Surgical Laparotomy for Repeated Delayed Arterial Hemorrhage after Pancreaticoduodenectomy

TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMPLICATED BY PANCREATORAGIA

OBJECTIVE

The aim: To present and share our experience in the treatment of pancreatoragia which could help to prevent pancreatoragia in patients with chronic pan¬creatitis in the pre- and postoperative period.

PATIENTS AND METHODS

Materials and methods: Surgical treatment of complicated chronic pancreatitis (CP) was performed on 249 patients in the surgical clinic of the medical faculty №2 of National Pirogov Memorial Medical University of Vinnytsia during 2000 - 2021. Pancreatorrhagia occurred in 6 (2.4%) patients, group A - 3 (1.2%) - as disease manifestation, group B - 3 (1.2%) - as complication after surgery. In group A the source of bleeding was the lower pancreato-duodenal artery: 2 (0.8%) had lower pancreaticoduodenal artery aneurysms with bleeding into the cyst, 1 (0.4%) - a year after previously performed pancreato-duodenal resection. In group B pancreatorrhagia developed in 3 (1.2%) patients after the Frey-Izbitsky local resection of the pancreas: 2 (0.8%) - from pancreato-jejuno anastomosis, 1(0.4%) - from pancreatopleural fistula.

CONCLUSION

Conclusions: Pancreatoragia, as a manifestation of chronic pancreatitis, occurred in 6 (2.4%) patients. Bleeding occurred as a manifestation of the disease in 3 (1.2%) patients and in 3 (1.2%) patients - in the postoperative period. It is possible to use fibrin or cyanoacrylate glue to filling the defect of the pancreatic duct or to suture vessels in the parenchyma of the pancreas by PDS for the prevention of pancreatoragia in the postoperative period.

Endovascular therapy choices for different sites of delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery: a retrospective study

Background

Angiography and subsequent endovascular therapy is an effective technique for delayed postoperative arterial hemorrhage (PAH) after hepatobiliary pancreatic surgery. In this research, we aimed to evaluate endovascular therapy choices for different sites of delayed PAH after hepatobiliary pancreatic surgery.

Methods

A total of 85 patients with delayed PAH who underwent endovascular therapy at the Department of Radioactive Intervention of Eastern Hepatobiliary Surgery Hospital were retrospectively enrolled. According to the hemorrhage site, participants were divided into 3 groups, all of whom then received embolization, covered stent placement, or a combination of both. Ongoing or recurrent hemorrhages, intervention times, complications associated with intervention, and mortality rate were documented. The chi-squared (χ²) test was used for statistical analysis.

Results

A total of 22 participants with arterial branch hemorrhage underwent superselective embolization. Overall, 81.8% (18/22) of patients underwent embolization once. The successful hemostasis rate was 77.3% (17/22), and the mortality rate was 13.6% (3/22). A total of 53 participants with arterial trunk hemorrhage underwent embolization or covered stent placement. The rate of multi-time intervention, failure to achieve hemostasis, complications associated with intervention, and mortality was lower in the stent group than in the embolization group, and there was a significant difference in complications between the 2 groups (χ²=4.93, P=0.026). Among a total of 10 patients with multisite hemorrhage who underwent embolization, covered stent placement, or a combination, the successful hemostasis rate was 20%; and the mortality rate was 70%.

Conclusions

Superselective embolization is a safe treatment method for arterial branch hemorrhage, and covered stent placement may be a better choice for arterial trunk hemorrhage. Verification of these findings is required via additional large population studies.