, p&lt;0.001) and rCBF in CS region were significantly higher in early CS hemorrhage than non-CS hemorrhage (lower CS slice 1.55 vs 0.98, p=0.001, middle CS slice 1.31 vs 0.92, p=0.018). There were no significant differences in rCBF on 12-48 hours PWI between the late hemorrhage and non-hemorrhage group. Conclusions: Most intracerebral hemorrhages after thrombectomy were seen within 12 hours after intervention. A rCBF increase in hemorrhage cases was not seen on PWI within 12 hours after thrombectomy. rCBF increases on PWI 12-48 hours after thrombectomy, however, was associated with post-thrombectomy hemorrhage within 12 hours.

Abstract TP410: Early Radiographic Recurrence or Extension Predicts Late Clinical Recurrence in Pediatric Acute Ischemic Stroke

Introduction: Pediatric AIS has a high recurrence rate of 10-25%. We observed a high rate of early radiographic recurrence or extension of stroke on repeat MRI performed within 2 weeks of index stroke and hypothesized that early radiographic extension of stroke or recurrent stroke would predict late clinical recurrence. Methods: IRB approved retrospective chart review of children ages 1 week to 18 years with AIS in our institutional pediatric stroke database who had repeat MRI within two weeks of initial acute presentation. We collected clinical and demographic data and reviewed f/u MRI studies for the presence of extension, new stroke, and hemorrhage. Results: 70 patients had early repeat MRI. 23 (33%) had early extension or new stroke on repeat MRI. Of these, 5 (21.7 %) had late clinical recurrence while only 1/47 (2.2%) who did not have early recurrence/extension went on to have late recurrence. 4/70 (5.7 %) had hemorrhagic conversion (only one was symptomatic -headache). Radiographic extension or new stroke on early repeat MRI was significantly associated with late recurrence (p=0.013). Using logistic regression, early extension/recurrence was found to be predictive of late recurrence, (OR 19.5, 95%CI 1.7-228). Conclusion: Children with AIS have a high rate of ongoing early, clinically silent, ischemic injury despite anticoagulation or antiplatelet therapy, which is associated with late clinical recurrence. This early imaging finding may serve as a biomarker that might prove useful as an endpoint in clinical trials comparing early antithrombotic therapies or to identify patients at higher risk of subsequent recurrent overt stroke who might benefit from intensified therapy. Given the high rate of early and late recurrence and low hemorrhage rates from current antithrombotic therapies, more aggressive therapy with dual antithrombotic agents should be investigated.

Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

ObjectiveTo evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta. MethodsThe clinical data of 623 patients with pernicious placenta previa combined with placenta accrete, who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed. All patients underwent abdominal aortic balloon occlusion combined with cesarean section, and 78 patients underwent sequential bilateral uterine artery embolization. We analyzed the operation time, intraoperative blood loss, blood transfusion volume, intraoperative and postoperative complications, fetal radiation exposure time and dose, and the Apgar score of the newborns. We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete. ResultsOf the 623 patients, 545 underwent only abdominal aortic balloon occlusion, and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding. The uterus was successfully preserved in all patients. Except for five cases of right lower extremity arterial thrombosis, the remaining patients did not have postoperative lower extremity arteriovenous thrombosis, renal insufficiency, late postpartum hemorrhage, ectopic embolism, spinal cord or peripheral nerve damage, pelvic infection, or other serious complications. The mean operative time was 65.3 (±14.5) min. The mean intraoperative blood loss was620 (±570) ml. Ninety-six patients (15.4%, 96/623) were treated with blood transfusion, and the average amount of blood transfused was 750 (±400) ml. The average number of hospitalization days was 6.8 (±3.4) days, the average time of fetal ray exposure was 5.2 (±1.6) s, and the average radiation dose was 4.1 (±2.7) mGy. The neonatal Apgar score, was 8.4 (±0.6) points at 1 ​min, and 9.6 (±0.4) points at 5 ​min. In the follow-up to May 31, 2019, 29 patients were lost to follow-up, 96 were lactating, and 498 were menstruating. Except for the cases lost to follow-up, the remaining 596 surviving newborns (including 2 twins) showed no abnormalities at the 42-day postnatal outpatient follow-up examination. ConclusionBalloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

Usefulness of dynamic computed tomography for diagnosing and evaluating uterine artery pseudoaneurysms in women with late post-partum hemorrhage not complicated by retained products of conception.

