Incidence and Management of Bile Leakage After Hepatic Resection for Malignant Hepatic Tumors

Tanaka, Shogo; Hirohashi, Kazuhiro; Tanaka, Hiromu; Shuto, Taichi; Kubo, Shoji; Takemura, Shigekazu; Yamamoto, Takatsugu; Uenishi, Takahiro; Kinoshita, Hiroaki

doi:10.1016/s1072-7515(02)01288-7

Cited by 157 publications

(144 citation statements)

References 30 publications

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“…In a recent report, TANAKA et al (29) published a leakage rate of 7.2%, with a significant number of the patients with this complication requiring reintervention. In a series of 5.5% of biliary leakage, LAM et al (18) , in agreement with BISMUTH et al (2) , concluded that intraoperative dye tests significantly reduced fistula rates.…”

Section: Discussionmentioning

confidence: 99%

Liver resection: 10-year experience from a single Institution

Coelho

Claus

Machuca

et al. 2004

Arq. Gastroenterol.

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BACKGROUND: Liver resection constitutes the main treatment of most liver primary neoplasms and selected cases of metastatic tumors. However, this procedure is associated with significant morbidity and mortality rates. AIM: To analyze our experience with liver resections over a period of 10 years to determine the morbidity, mortality and risk factors of hepatectomy. PATIENTS AND METHODS: Retrospective review of medical records of patients who underwent liver resection from January 1994 to March 2003. RESULTS: Eighty-three (41 women and 42 men) patients underwent liver resection during the study period, with a mean age of 52.7 years (range 13-82 years). Metastatic colorectal carcinoma and hepatocellular carcinoma were the main indications for hepatic resection, with 36 and 19 patients, respectively. Extended and major resections were performed in 20.4% and 40.9% of the patients, respectively. Blood transfusion was needed in 38.5% of the operations. Overall morbidity was 44.5%. Life-threatening complications occurred in 22.8% of cases and the most common were pneumonia, hepatic failure, intraabdominal collection and intraabdominal bleeding. Among minor complications (30%), the most common were biliary leakage and pleural effusion. Size of the tumor and blood transfusion were associated with major complications (P = 0.0185 and P = 0.0141, respectively). Operative mortality was 8.4% and risk factors related to mortality were increased age and use of vascular exclusion (P = 0.0395 and P = 0.0404, respectively). Median hospital stay was 6.7 days. CONCLUSION: Liver resections can be performed with low mortality and acceptable morbidity rates. Blood transfusion may be reduced by employing meticulous technique and, whenever indicated, vascular exclusion.

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Section: Discussionmentioning

confidence: 99%

Liver resection: 10-year experience from a single Institution

Coelho

Claus

Machuca

et al. 2004

Arq. Gastroenterol.

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“…After stapler hepatectomy, bile leak or bilioma was recorded in only 8% of cases [22] which can rarely be achieved with conventional resection techniques [37]. The innovative advantage of using staplers is that they are generally very fast, in contrast to CUSA.…”

Section: Discussionmentioning

confidence: 99%

The Use of Endo-GIA Vascular Staplers in Liver Surgery and Their Potential Benefit:A Review

et al. 2007

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Stapling devices have been introduced for safety and to reduce the overall operative time in many surgical procedures. In hepatobiliary surgery, i.e. liver resection, several types of staplers are in use. While transection of hepatic vessels with vascular staplers is well established, their use in dissecting hepatic parenchyma has only been assessed recently. Its advantages were especially a low rate of biliary complications (i.e., bile fistulas, bilioma) and reduced bleeding. As expected, the operative time was decreased dramatically while both the complication rate in general and the overall costs for stapler hepatectomy were comparable with other techniques used in high-volume centers. Thus, endo-GIA vascular staplers can be safely used to dissect the hepatic parenchyma in a routine clinical setting with low incidence of surgical complications.

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“…According to the results of Tanaka et al [20], patients with cirrhosis had a lower incidence of biliary leakage, but the difference was not statistically significant (4.5 vs. 8.7%, p = 0.20). Nagano et al [11] detected advanced age, large incisional surface areas, and high-risk operations (procedures associated with exposure of the major glissonian sheath around the liver hilus) significant on univariate analysis.…”

Section: Incidence and Risk Factors Of Biliary Leakagementioning

confidence: 95%

Prevention of Biliary Leakage after Partial Liver Resection Using Topical Hemostatic Agents

et al. 2007

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Liver resection is widely accepted as the only potentially curative treatment in malignant or benign hepatobiliary lesions. Although not frequent, biliary leakage is a postoperative complication which may have considerable consequences. The field of topical hemostatic agents is rapidly developing, with various products currently available. This article reviews the risk factors associated with biliary leakage and the methods used for testing or prevention of biliary leakage. A literature search was performed using key words related to experimental and clinical studies dealing with biliary leakage. Experimental studies assessed the potential biliostatic effect of different topical hemostatic agents after bile duct reconstruction. Clinical series show biliary leakage rates up to 12%. There is no evidence that flushing of the bile duct system after resection reduces the incidence of biliary leakage. Further controlled studies are needed to clarify the preventive effect of topical hemostatic agents on biliary leakage after liver resection.

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Incidence and Management of Bile Leakage After Hepatic Resection for Malignant Hepatic Tumors

Cited by 157 publications

References 30 publications

Liver resection: 10-year experience from a single Institution

Liver resection: 10-year experience from a single Institution

The Use of Endo-GIA Vascular Staplers in Liver Surgery and Their Potential Benefit:A Review

Prevention of Biliary Leakage after Partial Liver Resection Using Topical Hemostatic Agents

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