Bleeding complication after pancreatic surgery: role of harmonic scalpel

Abstract

In this modern era of technological advancements, though many centers are contemplating complex surgical procedures on the pancreas, morbidity is still high and around 30-35 %. Post-operative bleeding complications are the most worrisome of all, which need vigilance by the operating team. Early recognition and prompt management using endoscopy, intervention radiology or urgent surgery, with a low threshold for relaparotomy is needed to avoid mortality. After successfully completing more than 500 Whipple's operations and over 300 Frey's procedures in the last 10 years, our bleeding complication, which is around 2 %, has substantially increased. This increase over the last couple of years is seen with usage of harmonic scalpel in pancreatic surgery. Here we report our recent encounter with bleeding in the post-operative period after Whipple's pancreaticoduodenectomy and Frey's procedure, where harmonic scalpel was used. We have recommended our suggestion to avoid this complication, by adopting a simple technique. We have achieved optimal results by applying this technique in our subsequent cases.

Keywords: Bleeding complication; Frey’s procedure; Harmonic scalpel; Whipple’s pancreaticoduodenectomy.

Fig. 1

Whipples's pancreaticoduodenectomy: Pancreatic stump bleed

Fig. 2

Frey's Procedure: Post operative bleed from cored Head of Pancreas