Clinical score to predict the risk of bile leakage after liver resection

Abstract

BackgroundIn liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection.MethodsWe analyzed the postoperative course in 518 patients who underwent liver resection for malignancy to identify independent predictors of bile leakage, which was defined as “a drain fluid bilirubin concentration at least three times the serum bilirubin concentration on or after postoperative day 3,” as proposed by the International Study Group of Liver Surgery. To confirm the robustness of the risk score system for bile leakage, we analyzed the independent series of 289 patients undergoing liver resection for malignancy.ResultsAmong 81 (15.6 %) patients with bile leakage, 76 had grade A bile leakage, and five had grade C leakage and underwent reoperation. The median postoperative hospital stay was significantly longer in patients with bile leakage (median, 14 days; range, 8 to 34) than in those without bile leakage (11 days; 5 to 62; P = 0.001). There was no hepatic insufficiency or in-hospital death. The risk score model was based on the four independent predictors of postoperative bile leakage: non-anatomical resection (odds ratio, 3.16; 95 % confidence interval [CI], 1.72 to 6.07; P < 0.001), indocyanine green clearance rate (2.43; 1.32 to 7.76; P = 0.004), albumin level (2.29; 1.23 to 4.22; P = 0.01), and weight of resected specimen (1.97; 1.11 to 3.51; P = 0.02). When this risk score system was used to assign patients to low-, middle-, and high-risk groups, the frequency of bile leakage in the high-risk group was 2.64 (95 % CI, 1.12 to 6.41; P = 0.04) than that in the low-risk group. Among the independent series for validation, 4 (5.7 %), 16 (10.0 %), and 10 (16.6 %) patients in low-, middle, and high-risk groups were given a diagnosis of bile leakage after operation, respectively (P = 0.144).ConclusionsOur risk score model can be used to predict the risk of bile leakage after liver resection.

Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

“…Kilic et al [ 18 ] suggested that, when the mass diameter was adopted as 7.5 cm, the sensitivity and specificity for biliary-cyst communication were 79% and 73%, respectively. Other authors [ 9 ] have found that a lesion size greater than 10.5 cm is a vital predictor of cyst-biliary communication. When HAE masses are large or invade the hepatic portal vessels, various blood vascular complications occur, including the vena–cava syndrome, Budd–Chiari syndrome, and jaundice obstructive or bile duct dilatation due to narrowing of the hepatic veins [ 27 ] or inferior vena cava [ 28 ] or hilar bile duct, respectively.…”

“…[ 6 , 29 ] The greater the cut surface area of hepatectomy, the greater the damage to the small bile ducts. Kajiwara et al [ 9 ] set up a risk score model and revealed that the weight of the resected specimen ( P = .02) and nonanatomical resection ( P < .001) were independent predictors of postoperative BL. On the other hand, with a greater amount of blood loss, bile duct ischemia may ignore potential bile leak sites for surgeon.…”

“…Complications such as bile leakage (BL), portal hypertension, Budd–Chiari syndrome and liver rupture have been reported in advanced stages, and these indicate the invasive growth performance of the HAE. [ 5 ] Various complications occur after liver resection, but biliary leakage has been one of the most common and complex complications with a revealed incidence ranging from 3.6% to 15.6% [ 6 – 9 ] ; after hepaticojejunostomy, it ranges from 0.4% to 8%. [ 10 ] BL, as a significant complication after hepatectomy, [ 6 ] always leads to delayed pull-out of the abdominal drainage tube, prolonged hospital stay, application of additional inspection methods (minimally invasive and endoscopic methods) and interventions, even surgery again.…”

Postoperative Biliary Leak Treated with Chemical Bile Duct Ablation Using Absolute Ethanol: A Report of Two Cases

“…The postoperative biliary leak is a recognized complication of hepatobiliary and pancreatic surgery, with a reported frequency ranging from 0.5% to 15.6% [ 1 , 2 – 7 ]. Independent risk factors for postoperative biliary leak include preoperative cholangitis, complex hepatectomy, and a long operating time [ 6 , 8 ].…”

Risk Factors of Bile Leakage After Liver Resection

“…Под билиарными осложнениями понимают нарушение герметичности желчных протоков после нарушения их целостности. Следствием желчеистечения может быть развитие биломы, желчного свища и желчного перитонита [1][2][3].…”