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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Evaluation of the white test for the intraoperative detection of bile leakage.
TL;DR: The White test detected a significantly higher number of bile leakage sites compared with the conventional method (Wilcoxon signed-rank test; P < 0.001) and it is recommended that surgeons investigating biles leakage sites during liver resections should use the White test instead of the conventional bile leaking test.
Journal ArticleDOI
Biliary Leakage After Hepatobiliary and Pancreatic Surgery: A Classification System to Guide the Proper Percutaneous Treatment
Giancarlo Mansueto,Francesco Lorenzo Gatti,Enrico Boninsegna,Simone Conci,Alfredo Guglielmi,Alberto Contro +5 more
TL;DR: An anatomical classification of biliary fistula is proposed to guide the most appropriate percutaneous approach in all kinds of bile leakage, even in severe cases; these are safe techniques with a high success rate.
Journal ArticleDOI
A novel scoring system for evaluating the difficulty of lysis of adhesion and surgical risk at repeat hepatectomy.
TL;DR: A new scoring system for evaluating the severity of adhesion after hepatectomy is created and its performance is tested looking at the correlation with morbidity rate.
Journal ArticleDOI
Treatment strategy for isolated bile leakage after hepatectomy: Literature review
Norio Kubo,Ken Shirabe +1 more
TL;DR: This review aimed to clarify the treatment strategy for IBL by summarizing studies on IBL after hepatectomy without extrahepatic bile duct resection, and considered non‐surgical treatment such as PTPE, PTPe with bileduct ablation, and endoscopic methods as effective treatment approaches.
Journal ArticleDOI
Meta-Analysis and Meta-Regression of Risk Factors for Surgical Site Infections in Hepatic and Pancreatic Resection.
Keno Mentor,Bathiya Ratnayake,Nasreen Akter,Giorgio Alessandri,Gourab Sen,Jeremy French,Derek Manas,John S. Hammond,Sanjay Pandanaboyana,Sanjay Pandanaboyana +9 more
TL;DR: The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection, and biliary resections during liver surgery increase the rates of SSI.
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
TL;DR: Assessment of the nature of changes in the field of hepatic resectional surgery and their impact on perioperative outcome to establish a baseline for this type of surgery.
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One thousand fifty-six hepatectomies without mortality in 8 years.
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.
Journal ArticleDOI
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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