Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post‐operative bile leak?

Nanashima, Atsushi; Abo, Takafumi; Shibuya, Ayako; Tominaga, Tetsuro; Matsumoto, Aya; Tou, Kazuo; Kitajima, Masaki; Takeshita, Hiroaki; Hidaka, Shigekazu; Tsuchiya, Tomoshi; Yamasaki, Naoya; Nagayasu, Takeshi

doi:10.1111/j.1477-2574.2012.00611.x

Cited by 20 publications

(23 citation statements)

References 11 publications

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“…We know that complete drainage of intra-abdominal fluid collections by operative drains, secondary drainage puncture, and endoscopic nasobiliary drainage can help with this goal, but we also showed that there was a marginal tendency toward decreased organ/space SSI rates among patients with cystic duct tubes that were placed preemptively for bile leakage. This is consistent with a previous report showing that a transcystic drainage tube inserted after hepatectomy could help prevent or treat bile leakage [26]. Because cystic tubes were inserted in patients having a high risk of postoperative bile leakage, although it did not reach statistical difference, the result that the rate of organ/space SSI in patients with cystic tubes was lower than that in those without cystic tubes may have some clinical value; that is, the cystic tube might have prevented subsequent organ/space SSI after bile leakage.…”

Section: Discussionsupporting

confidence: 81%

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata

Hasegawa²,

Kobayashi³

et al. 2017

Dig Surg

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Aims: To clarify the clinical impact, risk factors, and preventive methods for surgical site infection (SSI) after hepatectomy for hepatocellular carcinoma (HCC). Methods: We included 879 consecutive patients who underwent hepatectomy for HCC between 2002 and 2011. Univariate and multivariate analyses were conducted to identify the risk factors for incisional and organ/space SSIs. ORs and 95% CIs are reported. Results: The incidences of incisional and organ/space SSIs were 24 (2.7%) and 73 (8.3%), respectively. High body mass index, multiple resections, and organ/space SSI were associated with incisional SSIs, while repeat hepatectomy (OR 2.14, 95% CI 1.27-3.60), ascites (OR 2.97, 95% CI 1.55-5.48), and bile leakage (OR 4.77, 95% CI 2.77-8.11) were independent risk factors for organ/space SSI. Among the cases with bile leakage, lower rates of organ/space SSIs tended to be observed in patients with cystic duct tubes than in patients without such tubes (13.2 vs. 26.5%, p = 0.157). Retrograde drain infections increased when drain placement was prolonged for more than 4 postoperative days. Conclusion: Bile leakage was associated with the greatest risk of organ/space SSI after hepatectomy for HCC. Cystic duct tubes might be useful for preventing bile leakage and subsequent organ/space SSI after procedures that extensively expose Glissonean pedicles.

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Section: Discussionsupporting

confidence: 81%

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata

Hasegawa²,

Kobayashi³

et al. 2017

Dig Surg

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“…A beneficial impact of T‐tube insertion in the choledochal duct on postoperative biliary fistula has also been reported in a subgroup of patients undergoing extended hemihepatectomy. In contrast, other authors have found no evidence of a difference in frequency of bile leakage in patients with or without transcystic tube insertion. Some studies, including experimental animal studies, have even indicated that external biliary drainage is not only ineffective but is in fact associated with worse liver regeneration after hepatectomy owing to loss of bile acid from the intestine during external drainage.…”

Section: Discussionmentioning

confidence: 90%

“…According to the literature, a biliary fistula rate of 15 per cent could be expected in the control group. The sample size was estimated to reveal a difference of 10 per cent between the two groups for the primary endpoint, which would be clinically relevant.…”

Section: Methodsmentioning

confidence: 94%

“…The results of this randomized trial provide evidence to bring an end to the controversy regarding the use of biliary drainage during hepatectomy; this practice is variable between surgical teams and its use is based only on retrospective studies.…”

