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Langenbeck's Archives of Surgery

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01-03-2013 | Original Article

Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database

Authors: B. Darnis, R. Lebeau, X. Chopin-Laly, M. Adham

Published in: Langenbeck's Archives of Surgery | Issue 3/2013

Abstract

Background

Postpancreatectomy hemorrhage (PPH) is a dreaded complication in pancreatic surgery. Today, there is a definition and grading of PPH without therapeutic consensus. We reviewed our prospective database to identify predictors and assess therapeutic strategy.

Method

We included all patients who underwent pancreatectomy between 2005 and 2010. Data were collected prospectively. We used the International Study Group Of Pancreatic Surgery (ISGPS) definition for PPH to include patients in the PPH group.

Results

Forty-six of 285 patients showed a PPH (16.1 %). The ISGPS classification was graded A = 3, B = 26, and C = 17. The average time to the onset of PPH was 7 days. CT-scan identified the origin of PPH in 43.5 % of the cases. PPH was responsible for a longer duration of hospital stay (p = 0.004), a higher hospital mortality (21.7 vs 2.5 %, p < 0.0001) and a lower survival (40 vs 70 % (p = 0.05) at 36 months). The first-intention treatment of PPH was conservative in 32 % and interventional in 68 %: endoscopy (6.4 %), transcatheter arterial embolization (TAE, 30.4 %), and surgical (30.4 %). In multivariate analysis, predictors of PPH were: pancreatic fistula (24 vs 8 % p = 0.028), pancreatoduodenectomy (70 vs 43 % p = 0.029), age (61.6 vs 58.8 %, p = 0.03), and nutritional risk index (NRI) (p = 0.048).

Conclusion

In our series, risk factors for PPH were age, pancreatic fistula, pancreatoduodenectomy, and NRI. Its occurrence is associated with significantly higher hospital mortality and a lower survival rate. Our first-line treatment was radiological TAE. Surgical treatment is offered in case of failure of interventional radiology or in case of uncontrolled hemodynamic.

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Title: Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database
Authors: B. Darnis
R. Lebeau
X. Chopin-Laly
M. Adham
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 3/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1047-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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