Management and outcomes of haemorrhage after pancreatogastrostomy versus pancreatojejunostomy

• Published in: British journal of surgery 2011-11, Vol.98 (11), p.1599-1607
• Main Authors: Eckardt, A. J., Klein, F., Adler, A., Veltzke-Schlieker, W., Warnick, P., Bahra, M., Wiedenmann, B., Neuhaus, P., Neumann, K., Glanemann, M.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Endoscopy, Gastrointestinal; Female; Gastrostomy - methods; General aspects; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Pancreaticojejunostomy - methods; Postoperative Hemorrhage - prevention & control; Retrospective Studies; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.7623

Background: Postpancreatectomy haemorrhage (PPH) is a major cause of morbidity and mortality after pancreaticoduodenectomy (PD). It remains unclear whether performance of a pancreatogastrostomy (PG) instead of a pancreatojejunostomy (PJ) improves outcomes owing to better endoscopic accessibility. Methods: A large retrospective analysis was undertaken to compare outcomes of PPH, depending on whether a PG or PJ was performed. The primary outcome was the rate of successful endoscopy. A secondary outcome was the therapeutic success after adding surgery. Results: Of 944 patients who had a PD, 8·4 per cent developed PPH. Endoscopy was the primary intervention in 21 (81 per cent) of 26 patients with a PG and 34 (64 per cent) of 53 with a PJ; it identified the bleeding site in 35 and 25 per cent respectively (P = 0·347). Successful endoscopic treatment was more common in the PG group (31 versus 9 per cent; P = 0·026). Surgery was performed for PPH in 15 patients (58 per cent) with a PG and 35 (66 per cent) with a PJ (P = 0·470). The majority of haemorrhages that required surgery were non‐anastomotic intra‐abdominal haemorrhages (12 of 15 versus 21 of 35; P = 0·171). Endoscopic or conservative treatment for PPH was successful in 42 per cent of patients with a PG and 32 per cent with a PJ (P = 0·520). The success rate increased to 85 and 91 per cent respectively when surgery was included in the algorithm (P = 0·467). Conclusion: The type of pancreatic anastomosis and its inherent effect on endoscopic accessibility had very little impact on the outcome of PPH. This was because haemorrhage frequently occurred from intra‐abdominal or non‐anastomotic intraluminal lesions. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Pancreatogastrostomy not the solution