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Introduction
Postpancreatectomy Hemorrhage (PPH) is a rare but relevant complication after pancreatic resections. The aim of this study was to analyze risk factors and management of PPH in a large patient collective.
Methods
The study was carried out retrospectively on the basis of a prospectively maintained database. Patients with major pancreatic resections were included. PPH was defined according to the ISGPS. For statistical analysis, SPSS Software Version 20 was used.
Results
From 1994 to 2012, n=1082 Patienten aged 9 bis 89 years were included (729 pancreatoduodenektomies (PD), 188 distal pancreatic resections, 123 duodenum-preserving procedures and 42 pankreatectomies). Incidence of PPH was 7% and 3% for severe (Grade C) PPH, 90% were late (>24h postOP) PPH and about half of PPH had an intraluminal origin.
With Grade C PPH, mortality rose significantly to over 30% (overall 1.3%). Primary management consisted in endoscopic, angiographic and operative intervention. For severe PPH, success rate of non-operative therapy was around 50%. Risk factors for PPH were higher age and BMI and pancreatic fistula (POPF). Pancreatogastrostomy (PG) in PD had a significantly higher incidence of PPH than pancreatojejunostomy (PJ) mostly due to intraluminal PPH from the PG site. However, mortality after occurrence of PPH was significantly lower with PG (8% vs 28%, p<0.05) compared to PJ, and PG was independently associated with lower overall mortality survival in multivariate analysis, while age, POPF and PPH were the relevant risk factors for death.
Conclusions
PPH is a major determinant of mortality risk in pancreatic surgery. Non-operative management is successful in about half of cases of severe PPH. Intraluminal PPH is more frequent with PG, however mortality after PPH and overall mortality were significantly reduced with PG.