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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Albumin-Bilirubin Score: Predicting Short-Term Outcomes Including Bile Leak and Post-hepatectomy Liver Failure Following Hepatic Resection
Nikolaos Andreatos,Neda Amini,Faiz Gani,Georgios A. Margonis,Kazunari Sasaki,Vanessa M. Thompson,David J. Bentrem,Bruce L. Hall,Henry A. Pitt,Ana Wilson,Timothy M. Pawlik,Timothy M. Pawlik +11 more
TL;DR: The ALBI score was associated with short-term post-operative outcomes following hepatic resection and represents a useful pre-operative risk-assessment tool to identify patients at risk for adverse post-operative outcomes.
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The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial
Gianfranco Silecchia,Cristian Eugeniu Boru,Jean Mouiel,Marco Rossi,Marco Anselmino,Mario Morino,Mario Toppino,Achille L. Gaspari,Paolo Gentileschi,RM Tacchino,Nicola Basso +10 more
TL;DR: The use of fibrin sealant in laparoscopic RYGBP may be beneficial in reducing the reintervention rate for major perioperative complications, and larger studies are needed.
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Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections
TL;DR: BL remains frequent after liver resection and has a dramatic impact on patient survival and care costs, which could be reduced by avoiding the pre-operative use of bevacizumab, avoiding selective clamping and performing a blue dye test in all resections.
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Preoperative Biliary Drainage Increases Infectious Complications after Hepatectomy for Proximal Bile Duct Tumor Obstruction
Alessandro Ferrero,Roberto Lo Tesoriere,Luca Viganò,Luisa Caggiano,Enrico Sgotto,Lorenzo Capussotti +5 more
TL;DR: Overall mortality and morbidity after liver resection are not improved by preoperative biliary drainage in jaundiced patients and prehepatectomy bile drainage increases the incidence of infectious complications.
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A prospective study of the efficacy of clinical application of a new carrier-bound fibrin sealant after liver resection.
Javier Briceño,Álvaro Naranjo,Ruben Ciria,Rafael Díaz-Nieto,J.M. Sánchez-Hidalgo,A. Luque,S. Rufian,Pedro López-Cillero +7 more
TL;DR: The use of a new carrier-bound collagen sponge after major liver resection may be recommended because of its clinical and cost-savings effectiveness.
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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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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