Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction

Abstract

Background and Aim: The risk factors for bile leakage after hepatectomy without biliary reconstruction are controversial. This study investigated the risk factors for bile leakage after hepatectomy without biliary reconstruction.Methods: We searched databases (Embase (Ovid), Medline (Ovid), PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and May 1, 2021, to evaluate the risk factors for bile leakage after hepatectomy without biliary reconstruction.Results: A total of 16 articles were included in this study, and the overall results showed that sex (OR: 1.21, 95% CI: 1.04–1.42), diabetes (OR: 1.21, 95% CI: 1.05–1.38), left trisectionectomy (OR: 3.53, 95% CI: 2.32–5.36), central hepatectomy (OR: 3.28, 95% CI: 2.63–4.08), extended hemihepatectomy (OR: 2.56, 95% CI: 1.55–4.22), segment I hepatectomy (OR: 2.56, 95% CI: 1.50–4.40), intraoperative blood transfusion (OR:2.40 95%CI:1.79–3.22), anatomical hepatectomy (OR: 1.70, 95% CI: 1.19–2.44) and intraoperative bleeding ≥1,000 ml (OR: 2.46, 95% CI: 2.12–2.85) were risk factors for biliary leakage. Age >75 years, cirrhosis, underlying liver disease, left hepatectomy, right hepatectomy, benign disease, Child–Pugh class A/B, and pre-operative albumin <3.5 g/dL were not risk factors for bile leakage after hepatectomy without biliary reconstruction.Conclusion: Comprehensive research in the literature revealed that sex, diabetes, left trisectionectomy, central hepatectomy, extended hemihepatectomy, segment I hepatectomy, intraoperative blood transfusion, anatomical hepatectomy and intraoperative bleeding ≥1,000 ml were risk factors for biliary leakage.

Risk factors for bile leakage after liver resection for neoplastic disease

“…Resection involving the right lateral segments (S6-S7) is also strongly associated with the onset of the fistula: this is probably due to pumping action of the right diaphragm that increases the residual right hepatic bile duct pressure and increases bile leakage. (44) From the analysis of the data, a strong association (evaluated univariate) emerged between the presence of biliary anastomosis and the onset of the fistula. This association is well known in the literature.…”

“…(43) This condition, associated with microcirculatory disorders caused by metabolic disorders can damage the residual liver after hepatectomy and affect healing of the cut surface tissue, which may increase the risk of postoperative bile leakage. (44) Intraoperative blood loss is also a risk factor related to the onset of fistula. Anemization associated with clamping of the hepatic pedicle (Pringle's maneuver), sometimes necessary to dominate massive bleeding, could cause ischemia of the liver and reperfusion injury with effects on liver function and fistula development.…”

“…The amines act on the microcirculation, helping to create ischemia of the liver which is correlated with a disorder of parenchyma scarring and the onset of biliary fistula. (44) T…”

Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer

“…Imaging studies include ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and hepatobiliary iminodiacetic acid scans, which reveal the presence and location of bile leaks or biloma[ 23 ]. Endoscopic or percutaneous interventions include ERCP or PTC, which can not only confirm the diagnosis but also provide therapeutic options such as stenting or drainage[ 9 , 20 ].…”

“…It can cause abdominal pain, fever, infection, biloma formation, delayed wound healing, prolonged hospital stays, increased morbidity and mortality, and impaired quality of life. The reported incidence of bile leak after hepatectomy ranges from 3% to 27% depending on the definition, diagnosis, and classification criteria[ 9 ]. Several risk factors for bile leakage after hepatectomy have been identified, including the tumor location, extent of resection, operative time, blood loss, liver function, biliary pressure, surgical techniques, and drainage management[ 10 ].…”