BACKGROUND: Most pancreatic leaks after pancreaticoduodenectomy were initially treated conservatively, and for the most part, they were self-limiting and closed spontaneously. But in a few patients, hemorrhage occurred 1 to 3weeks postoperatively and remained a fatal complication after pancreaticoduodenectomy. STUDY DESIGN: To identify possible risk factors for massive bleeding, the medical records of 402 patients who had pancreaticoduodenectomies were reviewed for leak complications and analyzed for associations between the occurrence of massive bleeding and preoperative, intraoperative, postoperative, and pathologic parameters. RESULTS: In univariate logistic regression analysis, infectious clinical signs (p=0.021, odds ratio [OR]=7.06, 95% CI=1.34, 37.12) and bile in the drainage fluid (p=0.036, OR=5.89, 95% CI=1.13, 30.86) were associated with the risk of developing massive hemorrhage. This combination provided the highest estimate of massive bleeding after pancreatic leak (p=0.005, OR=8.57, 95% CI=1.92, 38.35). CONCLUSIONS: Both infectious clinical signs and bile content in the drainage fluid considerably increase the risk of massive bleeding after pancreatic leak. Close observation of patients with these ominous signs is warranted.
BACKGROUND: Most pancreatic leaks after pancreaticoduodenectomy were initially treated conservatively, and for the most part, they were self-limiting and closed spontaneously. But in a few patients, hemorrhage occurred 1 to 3weeks postoperatively and remained a fatal complication after pancreaticoduodenectomy. STUDY DESIGN: To identify possible risk factors for massive bleeding, the medical records of 402 patients who had pancreaticoduodenectomies were reviewed for leak complications and analyzed for associations between the occurrence of massive bleeding and preoperative, intraoperative, postoperative, and pathologic parameters. RESULTS: In univariate logistic regression analysis, infectious clinical signs (p=0.021, odds ratio [OR]=7.06, 95% CI=1.34, 37.12) and bile in the drainage fluid (p=0.036, OR=5.89, 95% CI=1.13, 30.86) were associated with the risk of developing massive hemorrhage. This combination provided the highest estimate of massive bleeding after pancreatic leak (p=0.005, OR=8.57, 95% CI=1.92, 38.35). CONCLUSIONS: Both infectious clinical signs and bile content in the drainage fluid considerably increase the risk of massive bleeding after pancreatic leak. Close observation of patients with these ominous signs is warranted.
Authors: M J Mañas-Gómez; R Rodríguez-Revuelto; J Balsells-Valls; J J Olsina-Kissler; M Caralt-Barba; M Pérez-Lafuente; R Charco-Torra Journal: World J Surg Date: 2011-11 Impact factor: 3.352
Authors: Thilo Welsch; Hanna Eisele; Stefanie Zschäbitz; Ulf Hinz; Markus W Büchler; Moritz N Wente Journal: Langenbecks Arch Surg Date: 2011-05-25 Impact factor: 3.445
Authors: Gyulnara G Kasumova; Mariam F Eskander; Tara S Kent; Sing Chau Ng; A James Moser; Muneeb Ahmed; Douglas K Pleskow; Mark P Callery; Jennifer F Tseng Journal: HPB (Oxford) Date: 2016-08-11 Impact factor: 3.647
Authors: G Rajarathinam; D G Kannan; V Vimalraj; A Amudhan; S Rajendran; D Jyotibasu; T G Balachandar; S Jeswanth; P Ravichandran; R Surendran Journal: HPB (Oxford) Date: 2008 Impact factor: 3.647