Posthepatectomy bile leakage: how to manage.
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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References
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Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis.
Hiromichi Ishii,Toshiya Ochiai,Yasutoshi Murayama,Shuhei Komatsu,Atsushi Shiozaki,Yoshiaki Kuriu,Hisashi Ikoma,Masayoshi Nakanishi,Daisuke Ichikawa,Hitoshi Fujiwara,Kazuma Okamoto,Yukihito Kokuba,Teruhisa Sonoyama,Eigo Otsuji +13 more
TL;DR: Investigation of perioperative risk factors and management of postoperative bile leakage after hepatic resection without extrahepatic biliary resection and reconstruction found meticulous procedures are necessary during parenchymal hepatics resection, especially during central bisectionectomy.
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Prevention of biliary leakage after partial liver resection using topical hemostatic agents.
TL;DR: There is no evidence that flushing of the bile duct system after resection reduces the incidence of biliary leakage, and further controlled studies are needed to clarify the preventive effect of topical hemostatic agents on bile leakage after liver resection.
Journal ArticleDOI
Safety of Conservative Management of Bile Leakage after Hepatectomy with Biliary Reconstruction
Alessandro Ferrero,Nadia Russolillo,Luca Viganò,Enrico Sgotto,Roberto Lo Tesoriere,Marco Amisano,Lorenzo Capussotti +6 more
TL;DR: Conservative management of bile leakage after liver resection with biliary reconstruction is associated with higher rates of morbidity, the most severe complication is abdominal bleeding, which is related to the number of biliary ducts requiring reconstruction.
Journal ArticleDOI
Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases
Hiroshi Sadamori,Takahito Yagi,Hiroaki Matsuda,Susumu Shinoura,Yuzo Umeda,Ryuichi Yoshida,Daisuke Satoh,Takasi Utsumi,Teppei Ohnishi +8 more
TL;DR: Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
Journal Article
Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma.
Chih-Chun Lee,Gar-Yang Chau,Wing-Yiu Lui,Shyh-Haw Tsay,Kuang-Liang King,Che-Chuan Loong,Cheng-Yuan Hsia,Chew-Wun Wu +7 more
TL;DR: For HCC patients, preoperative chemoembolization and tumor(s) with central location are risk factors for post-hepatectomy bile leakage.
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