{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:55:08Z","timestamp":1767707708916},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:00:00Z","timestamp":1618617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:00:00Z","timestamp":1618617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:00:00Z","timestamp":1618617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The place of surgery and interventional radiology in the management of delayed (&gt;\u200924 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (<jats:italic>n<\/jats:italic>\u2009=\u200926), liver transplantation (<jats:italic>n<\/jats:italic>\u2009=\u200924) and other (<jats:italic>n<\/jats:italic>\u2009=\u20097). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and\/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting\/embolization of the most likely bleeding source or surveillance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mortality was 32% (<jats:italic>n<\/jats:italic>\u2009=\u200918). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (<jats:italic>p<\/jats:italic>\u2009=\u20090.14). Recurrence was similar after stenting and embolization (<jats:italic>n<\/jats:italic>\u2009=\u20094\/18, 22% vs <jats:italic>n<\/jats:italic>\u2009=\u20098\/26, 31%, <jats:italic>p<\/jats:italic>\u2009=\u20090.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (<jats:italic>n<\/jats:italic>\u2009=\u20092\/10, 20% vs. <jats:italic>n<\/jats:italic>\u2009=\u200911\/16, 69%, <jats:italic>p<\/jats:italic>\u2009=\u20090.042).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06116-1","type":"journal-article","created":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T20:02:21Z","timestamp":1618689741000},"page":"2432-2438","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes"],"prefix":"10.1002","volume":"45","author":[{"given":"Emmanuel","family":"Devant","sequence":"first","affiliation":[{"name":"Centre Hospitalier Universitaire Grenoble Alpes Department of Digestive Surgery Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edouard","family":"Girard","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire Grenoble Alpes Department of Digestive Surgery Grenoble France"},{"name":"Universit\u00e9 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