TITLE:
Recent Advances in the Study of Risk Factors and Prevention and Treatment Strategies for Postoperative Bleeding following Laparoscopic Pancreaticoduodenectomy
AUTHORS:
Kaiming Zhang, Yanliang Yang, Hongping Zuo, Zichen Yang, Haofeng Lu
KEYWORDS:
Laparoscopic Pancreaticoduodenectomy, Postoperative Hemorrhage, Risk Factors, Prevention, Treatment
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.9,
September
28,
2026
ABSTRACT: Laparoscopic pancreaticoduodenectomy (LPD) is an established but complex approach for ampullary and periampullary tumours, causing postoperative complications in 30% - 50% of cases. Postpancreatectomy haemorrhage (PPH) occurs in 1% - 8% of patients with an 11% - 38% mortality, making it one of the most lethal complications; early prevention and recognition are therefore essential. However, its risk factors remain incompletely characterized, and optimal management is not yet established. In order to inform perioperative management, this narrative review synthesized evidence on the presentation, classification, pathogenesis, and risk factors of PPH, together with preventive and therapeutic strategies. The review found risk factors distributed across preoperative (hyperbilirubinemia, advanced age, hypertension, ASA grade ≥ III, and elevated body mass index), intraoperative (soft pancreatic parenchyma, main pancreatic duct ≤ 3 mm, transfusion, increased blood loss, and prolonged operative time > 610 min), and postoperative phases, in which pancreatic fistula and intra-abdominal infection drive delayed haemorrhage via the cascade of fistula → infection → vascular erosion → pseudoaneurysm → haemorrhage. This review indicates that PPH arises from converging perioperative factors and warrants risk-stratified, whole-period prevention, with treatment following a severity-stratified algorithm: conservative management for mild haemorrhage, endovascular intervention first-line for moderate-to-severe haemorrhage, and prompt surgery for haemodynamically unstable patients.