Section: Discussionmentioning

confidence: 99%

“…Biliary fistula is one of the most common complications after hepatic resection, and remains a major cause of increased morbidity. The reported rate of biliary leakage after hepatectomy without biliary reconstruction ranges from 3·6 to 26 per cent. In addition to increasing morbidity and duration of hospital stay, this complication can be fatal as a result of a vicious circle involving sepsis, liver failure and death.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial

Maulat

Régimbeau

Buc

et al. 2020

British Journal of Surgery

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Background: Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula.Methods: This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers. The primary endpoint was the occurrence of biliary fistula after surgery. Secondary endpoints were morbidity, postoperative mortality, duration of hospital stay, reoperation, readmission to hospital, and complications caused by catheters. Intention-to-treat and per-protocol analyses were performed.Results: A total of 310 patients were randomized. In intention-to-treat analysis, there were 158 patients in the transcystic group and 149 in the control group. Seven patients were removed from the per-protocol analysis owing to protocol deviations. The biliary fistula rate was 5⋅9 per cent in intention-to-treat and 6⋅0 per cent in per-protocol analyses. The rate was similar in the transcystic and control groups (5⋅7 versus 6⋅0 per cent; P = 1⋅000). There were no differences in terms of morbidity (49⋅4 versus 46⋅3 per cent; P = 0⋅731), mortality (2⋅5 versus 4⋅7 per cent; P = 0⋅367) and reoperations (4⋅4 versus 10⋅1 per cent; P = 1⋅000). Median duration of hospital stay was longer in the transcystic group (11 versus 10 days; P = 0⋅042). The biliary fistula risk was associated with the width and length of the hepatic cut surface.Conclusion: This randomized trial did not demonstrate superiority of transcystic drainage during hepatectomy in preventing biliary fistula. The use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. Registration number: NCT01469442 (http://www .clinicaltrials.gov).

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Risk factors of postoperative bile leakage after liver resection: A systematic review and meta‐analysis

et al. 2023

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ObjectivePostoperative bile leakage (POBL) is one of the most common complications after liver resection. However, current studies on the risk factors for POBL and their impacts on surgical outcomes need to be more consistent. This study aims to conduct a meta‐analysis to analyze the risk factors for POBL after hepatectomy.MethodsWe incorporated all eligible studies from Embase, PubMed, and the Web of Science database (until July 2022) into this study. RevMan and STATA software were used to analyze the extracted data.ResultsA total of 39 studies, including 43,824 patients, were included in this meta‐analysis. We found that gender, partial hepatectomy, repeat of hepatectomy, extended hepatectomy, abdominal drain, diabetes, Child≥B, solitary tumor, and chemotherapy are the factors of grade B and C POBL. Some recognized risk factors were considered potential risk factors for grade B and C bile leakage because no subgroup analysis was performed, like HCC, cholangiocarcinoma, major resection, posterior sectionectomy, bi‐segmentectomy, S4 involved, S8 involved, central hepatectomy, and bile duct resection/reconstruction. Meanwhile, cirrhosis, benign diseases, left hepatectomy, and Segment 1 resection were not significant for grade B and C bile leakage. The influence of lateral sectionectomy, anterior sectionectomy, S1 involved, S3 involved, high‐risk procedure, laparoscope, and blood loss>1000 mL on POBL of ISGLS needs further research. Meanwhile, POBL significantly influenced overall survival (OS) after liver resection.ConclusionsWe identified several risk factors for POBL after hepatectomy, which could prompt the clinician to decrease POBL rates and make more beneficial decisions for patients who underwent the hepatectomy.

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Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post‐operative bile leak?

Abstract: The usefulness of the C tube in preventing post-hepatectomy bile leak could not be confirmed; however, both bile leak requiring clinical management and long hospitalization after a major hepatectomy could be reduced with C tube use.

Cited by 20 publications

References 11 publications

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial

Risk factors of postoperative bile leakage after liver resection: A systematic review and meta‐analysis

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