Postoperative Pancreatic Fistulas Complicated by Haemorrhage: Diagnosis and Treatment

Objective: We sought to review our experience with postoperative pancreatic fistulas complicated with bleeding. Patients and Methods: Between January 2001 and September 2015 307 patients underwent pancreatico-duodenoectomies or central pancreatectomies. All cares were reconstructed by pancreaticojejunostomy. Results: Overall 30 day mortality was 3.6% (11 of 307 patients). Seven patients (5 males and 2 females, 65.9 years (61-74)) had late post-pancreatectomy haemorrhage (PPH) with concomitant pancreatic fistulas. Time from surgery to diagnosis was 16.3 days (range: 11-25.) CT, angiography and gastroscopy were applied to diagnose the problem. In all patients the eroded stump of the gastroduodenal artery was the underlying cause. Three patients underwent surgery and four angiographic stenting for initial treatment. We lost 1 patient due to repeated bleeding and multiple organ failure. The remaining 6 patients were hospitalized for 65 days (25-121) and recovered. During the study period our treatment strategy changed from primary surgery to angiography with stenting. We also switched our technique of pancreaticojejunostomy from one layer to duct-to-mucosa anastomosis and observed a reduction of incidence. Conclusion: PPH is a life-threatening complication which can be treated preferably with interventional techniques, surgery remains for salvage therapy. Rösch Ch1, Gangl O1, Langer RM1, Gschwendtner M2 and Függer R1* 1Department of Surgery, Austria 2Institute for Radiology, Krankenhaus der Elisabethinen Linz, Austria Függer R, et al. Clinics in Oncology Pancreatic Cancer Remedy Publications LLC., | http://clinicsinoncology.com/ 2016 | Volume 1 | Article 1105 2 the incidence throughout the study period and possible changes in treatment modalities. Between January 2001 and September 2015 a total of 307 patients undergoing either pylorus preserving, classic Kausch-Whipple pancreaticoduodenectomy or central pancreatectomies with reconstruction by pancreaticojejunostomy was identified in our data base and is subject of this analysis. 30–day mortality was 3.6% (11 of 307) overall. Pancreatic fistulas complicated by bleeding were observed in 7 of 307 (2.3%) patients. There were five male and two female patients with a mean age of 65.9 years (min 61-max 74 years). Underlying pancreatic pathology were ductal pancreatic adenocarcinoma (n=4), extrahepatic bile duct carcinoma (n=1), IPMN (n=1) and microcystic adenoma (n=1). Six pylorus preserving pancreaticoduodenectomy and one central pancreatectomy were performed in these patients. Pancreaticojejunostomy was used in all patients for reconstruction, either by classic single layer anastomosis or by duct-to-mucosa anastomosis with selective use of loose pancreatic duct drains since October 2007. The anastomotic techniques applied are described in detail elsewhere [11].