Hemorrhage in the late postoperative phase may originate from the gastrointestinal tract such as peptic ulceration or ulceration from the anastomosis, but can also be from an intraabdominal site such as an eroded vessel or dehiscence of an anastomotic suture line
Hemorrhage
Delayed hemorrhage
Sepsis: 50% to 74% Anastomotic leakage:
23% to 65% Sentinel bleeding: 78%
to 100% Relaparotomy: 14% to
30%
Hemorrhage
Delayed hemorrhage
Department of Surgery, University of Freiburg, Germany
Mortality was between 1.1% and 4.8% Morbidity was between 24% and 46% Pancreatic leakage was between 9% and 20%
Operative time : 8.8 hours in the 1970s and 5.5 hours during the 2000s. Postoperative length of stay : 17 days in the 1980s to 9 days in the 2000s. Mortality: 1%
Introduction:classification
Hemorrhage
Pancreatic fistula
Intraabdominal abscess
Delayed gastric emptying
Wound infection
Diabetes Pancreatic exocrine
Morbidity:20% to 30%
Cameron JL
Incidence: Germany
Current practice patterns in pancreatic surgery: results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German Advanced Surgical Treatment study group)
Incidence: China & Japan
In China
Morbidity: 10% to 40%
In Japan
Morbidity: 12.3% to 45%
A series of 3,610 patients collected From 57 major Japanese instit70s operative mortality : 20% to 40% Postoperative morbidity : 40% to 60% During the last decade operative mortality: 2% to 3% Some centers : excess of 100 patients no perioperative death Unfortunately, complication rates remain high usually in excess of 25% to 35%
Hemorrhage
Early and delayed hemorrhage Incidence: 0.5% to 6.8%
Hemorrhage
Early hemorrhage
Hemorrhage within the first 24 hours after surgery is generally caused by a technical failure and needs immediate adequate hemostasis through a relaparotomy
The prevention and management of postoperative complications in
pancreatic surgery
The Department of Hepato-biliarypancreatic Surgery in Chang Hai Hospital
Incidence: America
To trace the evolution of pancreaticoduodenectomy from the decade of the 1960s through the first decade of the new Millenium, through the experience of one surgeon doing 1000 consecutive operations
insufficiency
• Gastric/biliary fistula • Organ failure (heart, liver, lung etc.) • Pancreatitis • Marginal ulceration • Splenic vein thrombosis
Introduction:definition
Septic DH
Gastroduodenal A. Hepatic A. Mesentery A. Pancreatic parenchyma A. PJ>HJ>GE>EE