Bile Leakage and Liver Resection: Where Is the Risk?
Lorenzo Capussotti,Alessandro Ferrero,Luca Viganò,Enrico Sgotto,Andrea Muratore,Roberto Polastri +5 more
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TLDR
Hematectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage, and intraoperative use of fibrin glue may reduce the risk of postoperativebile leakage.Abstract:
Hypothesis The knowledge of risk factors for bile leakage after liver resection could reduce its incidence. Design Retrospective study. Setting Tertiary care referral center. Patients The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003. Interventions Liver resections without biliary anastomoses. Main Outcome Measures Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics. Results Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis ( P = .05) or intraoperative use of fibrin glue ( P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma ( P P = .03), left hepatectomy extended to segment 1 ( P P = .006), and hepatectomy including segment 1 ( P = .001) or segment 4 ( P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage. Conclusions Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.read more
Citations
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Ethanol ablation for refractory bile leakage after complex hepatectomy.
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TL;DR: The aim of this study was to assess the value of ethanol ablation in refractory bile leakage and to recommend the use of EMT for posthepatectomy bile leaking.
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Liver resection without pedicle clamping: feasibility and need for "salvage clamping". Looking for the right clamping policy. Analysis of 512 consecutive resections.
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External Validation and Optimization of the French Association of Hepatopancreatobiliary Surgery and Transplantation's Score to Predict Severe Postoperative Biliary Leakage after Open or Laparoscopic Liver Resection.
Kayvan Mohkam,Kayvan Mohkam,David Fuks,Eric Vibert,Takeo Nomi,François Cauchy,Yoshikuni Kawaguchi,Emmanuel Boleslawski,Jean-Marc Regimbeau,Brice Gayet,Jean-Yves Mabrut,Jean-Yves Mabrut +11 more
TL;DR: Inclusion of conversion to open surgery as an additional factor to the ACHBT score allowed it to improve its performance to predict severe PHBL after laparoscopic hepatectomy, and represents an externally validated tool to predictsevere PHBL.
References
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Improvement in Perioperative Outcome After Hepatic Resection: Analysis of 1,803 Consecutive Cases Over the Past Decade
William R. Jarnagin,Mithat Gonen,Yuman Fong,Ronald P. DeMatteo,Leah Ben-Porat,Sarah A Little,Carlos U. Corvera,Sharon M. Weber,Leslie H. Blumgart +8 more
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Hiroshi Imamura,Yasuji Seyama,Norihiro Kokudo,Atsushi Maema,Yasuhiko Sugawara,Keiji Sano,Tadatoshi Takayama,Masatoshi Makuuchi +7 more
TL;DR: Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.
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Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system.
TL;DR: The Brisbane 2000 system of nomenclature of hepatic anatomy and resections was introduced to provide a universal terminology in an area that was plagued by confusing and inappropriate terminology.
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Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: Analysis of 1222 consecutive patients from a prospective database
Ronnie T.P. Poon,S. T. Fan,Chung Mau Lo,Chi Leung Liu,Chi Ming Lam,Wai Key Yuen,C Yeung,John Wong +7 more
TL;DR: Perioperative outcome has improved despite extending the indication of hepatectomy to more high-risk patients, and the role of hepATEctomy in the management of hepatobiliary diseases can be expanded.
Journal ArticleDOI
Bile Leakage After Hepatic Resection
Yo-ichi Yamashita,Takayuki Hamatsu,Tatsuya Rikimaru,Shinji Tanaka,Ken Shirabe,Mitsuo Shimada,Keizo Sugimachi +6 more
TL;DR: 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.
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