Diagnosis and management of bile leaks after blunt liver injury

“…Interestingly, in the discussion following the presentation of the systematic review and meta-analysis, which did not find a benefit to drain placement in hepato-pancreato-biliary surgery, three of the five discussants reported ongoing drain use in their practice [15]. Drains are still widely employed by trauma surgeons for the management of hepatic trauma, even at re-operation for an ongoing bile leak [18]. However, we cannot find a justification for drain placement in cases of excessive intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Drain use after open cholecystectomy: is there a justification?

Zaydfudim

Russell

Feurer

et al. 2009

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background Despite randomized trials showing no benefit, drain use after open cholecystectomy continues, perhaps as a result of more complicated patient presentation. We examined the reasons for drain use in patients undergoing open cholecystectomy and evaluated the effect of drain placement on surgical outcomes. Methods Univariate and multivariate analyses compared pre-and intraoperative factors associated with drain placement, and postoperative outcomes in patients undergoing open cholecystectomy at our institution between 2002 and 2007.Results In 160 patients who underwent open cholecystectomy as primary operative procedure, 92 patients (58%) had a drain placed. In 22% of the cases, the surgeon's stated reason for drain placement was hemorrhage, abscess, nonidentification of critical structures, bile spillage, or concern for a bile leak. No reason was provided in78% of the operative reports. Multivariate analysis revealed diagnoses of acute, chronic, or gangrenous cholecystitis (n=120, 75%), intraoperative bile spillage (n=60, 38%), and higher than median intraoperative blood loss (>200 ml) as independent predictors of drain use (all p≤0.042). Patients with drains had increased length of hospital stay, postoperative ICU admissions, rates of hospital re-admission, and use of post-operative endoscopy (all p≤0.04). Patients with and without drains had similar rates of postoperative percutaneous drainage, bile leaks, intra-abdominal abscesses, wound infections, and deaths (all p≥0.121). Conclusions The use of drains after open cholecystectomy was associated with complicated patient presentations: cholecystitis, intraoperative bile spillage, and high intraoperative blood loss. These patients had longer and more complicated postoperative course and more re-admissions. However, use of intraoperative drains was not associated with a reduction in the need for postoperative percutaneous drainage or in improvement in the rates of bile leaks, infections, or deaths.

show abstract

“…Imaging is critical in the diagnosis given the multiple therapeutic modalities available to aid in management. CT is highly effective in identifying hepatic complications and is indicated for patients who develop tachycardia, fever, leukocytosis, or changes in liver function tests, while HIDA is a useful adjunct for the diagnosis of bile leak [16,50].…”

Section: Complications Of Nonoperative Managementmentioning

confidence: 99%

“…Higher grade injury and transfusion requirements have been identified as risk factors for subsequent complications, while others have shown that central injury to the liver and the use of hepatic angioembolization to be independent risk factors for bile leak in patients managed nonoperatively, and angioembolization and high-grade injury are associated with hepatic necrosis [5,50,51]. A small biloma may resolve without any intervention, while percutaneous drainage is often effective for a larger biloma, and endoscopic retrograde cholangiopancreatography (ERCP) and stenting is an effective primary management strategy or adjunct for major bile leaks [33,52,53].…”

Section: Complications Of Nonoperative Managementmentioning

confidence: 99%

Management of blunt liver injury: what is new?

Ward

Alarcon

2015

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. On the other hand, recognition of the patient who should proceed to immediate laparotomy is of utmost importance. A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.

show abstract

Diagnosis and management of bile leaks after blunt liver injury

Cited by 62 publications

References 17 publications

Complex Hepatic Injuries: an Audit from a Tertiary Center

Complex Hepatic Injuries: an Audit from a Tertiary Center

Drain use after open cholecystectomy: is there a justification?

Management of blunt liver injury: what is new?

Contact Info

Product

Resources

About