Early Postoperative anastomotic hemorrhage after gastrectomy for gastric cancer

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 confirmation of bleeding and therapeutic intervention. © 2010 by International and Japanese Gastric Cancer Associations.