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Published on: May 5, 2023

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Incidence and Contemporary Management of Delayed Bleeding Following Pancreaticoduodenectomy

Joseph R Habib1, Shanshan Gao1, Ahn Joon Young2

  • 1Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.

World Journal of Surgery
|January 27, 2022
PubMed

Insights

Delayed bleeding after pancreaticoduodenectomy (PD) is a serious complication. Angiography is recommended for urgent bleeding, with surgery reserved for unstable patients or treatment failure.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Hepatobiliary Surgery

Background:

  • Delayed bleeding post-pancreaticoduodenectomy (PD) is a critical complication with unclear optimal management.
  • This study reviews institutional experience to define outcomes of different management strategies for post-PD bleeding.

Purpose of the Study:

  • To summarize the management and outcomes of delayed bleeding after pancreaticoduodenectomy.
  • To identify trends and factors influencing mortality in these patients.

Main Methods:

  • Retrospective review of 6201 patients undergoing PD between 1987 and 2020.
  • Delayed bleeding defined as occurring on or after postoperative day 5.
  • Analysis of bleeding patterns, causes, management approaches, and outcomes.

Main Results:

  • 130 patients (2.1%) experienced delayed bleeding, most commonly intraluminal (51.5%).
  • Gastroduodenal artery pseudoaneurysm was the most frequent cause (18.5%).
  • Overall mortality was 16.2% but decreased over time; angiography was a common first-line approach (52.3%).

Conclusions:

  • Delayed bleeding post-PD is a life-threatening event, often originating from the gastroduodenal artery.
  • Angiography with embolization is the preferred initial approach for urgent bleeding.
  • Surgical re-exploration is reserved for hemodynamically unstable patients or treatment failure.
Abstract

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