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Updated: Jun 25, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy
Laura Beyer1, Rémi Bonmardion, Sandrine Marciano
1Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord and Université de la Méditerranée, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
Insights
Delayed hemorrhage after pancreaticoduodenectomy is a serious complication. Conservative management, including embolization or covered stents, proved successful in all cases, offering a viable treatment option.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Vascular Surgery
Background:
- Hemorrhage is a significant complication following pancreaticoduodenectomy, occurring in 4-16% of patients.
- Established management guidelines for post-pancreaticoduodenectomy hemorrhage are lacking.
- This study investigates conservative management for delayed hemorrhage.
Purpose of the Study:
- To evaluate the efficacy of conservative management for delayed hemorrhage after pancreaticoduodenectomy.
- To establish potential management guidelines for this critical complication.
Main Methods:
- Retrospective review of 87 patients undergoing pancreaticoduodenectomy from January 2005 to August 2008.
- Analysis of medical charts for patients experiencing postoperative hemorrhage.
- Initial management included urgent contrast-enhanced computed tomography (CT) for all patients.
Main Results:
- Nine patients (10.3%) experienced delayed hemorrhage, with a mean onset of 20 days post-surgery.
- All bleeding sites were identified as arterial.
- Conservative treatment (embolization or covered stent) was successful in all nine patients.
- Two patients required reoperation for gastrointestinal perforation post-embolization.
- All patients survived the complication.
Conclusions:
- Conservative management, integrating endovascular procedures and aggressive resuscitation, is effective for delayed hemorrhage post-pancreaticoduodenectomy.
- Endovascular techniques offer a successful alternative to surgery in managing arterial bleeding.
- This approach can improve outcomes and survival rates for patients experiencing this complication.
Introduction:
Hemorrhage after pancreaticoduodenectomy is a life-threatening complication, which occurs in 4% to 16% of cases, even in experienced centers. Many diagnostic and therapeutic options exist but no one has yet established management guidelines. This study aimed to determine the role of conservative management in delayed hemorrhage.
Patients And Methods:
From January 2005 to August 2008, 87 patients underwent pancreaticoduodenectomy at our center. We reviewed, retrospectively, the medical charts of all patients who had experienced postoperative hemorrhage.
Results And Discussion:
Early hemorrhage occurred in one patient, who underwent successful reoperation. Nine patients presented with delayed hemorrhage (10.3%), including three with sentinel bleeding. Mean onset was 20 days post-surgery. We used the same initial management for each patient: all had an urgent contrast computed tomography scan. In every case, the bleeding site was arterial. Conservative treatment (embolization or covered stent) was successful in every case. We reoperated on two patients for gastrointestinal perforation, at 9 days and 2 months after embolization, respectively. We transferred seven patients to an intensive care unit, with an average stay of 8 days. Mean hospital stay was 43 days (33-60). All patients survived.
Conclusion:
Conservative management, combining endovascular procedures and aggressive resuscitation, is appropriate for most cases of delayed hemorrhage after pancreaticoduodenectomy.
