Reoperation for post-hepatectomy hemorrhage: increased risk of mortality

Reoperation for post-hepatectomy hemorrhage (PHH) represents an important complication in patients undergoing liver resection. Yet, few studies have reported its presentation and patient outcomes of this event.

Among the 2,086 patients who underwent elective hepatectomy from 2000 to 2009 in our HPB unit, the perioperative data of 12 (0.6 %) patients who underwent re-laparotomy for PHH were retrospectively analyzed.

The diagnosis of PHH was established in all cases by the presence of blood in the drain. The mean interval time between the end of liver resection and the diagnosis of bleeding and reoperation were 17 h (1-43) and 38 h (1-93), respectively. The causes of bleeding were the hepatic vein branch (n = 4), liver cut surface (n = 3), and a hepatic artery branch (n = 2). In three cases, no bleeding spot was identified. Postoperative death occurred in 3 patients (25 %) between 15 and 18 days after re-laparotomy. These 3 patients were all cirrhotic; 2 underwent early re-laparotomy (≤6 h) and 1 underwent re-laparotomy 24 h after the first recognition of active bleeding.

Reoperation for PHH remains an important morbid event after liver resection. Death in patients with this complication is considerably high. It is diagnosed mainly on the aspect of the abdominal drain, justifying its use in risky patients.