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Gastric Cancer

, Volume 13, Issue 1, pp 50–57 | Cite as

Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer

  • Yutaka Tanizawa
  • Etsuro Bando
  • Taiichi Kawamura
  • Masanori Tokunaga
  • Hiroyuki Ono
  • Masanori Terashima
Original Article

Abstract

Background

Postoperative anastomotic hemorrhage is a relatively rare complication, but it is lethal if not treated immediately.

Methods

Of 1400 patients with gastric cancer who underwent gastrectomy between September 2002 and December 2007, postoperative anastomotic hemorrhage was observed in 6 patients. The surgical procedures, bleeding sites, methods of hemostasis, and clinical courses of these 6 patients were analyzed.

Results

Of the 1400 patients, 878, 72, and 450 underwent distal, proximal, and total gastrectomy, respectively. The bleeding sites were as follows: transection line of the stomach using a linear stapler (n = 1); gastroduodenostomy using a circular stapler (n = 3); gastrojejunostomy by hand-suture (n = 1); and esophagojejunostomy using a circular stapler (n = 1). Five patients achieved complete hemostasis with endoscopic treatment. One patient underwent re-operation for anastomotic hemorrhage without endoscopic therapy. Two patients had delayed gastric emptying, and one patient developed an intraabdominal abscess after hemostatic treatment.

Conclusion

Postoperative anastomotic hemorrhage is an infrequent but potentially life-threatening complication. Endoscopy appears to be useful for both the confi rmation of bleeding and therapeutic intervention.

