Postoperative hemorrhage complications following the Whipple procedure
Osman Nuri Dilek1, Oğuzhan Özşay2, Turan Acar2, Emine Özlem Gür1, Salih Can Çelik2, Fevzi Cengiz2, Nejat Cin2, Mehmet Hacıyanlı1
1Department of General Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
2Clinic of General Surgery, Atatürk Training and Research Hospital, İzmir, Turkey
Objective: Although the Whipple operation is an essential surgical technique, its high morbidity (30% to 60%) and mortality (5%) are problems to be addressed. The incidence of postoperative hemorrhage has been reported between 5% and 16% in the literature. In this study, the data and results regarding postoperative hemorrhage complications from our clinic were evaluated.
Material and Methods: The files of 185 patients who had undergone Whipple operation in our hospital in the last five years were evaluated retrospectively, and the causes of hemorrhage were attempted to be determined.
Results: It was found that 6 out of the 13 (7%) patients who had hemorrhage died. In six of there 13 cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed in a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following the cessation of the drug.
Conclusion: Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple operations. In addition to standard methods, angiography and embolization have emerged as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, determination and elimination of independent risk factors, such as jaundice, affecting fistula formation and bleeding in the perioperative period, is important for prevention.
Keywords: Complication, hemorrhage, pancreas, treatment, whipple operation
This study was presented at the 20th National Surgery Congress, 13-17 April 2016, Antalya, Turkey.
Cite this article as: Dilek ON, Özşay O, Acar T, Gür EÖ, Çelik SC, Cengiz F, et al. Postoperative hemorrhage complications following the whipple procedure. Turk J Surg 2019; 35 (2): 136-141
Written informed consent was obtained from all the patients who participated in this study.
Concept - O.N.D.; Design - O.N.D.; Supervision - O.N.D.; Resource - O.Ö., N.C., T.A.; Materials - O.Ö., N.C., T.A.; Data Collection and/or Processing - E.Ö.G., M.H., S.C.Ç.; Analysis and/or Interpretation - O.N.D., E.Ö.G.; Literature Search - M.H., O.N.D.; Writing Manuscript - O.N.D.; Critical Reviews - O.N.D., M.H.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.