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. 2021 Aug;45(8):2432-2438.
doi: 10.1007/s00268-021-06116-1. Epub 2021 Apr 17.

Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

Emmanuel Devant  1 , Edouard Girard  1   2 , Julio Abba  1 , Julien Ghelfi  3 , Pierre-Yves Sage  1 , Christian Sengel  3 , Olivier Risse  1 , Ivan Bricault  2   3 , Bertrand Trilling  1   2 , Mircea Chirica  4
Affiliations

Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

Emmanuel Devant et al. World J Surg. 2021 Aug.

Abstract

Background: The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.

Methods: Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (n = 26), liver transplantation (n = 24) and other (n = 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.

Results: Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p = 0.14). Recurrence was similar after stenting and embolization (n = 4/18, 22% vs n = 8/26, 31%, p = 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n = 2/10, 20% vs. n = 11/16, 69%, p = 0.042).

Conclusion: IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.

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