Advances in the prevention and management of postoperative bleeding complications in pancreaticoduodenectomy: Current strategies and future directions precise

Table 1 Summary of prevention and management strategies for postoperative bleeding in pancreaticoduodenectomy

Strategy category	Specific intervention	Clinical context/indication	Supporting evidence
Intraoperative prevention	GDA stump wrapping with omentum, falciform ligament, or teres hepatis	High-risk patients for postoperative bleeding; standard PD procedure	Xu et al[2], Meng et al[5], Zheng et al[6]
	Optimal choice of pancreatic anastomosis (e.g., pancreaticojejunostomy)	Soft pancreatic texture; high risk for pancreatic fistula	Müssle et al[7]
	Careful dissection near mesenteric-portal vein junction	Patients with vascular involvement	Ball et al[8]
Postoperative detection	Predictive nomogram including body mass index, American Society of Anesthesiologists score, fistula presence	All PD patients	Duan et al[9]
	Routine postoperative computed tomography or Doppler ultrasound	Surveillance for pseudoaneurysm or active bleeding	Ma et al[10]
Interventional management	Angiographic embolization	Hemodynamically stable patients with detectable bleeding source	Izumi et al[11]
	Viabahn stent graft placement	GDA pseudoaneurysm with compromised hepatic artery flow	Izumi et al[11]
	Surgical re-intervention (arterial ligation or repair)	Recurrent or uncontrolled hemorrhage	Preston et al[12]
Patient-specific considerations	Preoperative management of antithrombotic therapy	Patients on anticoagulants or antiplatelet agents	Nakamura et al[13], Mita et al[14]
	Bridging anticoagulation with low molecular weight heparin	Patients requiring temporary cessation of oral anticoagulants	Russell et al[15]

GDA: Gastroduodenal artery; PD: Pancreaticoduodenectomy.