Posthepatectomy bile leakage: how to manage.
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TLDR
The incidence of posthepatectomy biliary leakage has decreased over time, while PTD and endoscopic stenting are effective treatment modalities.Abstract:
Background: Biliary leakage after liver resection continues to be reported. Management of bile leakage has changed in recent years, with nowadays non-surgical procedures as the preferred treatment. Methods: Biliary leakage and management were assessed in 381 patients who underwent liver resection between January 2005 and April 2011. Results: The overall rate of biliary leakage after liver resection was 5.0%, with a higher incidence in patients who had undergone concomitant hepaticojejunostomy (HJ; 13.6 vs. 3.2%). Hospital stay (p = 0.047), major resections (p = 0.018), operation time (p = 0.011), and relaparotomy (p = 0.002) were risk factors for postoperative bile leakage. Multivariate analysis identified relaparotomy as an independent factor (OR 4.216, p = 0.034). Bile leakage in patients without HJ (n = 10) was managed in 6 patients by percutaneous transhepatic biliary drainage (PTD), and in 3 patients by endoscopic drainage. One patient was treated surgically. All patients with an HJ and postoperative bile leakage (n = 9) underwent PTD. Conclusion: The incidence of posthepatectomy biliary leakage has decreased over time, while PTD and endoscopic stenting are effective treatment modalities. PTD is the treatment of choice in bile leakage after resection combined with HJ.read more
Citations
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Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery.
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TL;DR: A uniform definition and severity grading of bile leakage is proposed to enable a standardized comparison of the results of different clinical trials and may facilitate an objective evaluation of diagnostic and therapeutic modalities in the field of hepatobiliary and pancreatic operative therapy.
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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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Bile Leakage and Liver Resection: Where Is the Risk?
Lorenzo Capussotti,Alessandro Ferrero,Luca Viganò,Enrico Sgotto,Andrea Muratore,Roberto Polastri +5 more
TL;DR: 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.
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Risk Factors and Management of Bile Leakage after Hepatic Resection
Yasuhiko Nagano,Shinji Togo,Kuniya Tanaka,Hidenori Masui,Itaru Endo,Hitoshi Sekido,Kaoru Nagahori,Hiroshi Shimada +7 more
TL;DR: The aim of this study was to identify the perioperative risk factors for postoperative bile leakage after hepatic resection and to propose a treatment strategy for such leakage when it does occur, and to show that patients with involvement of the proximal bile duct were slower to heal than those with no demonstrable biles duct involvement.
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