Hemorrhage After Pancreatectomy Over the Past 5 Years

Hiroyuki Sugimoto, Tetsuya Kaneko, Shin Takeda, Soichiro Inoue and Akimasa Nakao

Department of Surgery II, Nagoya University School of Medicine

Although postpancreatectomic complications have decreased due to improved surgical technique and perioperative care, intraabdominal hemorrhage caused by anastomotic leakage or pancreatic fistula remains a potentially lethal complication. Several types of pancreatectomy have been done in benign pancreatic disease, but with the same complications. Patients and Methods: We analyzed hemorrhage characteristics and postpancreatectomy management. Between January 1996 and December 2000, of 90 patients undergoing pancreatectomy at our hospital, 6 (6.7%) suffered intraabdominal hemorrhages and 2 recurrent hemorrhage. Diseases involving hemorhage were 1 pancreatic cancer, 1 common bile duct cancer, 3 intraductal papillary mucinous tumors, and 1 of pancreatitis. Results: Hemorrhage was more frequent in benign disease than in malignancies, of though not statistically significant (p=0.0555). Surgery involved pancreatoduodenectomy in 2 cases, pylorus-preserving pancreatoduodenectomy in 1, and segmental resection (SR) in 3, so hemorrhage was significantly more frequent in SR than in any other operation (p=0.0367). No significant differences were seen in reconstruction or in anastomosis technique, or between cases with or without leakage among the 90 cases (p=0.0787). Delayed hemorrhage was significantly more frequent in anastomotic leakage (p=0.0462). Hemorrhage was managed by 6 laparotomies in 5 patients and transcatheter arterial embolization in 2 cases, all with favorable outcomes. Conclusion: Hemorrhage after pancreatectomy was significantly more frequent in segmental resection. Although the outocome after hemorrhage in laparotomy patients had not been good, a good outcome is now possible in hemorrhage after pancreatectomy whom hemostasis is induced immediately.

Key words
hemorrhage, leakage, complication, pancreatectomy

Reprint requests
Hiroyuki Sugimoto Department of Surgery II, Nagoya University School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
November 27, 2001

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