Systematic review of delayed postoperative hemorrhage after pancreatic resection.

Détails

Ressource 1Télécharger: serval:BIB_CCEF1F0BD65F.P001 (368.07 [Ko])
Etat: Public
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ID Serval
serval:BIB_CCEF1F0BD65F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Systematic review of delayed postoperative hemorrhage after pancreatic resection.
Périodique
Journal of Gastrointestinal Surgery
Auteur(s)
Roulin D., Cerantola Y., Demartines N., Schäfer M.
ISSN
1873-4626 (Electronic)
ISSN-L
1091-255X
Statut éditorial
Publié
Date de publication
2011
Volume
15
Numéro
6
Pages
1055-1062
Langue
anglais
Résumé
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.
Pubmed
Web of science
Open Access
Oui
Création de la notice
25/05/2011 9:46
Dernière modification de la notice
13/05/2020 14:23
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