Management and outcomes of haemorrhage after pancreatogastrostomy versus pancreatojejunostomy (Br J Surg 2011: 98: 1599-1607).

摘要

Postpancreatectomy haemorrhage (PPH) is a relatively rare (2-5 per cent) complication after pancreatectomy but one of the most severe. It is associated with a high mortality rate, in particular the combination of bleeding and anastomotic leakage or abscess formation. Management is mainly dependent on the origin/aetiology, location of the bleeding and time interval after surgery.Haemorrhage within the first 24 h after surgery is generally caused by a technical failure and needs immediate haemosta-sis by relaparotomy. Delayed haemorrhage may originate from the gastrointestinal tract (peptic ulcer or ulcer from the anastomosis) and present as an intrahiminal bleed. It might also originate from an eroded vessel (pseudoaneurysm) and/or dehiscence of the anastomosis causing intra-abdominal bleeding, or be a combined type.The incidence of 8-4 per cent in this study by Eckardt and colleagues is relatively high, probably owing to a large number of reflux-related haemorrhages. The authors showed for the group with intraluminal bleeding that endoscopic treatment was more successful for PPH in patients with a pancreatogastrostomy than in those with a pancreatojejunos-tomy, presumably owing to better accessibility. It is generally accepted that early endoscopy is indicated for diagnosis and treatment of an intraluminal bleed (irrespective of the type of anastomosis).