Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes
Background The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy. Methods Between 2005 and 2019, 57...
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| Veröffentlicht in: | World journal of surgery 2021-08, Vol.45 (8), p.2432-2438 |
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| creator | Devant, Emmanuel Girard, Edouard Abba, Julio Ghelfi, Julien Sage, Pierre-Yves Sengel, Christian Risse, Olivier Bricault, Ivan Trilling, Bertrand Chirica, Mircea |
| description | Background
The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.
Methods
Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (
n
= 26), liver transplantation (
n
= 24) and other (
n
= 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.
Results
Mortality was 32% (
n
= 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (
p
= 0.14). Recurrence was similar after stenting and embolization (
n
= 4/18, 22% vs
n
= 8/26, 31%,
p
= 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (
n
= 2/10, 20% vs.
n
= 11/16, 69%,
p
= 0.042).
Conclusion
IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks. |
| doi_str_mv | 10.1007/s00268-021-06116-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmed_primary_33866425</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2545289800</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4708-20d150ac2372c5b020e67bdf051657c0d5cff53d9fca7b3684fbade7f065606f3</originalsourceid><addsrcrecordid>eNqNkUGL1TAQx4Mo7nP1C3iQghdBqpOkSfu8aXVdZWWFVTyWNJ08-2iTmrTK-_aO9rmCB9lTJsnvN0zyZ-whh2ccoHyeAISuchA8B825zvkttuGFFLmQQt5mG5C6oJrLE3YvpT0ALzXou-xEykrrQqgNa1_jYA7YZR9DmsOE0cz9d8zOcQwxfjU7zOowTkNv6dzvsg9mH2J2tUzRjJiCDXRD27jDeKBLT8KIfs6M77LLZbaBqPvsjjNDwgfH9ZR9PnvzqT7PLy7fvqtfXuS2KKHKBXRcgbFClsKqFgSgLtvOgeJalRY6ZZ1Tsts6a8pW6qpwremwdKAVvcrJU_Zk7TvF8G3BNDdjnywOg_EYltQIRf31VuuS0Mf_oPuwRE_TEVUoUW0rAKLEStkYUoromin2o4mHhkPzK4FmTaChBJrfCTScpEfH1ks7Ynet_PlyAp6uwA9sg0u2R2_xGgMAXUCleUEVFERXN6frfqaYgq_D4mdSXxzVfsDDDWZvvry_enUGnPOKZLnKiTxP8f79of88_ifbAMMg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2545289800</pqid></control><display><type>article</type><title>Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes</title><source>SpringerNature Journals</source><source>Access via Wiley Online Library</source><source>Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><creator>Devant, Emmanuel ; Girard, Edouard ; Abba, Julio ; Ghelfi, Julien ; Sage, Pierre-Yves ; Sengel, Christian ; Risse, Olivier ; Bricault, Ivan ; Trilling, Bertrand ; Chirica, Mircea</creator><creatorcontrib>Devant, Emmanuel ; Girard, Edouard ; Abba, Julio ; Ghelfi, Julien ; Sage, Pierre-Yves ; Sengel, Christian ; Risse, Olivier ; Bricault, Ivan ; Trilling, Bertrand ; Chirica, Mircea</creatorcontrib><description>Background
The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.
Methods
Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (
n
= 26), liver transplantation (
n
= 24) and other (
n
= 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.
Results
Mortality was 32% (
n
= 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (
p
= 0.14). Recurrence was similar after stenting and embolization (
n
= 4/18, 22% vs
n
= 8/26, 31%,
p
= 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (
n
= 2/10, 20% vs.
n
= 11/16, 69%,
p
= 0.042).
Conclusion
IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-021-06116-1</identifier><identifier>PMID: 33866425</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Bleeding ; Cardiac Surgery ; Computed tomography ; Embolization ; General Surgery ; Hemorrhage ; Life Sciences & Biomedicine ; Liver transplantation ; Management ; Medicine ; Medicine & Public Health ; Original Scientific Report ; Pancreatic islet transplantation ; Patients ; Postoperative period ; Radiology ; Science & Technology ; Surgery ; Surveillance ; Thoracic Surgery ; Transplantation ; Vascular Surgery</subject><ispartof>World journal of surgery, 2021-08, Vol.45 (8), p.2432-2438</ispartof><rights>Société Internationale de Chirurgie 2021</rights><rights>2021 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>1</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000640861400004</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c4708-20d150ac2372c5b020e67bdf051657c0d5cff53d9fca7b3684fbade7f065606f3</citedby><cites>FETCH-LOGICAL-c4708-20d150ac2372c5b020e67bdf051657c0d5cff53d9fca7b3684fbade7f065606f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-021-06116-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-021-06116-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,39267,41497,42566,45583,45584,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33866425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Devant, Emmanuel</creatorcontrib><creatorcontrib>Girard, Edouard</creatorcontrib><creatorcontrib>Abba, Julio</creatorcontrib><creatorcontrib>Ghelfi, Julien</creatorcontrib><creatorcontrib>Sage, Pierre-Yves</creatorcontrib><creatorcontrib>Sengel, Christian</creatorcontrib><creatorcontrib>Risse, Olivier</creatorcontrib><creatorcontrib>Bricault, Ivan</creatorcontrib><creatorcontrib>Trilling, Bertrand</creatorcontrib><creatorcontrib>Chirica, Mircea</creatorcontrib><title>Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>WORLD J SURG</addtitle><addtitle>World J Surg</addtitle><description>Background
The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.
Methods
Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (
n
= 26), liver transplantation (
n
= 24) and other (
n
= 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.
Results
Mortality was 32% (
n
= 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (
p
= 0.14). Recurrence was similar after stenting and embolization (
n
= 4/18, 22% vs
n
= 8/26, 31%,
p
= 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (
n
= 2/10, 20% vs.
n
= 11/16, 69%,
p
= 0.042).
