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

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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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Authors and Affiliations

  1. Department of HBP Surgery, Edouard Herriot hospital, HCL, Lyon Faculty of Medicine, UCBL1, 5 Place d’Arsonval, 69437, Lyon, Cedex 03, France

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

Authors
  1. B. Darnis
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  2. R. Lebeau
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  3. X. Chopin-Laly
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  4. M. Adham
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Corresponding author

Correspondence to M. Adham.

Additional information

This paper was based on a previous communication at UEGW congress in 2011 (Poster session, Tuesday, October the 25, 2011: Post-pancreatectomy haemorrhage (PPH), a five year single center experience by B Darnis, R Lebeau, P Rivier, X Chopin-Laly, and M Adham).

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Darnis, B., Lebeau, R., Chopin-Laly, X. et al. Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Langenbecks Arch Surg 398, 441–448 (2013). https://doi.org/10.1007/s00423-013-1047-8

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  • DOI: https://doi.org/10.1007/s00423-013-1047-8

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