Original Paper

Risk Factors for Post-Pancreaticoduodenectomy Bleeding and Finding an Innovative Approach to Treatment
Hung-Kuang Wei^a, Shin-E Wang^a, Yi-Ming Shyr^a, Hsiuo-Shan Tseng^b, Wan-Chen Tsai^b, Tien-Hua Chen^a, Cheng-Hsi Su^a, Chew-Wun Wu^a, Wing-Yiu Lui^a

Departments of
^aSurgery, Taipei Veterans General Hospital, and
^bRadiology, Koo Foundation Sun Yat-Sen Cancer Center and Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan

Address of Corresponding Author

Dig Surg 2009;26:297-305 (DOI: 10.1159/000228245)

  Key Words

• Post-pancreaticoduodenectomy bleeding
• Gastroduodenal artery
• Transarterial embolization
• Covered stent

  Abstract

Background: This study is to determine the risk factors and outcome for post-pancreaticoduodenectomy bleeding, and to assess the roles of surgery and intravascular intervention in its management. Methods: Post-pancreaticoduodenectomy data of 628 patients were analyzed with regards to post-pancreaticoduodenectomy bleeding. Results: Post-pancreaticoduodenectomy bleeding occurred in 58 patients (9.2%) and led to death in 23 patients. Pancreatic leakage and intra-abdominal abscess were independent risk factors for both extraluminal and intraluminal post-pancreaticoduodenectomy bleeding. The most common source of bleeding was the gastroduodenal artery (n = 9, 24.3%), and 8 of these patients (88.9%) experienced gastroduodenal artery bleeding in late post-pancreaticoduodenectomy bleeding. Hemostasis for post-pancreaticoduodenectomy bleeding was achieved by surgery in 22 patients (78.6%) and intravascular intervention in 7 patients (58.3%). Transarterial embolization for gastroduodenal artery bleeding did not deteriorate liver function in most patients except for 1 who died of hepatic failure. Conclusions: The placement of metallic clips on the gastroduodenal artery stump during a pancreaticoduodenectomy is helpful in identifying overlooked intermittent sentinel bleeding during angiography. Transarterial embolization for gastroduodenal artery bleeding could not guarantee against hepatic failure. The intravascular placement of a covered stent is the preferred procedure to avoid the complete interruption of arterial blood supply to the liver.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Yi-Ming Shyr, MD
Division of General Surgery, Department of Surgery
Veterans General Hospital, 201 Section 2 Shih-Pai Road
Taipei 112 (Taiwan)
Tel. +886 2 2875 7652, Fax +886 2 2875 7537, E-Mail ymshyr@vghtpe.gov.tw

  Article Information

Received: October 17, 2008
Accepted: March 28, 2009
Published online: July 11, 2009
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 5, Number of References : 29