Conclusion
IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.</description><subject>Abdominal Surgery</subject><subject>Bleeding</subject><subject>Cardiac Surgery</subject><subject>Computed tomography</subject><subject>Embolization</subject><subject>General Surgery</subject><subject>Hemorrhage</subject><subject>Life Sciences & Biomedicine</subject><subject>Liver transplantation</subject><subject>Management</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Scientific Report</subject><subject>Pancreatic islet transplantation</subject><subject>Patients</subject><subject>Postoperative period</subject><subject>Radiology</subject><subject>Science & Technology</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Thoracic Surgery</subject><subject>Transplantation</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkUGL1TAQx4Mo7nP1C3iQghdBqpOkSfu8aXVdZWWFVTyWNJ08-2iTmrTK-_aO9rmCB9lTJsnvN0zyZ-whh2ccoHyeAISuchA8B825zvkttuGFFLmQQt5mG5C6oJrLE3YvpT0ALzXou-xEykrrQqgNa1_jYA7YZR9DmsOE0cz9d8zOcQwxfjU7zOowTkNv6dzvsg9mH2J2tUzRjJiCDXRD27jDeKBLT8KIfs6M77LLZbaBqPvsjjNDwgfH9ZR9PnvzqT7PLy7fvqtfXuS2KKHKBXRcgbFClsKqFgSgLtvOgeJalRY6ZZ1Tsts6a8pW6qpwremwdKAVvcrJU_Zk7TvF8G3BNDdjnywOg_EYltQIRf31VuuS0Mf_oPuwRE_TEVUoUW0rAKLEStkYUoromin2o4mHhkPzK4FmTaChBJrfCTScpEfH1ks7Ynet_PlyAp6uwA9sg0u2R2_xGgMAXUCleUEVFERXN6frfqaYgq_D4mdSXxzVfsDDDWZvvry_enUGnPOKZLnKiTxP8f79of88_ifbAMMg</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Devant, Emmanuel</creator><creator>Girard, Edouard</creator><creator>Abba, Julio</creator><creator>Ghelfi, Julien</creator><creator>Sage, Pierre-Yves</creator><creator>Sengel, Christian</creator><creator>Risse, Olivier</creator><creator>Bricault, Ivan</creator><creator>Trilling, Bertrand</creator><creator>Chirica, Mircea</creator><general>Springer International Publishing</general><general>Springer Nature</general><general>Springer Nature B.V</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>202108</creationdate><title>Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes</title><author>Devant, Emmanuel ; Girard, Edouard ; Abba, Julio ; Ghelfi, Julien ; Sage, Pierre-Yves ; Sengel, Christian ; Risse, Olivier ; Bricault, Ivan ; Trilling, Bertrand ; Chirica, Mircea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4708-20d150ac2372c5b020e67bdf051657c0d5cff53d9fca7b3684fbade7f065606f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Bleeding</topic><topic>Cardiac Surgery</topic><topic>Computed tomography</topic><topic>Embolization</topic><topic>General Surgery</topic><topic>Hemorrhage</topic><topic>Life Sciences & Biomedicine</topic><topic>Liver transplantation</topic><topic>Management</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Scientific Report</topic><topic>Pancreatic islet transplantation</topic><topic>Patients</topic><topic>Postoperative period</topic><topic>Radiology</topic><topic>Science & Technology</topic><topic>Surgery</topic><topic>Surveillance</topic><topic>Thoracic Surgery</topic><topic>Transplantation</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Devant, Emmanuel</creatorcontrib><creatorcontrib>Girard, Edouard</creatorcontrib><creatorcontrib>Abba, Julio</creatorcontrib><creatorcontrib>Ghelfi, Julien</creatorcontrib><creatorcontrib>Sage, Pierre-Yves</creatorcontrib><creatorcontrib>Sengel, Christian</creatorcontrib><creatorcontrib>Risse, Olivier</creatorcontrib><creatorcontrib>Bricault, Ivan</creatorcontrib><creatorcontrib>Trilling, Bertrand</creatorcontrib><creatorcontrib>Chirica, Mircea</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Devant, Emmanuel</au><au>Girard, Edouard</au><au>Abba, Julio</au><au>Ghelfi, Julien</au><au>Sage, Pierre-Yves</au><au>Sengel, Christian</au><au>Risse, Olivier</au><au>Bricault, Ivan</au><au>Trilling, Bertrand</au><au>Chirica, Mircea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><stitle>WORLD J SURG</stitle><addtitle>World J Surg</addtitle><date>2021-08</date><risdate>2021</risdate><volume>45</volume><issue>8</issue><spage>2432</spage><epage>2438</epage><pages>2432-2438</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.
Methods
Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (
n
= 26), liver transplantation (
n
= 24) and other (
n
= 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance.
Results
Mortality was 32% (
n
= 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (
p
= 0.14). Recurrence was similar after stenting and embolization (
n
= 4/18, 22% vs
n
= 8/26, 31%,
p
= 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (
n
= 2/10, 20% vs.
n
= 11/16, 69%,
p
= 0.042).
Conclusion
IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33866425</pmid><doi>10.1007/s00268-021-06116-1</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | SpringerNature Journals; Access via Wiley Online Library; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /> |
| subjects | Abdominal Surgery Bleeding Cardiac Surgery Computed tomography Embolization General Surgery Hemorrhage Life Sciences & Biomedicine Liver transplantation Management Medicine Medicine & Public Health Original Scientific Report Pancreatic islet transplantation Patients Postoperative period Radiology Science & Technology Surgery Surveillance Thoracic Surgery Transplantation Vascular Surgery |
| title | Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes |
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