We examined whether critical conditions, which were defined as having hemoglobin (Hb) less than 7.0 g/dL, shock index ≥1.0, or need for transfusion, were associated with the presence of extravasation (EV) on dynamic computed tomography (CT) in women with late post-partum hemorrhage (PPH). Forty post-partum women with late PPH without evident retained products of conception performed dynamic CT. Two radiologists retrospectively evaluated dynamic CT, and determined the presence or absence of EV and a sac-like structure within the uterine cavity with enhancement. Ultrasound images were available in 34/40 patients. Color Doppler flow in uterine cavity was evaluated in 33/34 (97%), and all women showed abnormal flow. Of 40 patients, dynamic CT revealed EV in 8 (20%), and a sac-like structure in 30 (75%). Thus, we diagnosed these 38 (95%) as having uterine artery pseudoaneurysm (UAP). Uterine artery embolization was performed in 36/38 diagnosed as having UAP, and in 2/2 patients with an unknown cause of hemorrhage. The incidence rates of critical conditions were significantly increased in PPH women with than without EV on dynamic CT: Hb <7.0 g/dL (62.5 vs 0%, [P < 0.001]), shock index ≥1.0 (50 vs 9.4% [P = 0.020]), and need for transfusion (37.5 vs 0% [P = 0.006]). Abnormal color Doppler flows were observed in all patients with either EV and sac on dynamic CT. Dynamic CT was useful for diagnosing UAP, and for evaluating critical conditions, in women with late PPH not complicated by retained products of conception.

Early and late infratentorial haemorrhages sharing a common mechanism: Answer

Early and late infratentorial haemorrhages sharing a common mechanism: Answer

Early and late infratentorial haemorrhages sharing a common mechanism

Early and late infratentorial haemorrhages sharing a common mechanism

Evaluation of perinatal outcome in early and late pregnancy haemorrhage in tertiary care centre

Evaluation of perinatal outcome in early and late pregnancy haemorrhage in tertiary care centre

Image Recognition and Analysis of Intrauterine Residues Based on Deep Learning and Semi-Supervised Learning

Residual placenta is one of the common types of postpartum complications in clinical practice. Residual placenta is also the main and most common cause of late postpartum hemorrhage. This article proposes a spatial pyramid loop module, which solves the problem that the existing network structure cannot effectively extract the semantic information and category information in the image at the same time. The spatial pyramid structure is used to effectively extract the semantic information and category information. In addition, this article proposes to use cyclic convolutional network to realize the transfer function of information at different scales, and build it in the spatial pyramid structure to further strengthen the ability to extract semantic information and category information. This article proposes a feature fusion module to solve the impact of image classification network used in the base network in the existing network structure. The attention mechanism is used to achieve the effective fusion of high-dimensional features and low-dimensional features in the base network to reduce the influence of the base network, so as to better recover the recognition and prediction results. A semantic category loss function is proposed to supervise the categories of objects in images. This article builds it on the feature layer with the smallest scale, which not only increases the intermediate supervision to make the network fully converge, but also reduces the difficulty of extracting category information, and makes full use of the information transfer function of the cyclic convolutional network. This article introduces uncertainty information into the field of image segmentation to provide the accuracy of segmentation. For the purpose of uncertainty information, this article improves the network structure. At the same time for the image segmentation task, this article improves the Bayesian cross entropy loss function. The experiment verifies the necessity of improving the Bayesian crossover function in this article and the effectiveness of the conditional random field used in this article, and also verifies the effectiveness of the proposed semi-supervised learning method.

Dose-volume Histogram-based Predictors for Hematuria and Rectal Hemorrhage in Patients Receiving Radiotherapy After Radical Prostatectomy.

The aim of this study was to evaluate the dose-volume histogram parameters for late hematuria and rectal hemorrhage in patients receiving radiotherapy after radical prostatectomy. Data of 86 patients treated between January 2006 and June 2019 were retrospectively evaluated. The median radiation dose was 64 Gy in 32 fractions. Receiver operating characteristic (ROC) curves were used to identify optimal cut-off values for late adverse events. Eleven patients experienced hematuria, and the 5-year cumulative rate was 18%. Four patients experienced rectal hemorrhage, and the 5-year cumulative rate was 7%. ROC curve analysis demonstrated the following significant cut-off values: bladder V50 Gy: 43% (p=0.02) and V40 Gy: 50% (p=0.03) for hematuria, and rectum V60 Gy: 13% (p=0.04) and V50 Gy: 33% (p=0.03) for rectal hemorrhage. This is the first study to identify dose constraints that may reduce hematuria and rectal hemorrhage in patients receiving radiotherapy in the postoperative setting.

