Postoperative hemorrhage complications after the Whipple procedure
1Department of General Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
2Clinic of General Surgery, Atatürk Training and Research Hospital, İzmir, Turkey
Introduction: The Whipple operation is an essential surgical technique; however, its high morbidity (30% to 60%) and mortality (5%) rates are problems that should be addressed. The incidence of postoperative hemorrhage is 5% to 16% in the literature. In this study, the data and results in our clinic regarding postoperative hemorrhage complications were evaluated.
Material and Methods: The files of 185 patients who underwent the Whipple operation in our hospital in the last five years were evaluated retrospectively, and we attempted to determine the causes of hemorrhage. It was found that 13 (7%) patients experienced hemorrhage, and six of them were found to have died. In six of these 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 on 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 cessation of the drug.
Discussion: 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 surgeries.
Results: In addition to known methods, angiography and embolization are emerging as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, the determination and elimination of independent risk factors, such as jaundice, that affect 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 paper as: Dilek ON, Özşay O, Acar T, Gür EÖ, Çelik SC, Cengiz F, Cin N, Hacıyanlı M. Postoperative hemorrhage complications after the Whipple procedure. Turk J Surg 2018; DOI: 10.5152/turkjsurg.2017.3758