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

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092912
Author(s):  
Xin Wu ◽  
Ge Chen ◽  
Wenming Wu ◽  
Taiping Zhang ◽  
Quan Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Statistical Significance ◽  
Hemoglobin Level ◽  
Secondary Intervention ◽  
Total Recovery ◽  
Postpancreatectomy Hemorrhage ◽  
Life Threatening ◽  
Male Sex

Objective Postpancreatectomy 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. Methods We 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. Results Of 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. Conclusions Male 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.

scholarly journals Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome

2016 ◽  
Vol 106 (1) ◽  
pp. 47-53 ◽  
Author(s):  
D. Ansari ◽  
B. Tingstedt ◽  
G. Lindell ◽  
I. Keussen ◽  
D. Ansari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Tertiary Care ◽  
Bile Leakage ◽  
Postoperative Pancreatic Fistula ◽  
Warning Sign ◽  
Postpancreatectomy Hemorrhage ◽  
Delayed Hemorrhage ◽  
Incidence Risk

Background and Aims: 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 in a tertiary care center. Materials and Methods: A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria. Results: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy. Conclusion: Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

2018 ◽  
Vol 68 (12) ◽  
pp. 2875-2878
Author(s):  
Delia Rusu Andriesi ◽  
Ana Maria Trofin ◽  
Irene Alexandra Cianga Spiridon ◽  
Corina Lupascu Ursulescu ◽  
Cristian Lupascu
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Postoperative Pancreatic Fistula ◽  
University Center ◽  
Preoperative Hemoglobin ◽  
Term Administration ◽  
Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

Neuroendocrine Pancreatic Tumors Are Risk Factors for Pancreatic Fistula after Pancreatic Surgery

2011 ◽  
Vol 28 (4) ◽  
pp. 263-269 ◽  
Author(s):  
Volker Fendrich ◽  
Marianne K. Merz ◽  
Jens Waldmann ◽  
Peter Langer ◽  
Anna E. Heverhagen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Pancreatic Tumors ◽  
Neuroendocrine Pancreatic Tumors

Risk Factors for Life-threatening Grade C Postoperative Pancreatic Fistula After Pancreatoduodenectomy Compared to Grade B

2019 ◽  
Vol 39 (4) ◽  
pp. 2199-2205 ◽  
Author(s):  
NAOKAZU CHIBA ◽  
SHIGETO OCHIAI ◽  
KEI YOKOZUKA ◽  
TAKAHIRO GUNJI ◽  
TORU SANO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Life Threatening

International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center

2017 ◽  
Vol 106 (3) ◽  
pp. 216-223 ◽  
Author(s):  
N. Dusch ◽  
A. Lietzmann ◽  
F. Barthels ◽  
M. Niedergethmann ◽  
F. Rückert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Delayed Gastric Emptying ◽  
International Study ◽  
Postoperative Pancreatic Fistula ◽  
Study Group ◽  
Postpancreatectomy Hemorrhage ◽  
International Study Group

Introduction: The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. Methods: Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann–Whitney U-test. Student’s t-tests and Fisher’s exact tests were performed. Results: A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay. Conclusion: Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.

Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors

2009 ◽  
Vol 197 (6) ◽  
pp. 702-709 ◽  
Author(s):  
David Fuks ◽  
Guillaume Piessen ◽  
Emmanuel Huet ◽  
Marion Tavernier ◽  
Philippe Zerbib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Life Threatening

Pulmonary Hypertension: A Common Complication in Thalassemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3612-3612
Author(s):  
Elliott P. Vichinsky ◽  
Claudia R. Morris ◽  
Ward Hagar ◽  
Jennifer Gardner ◽  
Sylvia Titi Singer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Cardiac Function ◽  
High Mortality ◽  
Ferritin Level ◽  
Statistical Significance ◽  
Hemoglobin Level ◽  
Common Complication ◽  
Iron Stores ◽  
Jet Velocity

Abstract Pulmonary hypertension (PHT) is a complication that is associated with high mortality rate. It is increasingly recognized in thalassemia intermedia (TI) as a leading factor in heart failure and death. Undetected PHT has been reported in 60–75% of patients. Data on PHT and thalassemia major is limited. However, these patients have many risk factors for PHT, including splenectomy, red cell phosphatidylserine exposure, coagulation abnormalities and iron overload. Since chronic hemolysis continues despite transfusion, these patients are also at risk for hemolysis-associated PHT. This is a recently described syndrome where free hemoglobin scavenges nitrous oxide and catalyzes the formation of reactive oxygen species. The purpose of this study is to determine the prevalence of PHT in transfused thalassemia patients and its risk factors. We compared the echocardiogram of 28 patients with their transfusion history, iron stores, chest x-ray, age, hemoglobin level, splenectomy status and cardiac function. The prevalence of PHT in this population was 57%. Sixteen of the 28 patients had a tricuspid regurgitant jet velocity ≥2.5 m/s, indicating PHT. 5 patients had a jet velocity ≥ 2.9 m/s suggestive of moderate PHT. Patients with PHT were more likely to be older (29±10 vs. 24±7 years without PHT, r=0.52, p=0.01) and male (56%). 41% of the female patients undergoing echocardiogram exam had PHT, while 82% of the men screened had PHT (p=0.03). PHT was also inversely related to ferritin level (r=−0.46, p=0.02). A history of an abnormal CXR occurred more frequently in the PHT group (38% vs. 8%, p=0.08), but did not reach statistical significance. However, there was no difference in hemoglobin level, creatinine, splenectomy rate (63% vs. 58%) or abnormal cardiac function between patients with PHT vs. those without PHT. Two of the 16 patients with PHT have initiated therapy with hypertransfusion or sildenafil. An intermittently transfused 25-year-old female patient lowered the tricuspid jet velocity from 3.2 to 2.4 m/s following hypertransfusion program. The second patient, a 44-year-old chronically transfused female, lowered her tricuspid jet velocity from 3 to 2.3 m/s within one month of sildenafil therapy. In conclusion, PHT is a common complication in transfused thalassemia patients that is under recognized and under treated. In contrast to other complications, adequate chelation and low iron stores are not protective. Since secondary PHT is associated with a high mortality and morbidity, annual screening with echocardiogram for all thalassemia patients is recommended. Early identification of PHT and its risk factors may prevent the irreversible cardiomyopathy that may develop. Prospective studies evaluating therapies, including hypertransfusion, sildenafil and arginine are needed.

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