Impaired Pancreatic Drainage as a Potential Key Mechanism in Postpancreatectomy Hemorrhage: A Retrospective Cohort...

Postoperative pancreatic fistula (POPF) is recognized as the main cause of postpancreatectomy hemorrhage (PPH). This study investigated the correlation between POPF and PPH after pancreatoduodenectomy (PD).

We retrospectively analyzed PDs at our center from January 2005 to December 2023. We documented patient characteristics, surgical factors, and outcomes and did a multivariate analysis of PPH.

Among 659 PD patients, the overall PPH incidence was 9.3% (n = 62), with 85.5% having late PPH. The PPH group had higher POPF rates, especially Grade B/C POPF. The PPH group also had higher postoperative pancreatic fluid accumulation on day 5 and a higher incidence of sustained peak amylase levels in the drainage fluid. Multivariate analysis showed intraoperative blood loss >1,000 mL, clinically relevant - POPF, and postoperative intra - abdominal infection as independent risk factors for late PPH.

Grade B/C POPF, significant intraoperative blood loss, and postoperative intra - abdominal infection are independently associated with late PPH. POPF may not be the only cause of PPH. Our findings suggest impaired pancreatic drainage may contribute to PPH, but this needs prospective validation.