J.Jpn. Surg. Soc.
ISSN 1880-1129

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J.Jpn. Surg. Soc.. 120(4): 436-441, 2019

Feature topic

PREVENTION AND TREATMENT OF POSTPANCREATECTOMY HEMORRHAGE

1) Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
2) Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

Hidetoshi Eguchi1), Yoshifumi Iwagami1), Hirofumi Akita1), Tadafumi Asaoka1), Takehiro Noda1), Kunihito Gotoh1), Shogo Kobayashi1), Masaki Mori2), Yuichiro Doki1)

Pancreatoduodenectomy has a relatively high incidence of postoperative complications including pancreatic fistula and not only early but also delayed bleeding, which usually occur postoperatively and may follow a serious course. Such postpancreatectomy hemorrhage (PPH) is classified using three criteria: time of onset; location and cause; and severity. PPH is further classified into grades A to C using these three criteria. Grade C, the most severe, is life-threatening, and thus prompt diagnosis and treatment are required. As a treatment for delayed PPH, a recent meta-analysis reported that interventional radiology (IVR) was superior to hemostasis via surgery. In order to avoid PPH, wrapping the stump of the gastroduodenal artery using the falciform ligament has been shown to be a possible method. Prompt embolization against a pseudoaneurysm or performing IVR immediately after observing sentinel bleeding may be required. Surgeons performing pancreatectomy should constantly update their knowledge of the pathology and treatment of PPH so that the most appropriate countermeasures can be taken.

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