HEMORRHAGE AFTER PANCREATICODUODENECTOMY

Objective The authors reviewed the hemorrhagic complications of patien ts who underwent pancreatoduodenectomies between 1972 and 1996. Summar y Background Data Although recent studies have demonstrated a reductio n in the mortality of pancreatic resection, morbidity is still high. B leeding is a close second to anastomotic dehiscence in the list of dan gerous postoperative complications. Methods The medical records from a prospective data bank of 559 patients who underwent pancreatic resect ion at the Surgical Clinic of Mannheim (Heidelberg University) were an alyzed in regard to postoperative hemorrhagic complications. Differenc es were evaluated with the Fisher exact test. Results The overall mort ality rate was 2.7%. Postoperative bleeding occurred in 42 patients (7 .5%), with 6 episodes ending fatally (14.3%). Erosive bleeding after p ancreatic leak was noted in 11 patients (26.2%), 4 of whom died. Gastr ointestinal hemorrhage occurred in 22 patients, and operative field he morrhage was present in 20 cases. Relaparotomy was necessary in 29 pat ients. An angiography with interventional embolization for recurrent b leeding was performed in three patients. Seven hemorrhages (4.6%) occu rred after pancreatectomy for chronic pancreatitis and 35 episodes of bleeding (8.6%) were encountered after pancreatectomy for malignant di sease. Obstructive jaundice was present in 359 patients (63.9%). In th is group of patients, 32 (8.9%) postoperative hemorrhages occurred. Pr eoperative biliary drainage did not influence the type and mortality r ate of postoperative hemorrhage in jaundiced patients. Conclusion The prevention of these bleeding complications depends in the first place on meticulous hemostatic technique. Preoperative biliary drainage does not lower postoperative bleeding complications in jaundiced patients. Continuous, close observation of the patient in the postoperative per iod, so as to detect complications in time, and expeditious hemostasis are paramount.