Abstract
Background A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed. Methods Between 2002-2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 902-908 |
| Number of pages | 7 |
| Journal | HPB |
| Volume | 17 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2015 |
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ASJC Scopus subject areas
- Hepatology
- Gastroenterology
Cite this
Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques. / Asai, Kengo; Zaydfudim, Victor; Truty, Mark; Reid-Lombardo, Kmarie; Kendrick, Michael; Que, Florencia; Nagorney, David; Andrews, James; Farnell, Michael.
In: HPB, Vol. 17, No. 10, 01.10.2015, p. 902-908.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques
AU - Asai, Kengo
AU - Zaydfudim, Victor
AU - Truty, Mark
AU - Reid-Lombardo, Kmarie
AU - Kendrick, Michael
AU - Que, Florencia
AU - Nagorney, David
AU - Andrews, James
AU - Farnell, Michael
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed. Methods Between 2002-2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem.
AB - Background A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed. Methods Between 2002-2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem.
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U2 - 10.1111/hpb.12464
DO - 10.1111/hpb.12464
M3 - Article
VL - 17
SP - 902
EP - 908
JO - HPB
JF - HPB
SN - 1365-182X
IS - 10
ER -