This is a retrospective and single-center study. We retrospectively reviewed the records of patients who underwent surgical resection between January 2004 and December 2019 at the Chang Gung Memorial Hospital (CGMH), Taiwan. Post-pancreatoduodenectomy hemorrhage data were collected from the CGMH imaging dataset. This protocol was approved by the CGMH Institutional Review Board and the Ethics Committee. The Ethics Committee waived the requirement for informed consent for this study. All methods in this study were carried out in accordance with the institutional guidelines and regulations of the Chang Gung Medical Foundation. The inclusion criteria were as follows: (a) patients received pancreatoduodenectomy or any periampullary region operation, with GDA ligation; (b) patients had clinical evidence of internal bleeding, with or without a positive finding on the computed tomography (CT) scan with contrast and/or the CTA (CT angiography) scan; (c) patients received angiography. This study excluded (a) patients without GDA ligation, and (b) cases where the patients’ bleeding site was not from the GDA stump.
We used an electronic search method to identify the medical records of patients treated at our hospital. The patients’ medical records and radiological images were retrospectively reviewed in the electronic database of our institution by assessing preoperative characteristics, postoperative hemorrhage, additional interventions, mortality, and postoperative complications (such as hepatic failure, abscess, or infarct).
There is a high prevalence of viral hepatitis in Taiwan; viral hepatitis induces liver cirrhosis (a calculated annual incidence of 2.4%) [13 (link),14 (link)], which subsequently causes portal hypertension and affects the entire liver perfusion. Because liver perfusion via the hepatic artery is sacrificed after TAE and may cause severe post-TAE complications, such as liver infarction, secondary liver abscesses, and hepatic failure, we included underlying liver disease (such as liver cirrhosis and any liver-related surgery) to evaluate their association with post-TAE complications.
All the patients’ vital signs were closely monitored, some through laboratory blood tests (especially in relation to liver function), in the intensive care unit after the TAE procedure. If patients showed any clinical signs or symptoms suggesting re-bleeding, repeated angiography with subsequent embolization was performed. The follow-up duration was measured from the time of surgery until death or after discharge, until 30 June 2022 (more than 6 months). No patient was lost to the follow-up.
We used an electronic search method to identify the medical records of patients treated at our hospital. The patients’ medical records and radiological images were retrospectively reviewed in the electronic database of our institution by assessing preoperative characteristics, postoperative hemorrhage, additional interventions, mortality, and postoperative complications (such as hepatic failure, abscess, or infarct).
There is a high prevalence of viral hepatitis in Taiwan; viral hepatitis induces liver cirrhosis (a calculated annual incidence of 2.4%) [13 (link),14 (link)], which subsequently causes portal hypertension and affects the entire liver perfusion. Because liver perfusion via the hepatic artery is sacrificed after TAE and may cause severe post-TAE complications, such as liver infarction, secondary liver abscesses, and hepatic failure, we included underlying liver disease (such as liver cirrhosis and any liver-related surgery) to evaluate their association with post-TAE complications.
All the patients’ vital signs were closely monitored, some through laboratory blood tests (especially in relation to liver function), in the intensive care unit after the TAE procedure. If patients showed any clinical signs or symptoms suggesting re-bleeding, repeated angiography with subsequent embolization was performed. The follow-up duration was measured from the time of surgery until death or after discharge, until 30 June 2022 (more than 6 months). No patient was lost to the follow-up.
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