Evaluation of perinatal outcome in early and late pregnancy haemorrhage in tertiary care centre

Evaluation of perinatal outcome in early and late pregnancy haemorrhage in tertiary care centre

PREGNANCY WITH UTERINE MYOMA AND AFTER MYOMECTOMY: RESULTS OF THE COHORT STUDY

Objective - to identify risk factors, complications, and pregnancy outcomes in patients with uterine fibroid (myoma) and after myomectomy. Material and methods. Investigated 100 pregnancy and delivery stories, where 1st group consists of 40 patients with uterine myoma from 3 to 12 cm, 2nd group - 30 patients with a history of myomectomy, 3rd group - control of 30 patients. Results. The average age of patients from group 1 is 34.9 years, group 2 - 35.7 years. Both in group 1 and group 2 there is a large percentage of surgical interventions on the uterus: a history of abortion (35%/20%) and miscarriage (15%/36.6%). Significant sizes of fibroids contribute to incorrect fetal position - breech presentation (17.5%/3.3%), transverse (2.5%), oblique (2.5%). The presence of fibroids is associated with certain complications: the growth of the placenta in the myomatous node (5%), disorder of blood supplying and ischemic changes of the nodes during pregnancy (2.5%), late postpartum hemorrhage (2.5%), fetal distress (12.5%). Surgical delivery by Cesarean section (85%) is the method of choice for uterine myoma, based on a combination of another relative indications. Caesarean section in such patients is associated with an increase in the volume of surgical intervention, in the form of conservative myomectomy according to indications (58.8%), which may be a factor in pathological blood loss (2.5%). Pregnancy and delivery after myomectomy is accompanied by the occurrence of specific complications: scar failure after myomectomy, the threatening of uterine rupture in the scar (6.7%), adhesions in the pelvis III-IV degrees (16.7%).

Intracranial Hemorrhage in Childhood Acute Leukemia: Incidence, Characteristics, and Contributing Factors

BackgroundAmong all cancers, hematologic malignancy has the highest rate of intracranial hemorrhage. However, there are limited data on intracranial hemorrhage in childhood acute leukemia. We aimed to determine the incidence, characteristics, and factors associated with intracranial hemorrhage in children with acute leukemia. MethodsWe reviewed a database of patients aged one month to 15 years diagnosed with acute leukemia during 2003 to 2016 at a hospital in Thailand. Characteristics of patients with intracranial hemorrhage were compared with those of patients without intracranial hemorrhage. Multiple logistic regression was used to determine the associated factors. We performed survival analyses to compare survival and hazard ratios between groups. ResultsThere were 494 children with acute leukemia (acute lymphoblastic leukemia 367, acute myelogenous leukemia 127). Median age was 4.9 years (interquartile range 3.0 to 9.2). Follow-up duration was 2.1 years. Intracranial hemorrhage occurred in 12 patients whose median age was 12.5 years (interquartile range 7.5 to 13.3). Incidence rate of intracranial hemorrhage was 6.2 (acute lymphoblastic leukemia 5.1, acute myelogenous leukemia 12.9) per 1000 person-years. Case fatality rate of intracranial hemorrhage was 75%. Patients with early intracranial hemorrhage had prolonged international normalized ratio and higher white blood cell count, whereas patients with late intracranial hemorrhage had more concurrent systemic infections. Most cases of intracranial hemorrhage were intraparenchymal with perihematomal edema. Median survival was 24 days in the intracranial hemorrhage group compared with four years in the non-intracranial hemorrhage group. Risk of death from intracranial hemorrhage was 3.2 times higher than that of the non-intracranial hemorrhage group. Age at diagnosis, initial white blood cell count, and lactate dehydrogenase were associated with increased risk of intracranial hemorrhage. ConclusionsIntracranial hemorrhage was common and often fatal in children with acute leukemia. Potential contributing factors differed by intracranial hemorrhage timing. Older age, white blood cell count, and lactate dehydrogenase were associated with high risk of intracranial hemorrhage.

