Systematic review of delayed postoperative hemorrhage after pancreatic resection.

Details

Serval ID
serval:BIB_37EEC8A9730A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Systematic review of delayed postoperative hemorrhage after pancreatic resection.
Journal
Journal of gastrointestinal surgery
Author(s)
Roulin D., Cerantola Y., Demartines N., Schäfer M.
ISSN
1873-4626 (Electronic)
ISSN-L
1091-255X
Publication state
Published
Issued date
06/2011
Peer-reviewed
Oui
Volume
15
Number
6
Pages
1055-1062
Language
english
Notes
Publication types: Journal Article ; Review ; Systematic Review
Publication Status: ppublish
Abstract
This review assesses the presentation, management, and outcome of delayed postpancreatectomy hemorrhage (PPH) and suggests a novel algorithm as possible standard of care.
An electronic search of Medline and Embase databases from January 1990 to February 2010 was undertaken. A random-effect meta-analysis for success rate and mortality of laparotomy vs. interventional radiology after delayed PPH was performed.
Fifteen studies comprising of 248 patients with delayed PPH were included. Its incidence was of 3.3%. A sentinel bleed heralding a delayed PPH was observed in 45% of cases. Pancreatic leaks or intraabdominal abscesses were found in 62%. Interventional radiology was attempted in 41%, and laparotomy was undertaken in 49%. On meta-analysis comparing laparotomy vs. interventional radiology, no significant difference could be found in terms of complete hemostasis (76% vs. 80%; P = 0.35). A statistically significant difference favored interventional radiology vs. laparotomy in term of mortality (22% vs. 47%; P = 0.02).
Proper management of postoperative complications, such as pancreatic leak and intraabdominal abscess, minimizes the risk of delayed PPH. Sentinel bleeding needs to be thoroughly investigated. If a pseudoaneurysm is detected, it has to be treated by interventional angiography, in order to prevent a further delayed PPH. Early angiography and embolization or stenting is safe and should be the procedure of choice. Surgery remains a therapeutic option if no interventional radiology is available, or patients cannot be resuscitated for an interventional treatment.
Keywords
Algorithms, Embolization, Therapeutic, Humans, Pancreatectomy/adverse effects, Postoperative Hemorrhage/diagnosis, Postoperative Hemorrhage/etiology, Postoperative Hemorrhage/surgery, Postoperative Hemorrhage/therapy, Stents
Pubmed
Web of science
Open Access
Yes
Create date
13/05/2020 13:26
Last modification date
14/05/2020 5:26
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