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Bile Leakage and Liver Resection: Where Is the Risk?

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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.

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References
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Journal ArticleDOI

Improvement in Perioperative Outcome After Hepatic Resection: Analysis of 1,803 Consecutive Cases Over the Past Decade

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.
Journal ArticleDOI

One thousand fifty-six hepatectomies without mortality in 8 years.

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.
Journal ArticleDOI

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

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

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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