Therapeutic value of endoscopic submucosal dissection for early colorectal cancers and precancerous colorectal lesions of different diameters

Objective To study the differences of endoscopic submucosal dissection (ESD) for colorectal tumors of different diameters. Methods Data of 210 cases which were treated with ESD for colorectal tumors at the Endoscopy Center, the Seventh Medical Center of PLA General Hospital from October 2012 to December 2015 were retrospectively analyzed. The lesions were divided into two groups according to different diameters (≥4.0 cm group and <4.0 cm group) for comparative analysis of related factors. Results The mean procedure time of ESD for 210 colorectal tumor cases was 50.3±42.7 min and the mean size of lesions was 7.98±10.84 cm2 . En bloc resection rate was 91.4%, R0 resection rate was 90.5%, and the curative resection rate was 88.6%. Perforation rate was 5.2% (11/210), and the late hemorrhage rate was 0.5% (1/210). Compared with lesions < 4.0 cm, those ≥ 4.0 cm required longer resection time (79.63±53.91 min VS 35.28±24.99 min, P<0.001); and the lesions were mainly located in the rectum (61.97%). LSTs were mainly mixed granular/nongranular type (54.93%); en bloc resection rate, complete resection rate and curative resection rate of the tumors ≥ 4.0 cm were all lower than those of tumors < 4.0 cm. The difference in complete resection rate was statistically significant (85.92% VS 94.24%; P=0.041). The perforation rate (7.04%) was higher in ≥ 4.0 cm group, but the difference was not statistically significant. Conclusions ESD of colorectal tumors of diameters ≥ 4.0 cm requires longer time with higher operation risk. Additionally, physicians should be more careful with non-rectal lesions. Key words: Colorectal cancer; Endoscopic submucosal dissection; Tumor diameter; Difference

Transcatheter Arterial Embolization for Late Postpancreatectomy Hemorrhage of Unusual Origin (Dorsal Pancreatic Artery): A Report of Three Cases

: Postpancreatectomy hemorrhage (PPH) is a rare but serious complication that can lead to death. Although the best treatment option for PPH remains controversial, transcatheter arterial embolization (TAE) has recently been introduced as a treatment with safety and efficacy, showing low morbidity and mortality, especially in late PPH (> 24 h after surgery). The most common location for PPH is the gastroduodenal artery stump; however, hemorrhage may occur from unusual sources, such as the dorsal pancreatic artery (DPA), which is often difficult to detect on angiography. Herein, the authors report three cases of delayed PPH from the DPA, occurring after a Frey procedure in one case and after pylorus-preserving pancreaticoduodenectomy in the other two. All patients were successfully treated using TAE. Although the involved artery was not identified on the first angiography in two patients, rebleeding was successfully managed by repeated endovascular procedures. Therefore, a careful and repetitive approach, based on awareness of the various causes of PPH, could increase the success rate of TAE.

Curation of late severe postoperative hemorrhage in a patient with a pancreatic fistula of class C

Curation of late severe postoperative hemorrhage in a patient with a pancreatic fistula of class C

Prevention and treatment of the hemorrhage after pancrea-ticoduodenectomy

Pancreaticoduodenectomy (PD) is a standard surgical method for periampullary cancer. The hemorrhage is a dangerous complication after PD, how to effectively prevent and treat hemorrhage is a difficult point of pancreatic surgery, and also a key for reducing postoperative mortality. Four famous experts and their teams in surgical field explored prevention and treatment of the hemorrhage after PD from different angles based on clinical experiences. Professor Shen Boyong has conducted a discussion on early and late hemorrhage after PD combined with previous successful experiences and prospective research data. Professor Chen Yajin suggested preventing hemorrhage in the aspects of anatomical resection, anastomosis and reconstruction, peritoneal drainage-tube placement and postoperative management based on different causes of hemorrhage. Professor Peng Bing paid attention to hemorrhage after laparoscopic PD, and supposed that intraoperative careful hemostasis, precise anastomosis, reasonable peritoneal drainage-tube placement and optimal perioperative management can reduce incidences of postoperative pancreatic fistula, biliary fistula and intra-abdominal infection, thereby lowering the incidence of hemorrhage. Professor Tan Guang respectively proposed processing strategies of hemorrhage for grading A (mild at early stage), B (severe at early stage and mild at late stage) and C (severe at late stage). Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Laparoscopy; Digestive tract reconstruction; Complications; Hemorrhage; Prevention