Diario del páncreas Acceso abierto

Abstracto

A Secondary Stenting after Salvage Surgery for Hemorrhage in Pancreatic Resection

Charles Vanbrugghe, Jacques Ewald, Anthony Sarran, Gilles Piana, Jean Robert Delpero

Introduction Management of delayed post-operative hemorrhage after pancreatic surgery needs interventional radiology or reintervention according to several clinical criteria (delay from surgery, hemodynamic status, arterial anatomy precluding interventional radiology…). Whatever the chosen procedure, re-bleeding after interventional radiology or reintervention is not rare. IR is not possible in case of hemodynamic instability and emergency surgery is very difficult, ligature in adverse local condition during surgery could explain that re-bleeding is not rare notably if the pancreatic anastomosis/remnant is preserved. Cases From 2000 to 2015, 899 patients were treated for pancreatic disease in our institution and three of them presented a delayed post-operative hemorrhage. Those three cases, two pancreaticoduodenectomy and one distal pancreatectomy underwent emergency surgery followed by IR to secure the arterial repair either by a covered stent or by transarterial embolization. Secondary IR procedure has been performed between six and 24 hours following surgery. No patient underwent re-bleeding or early postoperative death. Conclusion Interventional radiology following post-operative hemorrhage was a safe procedure and might decrease re-bleeding rate after reintervention. This attitude could permit a hemodynamic stabilization of the patient and organized safely a transfer for a stent-placement.