Bile Leakage After Hepatic Resection

TLDR: Patients with bile leakage from the hepatic hilum and postoperative uncontrollable ascites tend to have a poor prognosis, especially when a high-risk surgical procedure is performed in patients with liver cirrhosis, and more careful surgical procedures and use of an intraoperative biles leakage test are recommended.

Abstract: Because of recent advances in liver surgery, hepatic resections are being performed with increasing frequency, and the surgical death rate for such resections is decreasing. 1–7 Bile leakage, of course, is the primary complication occurring after liver surgery, and it can not only debase the quality of the postoperative course of patients, but also can lead to hospital death. Despite a significant decrease in the overall surgical complication rate in hepatic resections, the rate of bile leakage has not changed, with an incidence of 4.8% to 7.6% reported in recent large series. 2–8 The presence of bile, blood, and devitalized tissues in the dead space after hepatectomy may provide the ideal environment for bacterial growth and impair the normal host defense mechanisms. 9, 10 The combination of sudden reduction in the liver volume and development of an intraperitoneal septic complication after hepatectomy (IPSCH) frequently results in liver failure, leading to a grave prognosis. 11 The aims of this study were, therefore, to clarify the perioperative risk factors for postoperative bile leakage after hepatic resection, to evaluate the intraoperative bile leakage test as a preventive measure, and to propose a treatment strategy for postoperative bile leakage according to the outcome of these patients.