Reoperation due to bleeding after gastrectomy: A clinical analysis of 36 cases / 第二军医大学学报

ABSTRACT

Objective: To explore the causes, and prevention and treatment strategies of postoperative bleeding after gastrectomy. Methods: We retrospectively analyzed the clinical data of 36 reoperation patients with bleeding after radical gastrectomy in our hospital from Jan. 2014 to Dec. 2018. The gender, age, body mass index (BMI), first operation time, resection scope, reconstruction way, combined organ resection, bleeding interval, bleeding site, bleeding cause, intraoperative treatment, complications and hospital stay after second operation were recorded. According to the location of bleeding after operation, the patients were divided into intraperitoneal bleeding group and gastrointestinal bleeding group. Aforementioned clinical features were compared between the two groups. Results: Thirty-six cases of bleeding occurred 1-247 h after operation. Totally, 29 cases underwent second operation immediately and 7 cases underwent second operation after conservative treatment. During the reoperation, 18 cases of active bleeding of blood vessels were identified and ligated or sutured; 1 case of bleeding of spleen was diagnosed and the spleen was resected; 10 cases of hemoperitoneum were found, removed fully drained; and 7 cases of gastrointestinal bleeding were identified, strengthened and sutured. One patient died of malignant arrhythmia 2 d after reoperation. One patient had duodenal stump fistula, 1 patient had pancreatic fistula, and 1 patient had pneumonia; all the 3 patients were discharged after symptomatic treatment. One patient was complicated with postoperative wound disruption and was discharged after resewing treatment. The rest patients were discharged smoothly without continuous bleeding after reoperation. There were no significant differences in age, BMI, gender, first operation time, reconstruction way, hospital stay after reoperation, combined organ resection or bleeding interval between the intraperitoneal bleeding group (29 cases) and gastrointestinal bleeding group (7 cases) (all P < 0.05). In the intraperitoneal bleeding group, there were 2 cases (6.9%) receiving proximal gastrectomy, 5 cases (17.2%) distal gastrectomy, 17 cases (58.6%) total gastrectomy, and 5 cases (17.2%) residual gastrectomy, which was significantly different from the gastrointestinal bleeding group (0, 5 [71.4%], 2 [28.6%] and 0, respectively) (P = 0.035). Conclusion: Postoperative bleeding can be manifested as intraperitoneal bleeding and gastrointestinal bleeding, and active reoperation is an effective treatment.