Key words

Anastomosis Gastrectomy Gastric cancer Hemorrhage Postoperative complications 

Referenc

  1. 1.
    Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy: Japan Clinical Oncology Group Study 9501. J Clin Oncol 2004;22:2767–2773.CrossRefPubMedGoogle Scholar
  2. 2.
    McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastrooesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study BMJ 2003;22:1192–1197.CrossRefGoogle Scholar
  3. 3.
    Kim MC, Choi HJ, Jung GJ, Kim HH. Techniques and complications of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. Eur J Surg Oncol 2007;33:700–705.PubMedGoogle Scholar
  4. 4.
    Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepanik A. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial. Am J Surg 2007;193:10–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Hori S, Ochiai T, Gunji Y, Hayashi H, Suzuki T. A prospective randomized trial of hand-sutured versus mechanically stapled anastomoses for gastroduodenostomy after distal gastrectomy. Gastric Cancer 2004;7:24–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Yang HK, Lee HJ, Ahn HS, Yoo MW, Lee IK, Lee KU. Safety of modifi ed double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy. J Surg Oncol 2007;96:624–629.CrossRefPubMedGoogle Scholar
  7. 7.
    Tanimura S, Higashino M, Fukunaga Y, Kishida S, Nishikawa M, Ogata A, et al. Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 2005;19:1177–1181.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim CB, Suh KW, Moon JI, Min JS. Roux-en-Y end-to-side esophagojejunostomy with stapler after total gastrectomy. Yonsei Med J 1993;34:334–339.PubMedGoogle Scholar
  9. 9.
    Pedrazzani C, Marrelli D, Rampone B, De Stefano A, Corso G, Fotia G, et al. Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 2007;52:1757–1763.CrossRefPubMedGoogle Scholar
  10. 10.
    Umano Y, Horiuchi T, Inoue M, Shono Y, Oku Y, Tanishima H, et al. Endoscopic microwave coagulation therapy of postoperative hemorrhage from a stapled anastomosis. Hepatogastroenterology 2005;52:1768–1770.PubMedGoogle Scholar
  11. 11.
    Fischer MG. Bleeding from stapler anastomosis. Am J Surg 1976;131:745–747.CrossRefPubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association. Guidelines for diagnosis and treatment of carcinoma of the stomach (in Japanese). Tokyo: Kanehara; 2004.Google Scholar
  13. 13.
    Japanese Gastric Association. Japanese classifi cation of gastric carcinoma. 2nd English edition. Gastric Cancer 1998;1:10–24.CrossRefGoogle Scholar
  14. 14.
    Nguyen NT, Longoria M, Chalifoux S, Wilson SE. Gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg 2004;14:1308–1312.CrossRefPubMedGoogle Scholar
  15. 15.
    Mehran A, Szomstein S, Zundel N, Rosenthal R. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13:842–847.CrossRefPubMedGoogle Scholar
  16. 16.
    Bakhos C, Alkhoury F, Kyriakides T, Reinhold R, Nadzam G. Early postoperative hemorrhage after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg 2009;19:153–157.CrossRefPubMedGoogle Scholar
  17. 17.
    Fernández-Esparrach G, Bordas JM, Pellisé M, Gimeno-García AZ, Lacy A, Delgado S, et al. Endoscopic management of early GI hemorrhage after laparoscopic gastric bypass. Gastrointest Endosc 2008;67:552–555.CrossRefPubMedGoogle Scholar
  18. 18.
    Jamil LH, Krause KR, Chengelis DL, Jury RP, Jackson CM, Cannon ME, et al. Endoscopic management of early upper gastrointestinal hemorrhage following laparoscopic Roux-en-Y gastric bypass. Am J Gastroenterol 2008;103:86–91.PubMedGoogle Scholar
  19. 19.
    Tang SJ, Rivas H, Tang L, Lara LF, Sreenarasimhaiah J, Rockey DC. Endoscopic hemostasis using endoclip in early gastrointestinal hemorrhage after gastric bypass surgery. Obes Surg 2007;17:1261–1267.CrossRefPubMedGoogle Scholar
  20. 20.
    Guo SB, Gong AX, Leng J, Ma J, Ge LM. Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract. World J Gastroenterol 2009;15:4322–4326.CrossRefPubMedGoogle Scholar
  21. 21.
    Mayer G, Lingenfelser T, Ell C. The role of endoscopy in early postoperative haemorrhage. Best Pract Res Clin Gastroenterol 2004;18:799–807.PubMedGoogle Scholar
  22. 22.
    Tan KK, Wong D, Sim R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg 2008;32:2707–2715.CrossRefPubMedGoogle Scholar
  23. 23.
    Jex RK, van Heerden JA, Wolff BG, Ready RL, Ilstrup DM. Gastrointestinal anastomoses. Factors affecting early complications. Ann Surg 1987;206:138–141.CrossRefPubMedGoogle Scholar
  24. 24.
    Doglietto GB, Papa V, Tortorelli AP, Bossola M, Covino M, Pacelli F. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial. Arch Surg 2004;139:1309–1313.CrossRefPubMedGoogle Scholar
  25. 25.
    Akbaba S, Kayaalp C, Savkilioglu M. Nasogastric decompression after total gastrectomy. Hepatogastroenterology 2004;51:1881–1885.PubMedGoogle Scholar
  26. 26.
    Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg 2002;168:379–383.CrossRefPubMedGoogle Scholar
  27. 27.
    Wu CC, Hwang CR, Liu TJ. There is no need for nasogastric decompression after partial gastrectomy with extensive lymphadenectomy. Eur J Surg 1994;160:369–373.PubMedGoogle Scholar
  28. 28.
    Chung HY, Yu W. Reevaluation of routine gastrointestinal decompression after gastrectomy for gastric cancer. Hepatogastroenterology 2003;50:1190–1192.PubMedGoogle Scholar
  29. 29.
    Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery with versus without nasogastric decompression. Yonsei Med J 2002;43:451–456.PubMedGoogle Scholar
  30. 30.
    Carrère N, Seulin P, Julio CH, Bloom E, Gouzi JL, Pradère B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg 20 2007;31:122–127CrossRefGoogle Scholar
  31. 31.
    Hyung WJ, Noh SH, Shin DW, Huh J, Huh BJ, Choi SH, et al. Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Ann Surg Oncol 2002;9:5–12.CrossRefPubMedGoogle Scholar
  32. 32.
    Fong Y, Karpeh M, Brennan MF. Association of perioperative transfusions with poor outcome in resection of gastric adenocarcinoma. Am J Surg 1994;167:256–260.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2010

Authors and Affiliations

  • Yutaka Tanizawa
    • 1
  • Etsuro Bando
    • 1
  • Taiichi Kawamura
    • 1
  • Masanori Tokunaga
    • 1
  • Hiroyuki Ono
    • 2
  • Masanori Terashima
    • 1
  1. 1.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
  2. 2.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan

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