Bile Leakage After Hepatic Resection

Abstract

ObjectiveTo identify the perioperative risk factors for postoperative bile leakage after hepatic resection, to evaluate the intraoperative bile leakage test as a preventive measure, and to propose a treatment strategy for postoperative bile leakage according to the outcome of these patients. Summary Background DataBile leakage remains a common cause of major complications after hepatic resection. MethodsBetween January 1985 and June 1999, 781 hepatic resections without bilioenteric anastomosis were performed at the authors' institution. Perioperative risk factors related to postoperative bile leakage were identified using univariate and multivariate analysis. The characteristics of patients with intractable bile leakage and the effect of intraoperative bile leakage test were also examined. Management was evaluated in relation to the outcomes and the clinical characteristics of the patients with bile leakage. ResultsBile leakage developed in 31 (4.0%) of 781 hepatic resections. This complication carried high risks for surgical death (two patients [6.5%] died). The stepwise logistic regression analysis identified high-risk surgical procedure, in which the cut surface exposed the major Glisson's sheath and included the hepatic hilum (i.e., anterior segmentectomy, central bisegmentectomy, or total caudate lobectomy), as the independent predictor of the development of postoperative bile leakage. None of the 102 cases in which an intraoperative bile leakage test was performed were subsequently complicated by postoperative bile leakage, and the preventive effect of the test was statistically significant. Patients with fisterographically demonstrable leakage from the hepatic hilum and with postoperative uncontrollable ascites had poor outcomes. ConclusionPatients with bile leakage from the hepatic hilum and postoperative uncontrollable ascites tend to have a poor prognosis. Therefore, especially when a high-risk surgical procedure is performed in patients with liver cirrhosis, more careful surgical procedures and use of an intraoperative bile leakage test are recommended.Because of recent advances in liver surgery, hepatic resections are being performed with increasing frequency, and the surgical death rate for such resections is decreasing. [1][2][3][4][5][6][7] Bile leakage, of course, is the primary complication occurring after liver surgery, and it can not only debase the quality of the postoperative course of patients, but also can lead to hospital death. Despite a significant decrease in the overall surgical complication rate in hepatic resections, the rate of bile leakage has not changed, with an incidence of 4.8% to 7.6% reported in recent large series.2-8 The presence of bile, blood, and devitalized tissues in the dead space after hepatectomy may provide the ideal environment for bacterial growth and impair the normal host defense mechanisms.9, 10 The combination of sudden reduction in the liver volume and development of an intraperitoneal septic complication after hepatectomy (IPSCH) frequently results in live...

The small remnant liver after major liver resection: How common and how relevant?

“…Also, biliary leakage is correlated with the care with which liver transection is performed 38 and the location of the transection plane rather than with the extent of resection. 39,40 Thus, the increase in the rate of biliary complications and ascites in patients with very large liver remnant volumes (Ͼ60%) compared with those with liver volumes 51% to 60%, is not likely related to volume but rather to technical issues. The same arguments likely hold true for postoperative bleeding and pulmonary complications.…”

Central Bisegmentectomy for Malignant Liver Tumors: Experience in 8 Patients

“…7 The ICGR 15 is useful for predicting the safe limit of liver resection in each patient, and liver volumetry using computed tomography is helpful for evaluating whether the [8][9][10] Preserving more liver parenchyma decreases morbidity and mortality rates 11 and increases the possibility of the second hepatic resection in the case of a recurrent intrahepatic tumor. 12 However, more extensive dissection of vascular pedicles and larger resection surfaces of liver parenchyma in CBS may result in excessive blood loss, longer duration of operation, or greater incidence of postoperative bile leakage, 8,13,14 and CBS has not been frequently used for treatment of centrally located liver tumors. Because of the ability to prevent excessive intraoperative blood loss and postoperative complications using recent surgical techniques, image technologies, and preoperative assessment of liver function and measuring of remnant liver volume, CBS leads to a better therapeutic outcome for centrally located liver tumors, especially in patients with preoperative impaired liver function.…”

Risk Factors Associated with Surgical Site Infection after Hepatectomy for Liver Disease

“…Postoperative bile leakage was defined as the drainage of macroscopic bile from the surgical drains for more than 7 days after the operation [20] and the definition of the International Study Group of Liver Surgery was used from May 2011 [21]. SSI was defined as a condition in which purulent discharge was observed from any incision or space that was manipulated during an operation, within 30 days of that operation and with or without microbiological evidence, according to the guideline issued by CDC [6].…”