Posthepatectomy Bile Leakage: How to Manage

Abstract

Background: Biliary leakage after liver resection continues to be reported. Management of bile leakage has changed in recent years, with nowadays non-surgical procedures as the preferred treatment. Methods: Biliary leakage and management were assessed in 381 patients who underwent liver resection between January 2005 and April 2011. Results: The overall rate of biliary leakage after liver resection was 5.0%, with a higher incidence in patients who had undergone concomitant hepaticojejunostomy (HJ; 13.6 vs. 3.2%). Hospital stay (p = 0.047), major resections (p = 0.018), operation time (p = 0.011), and relaparotomy (p = 0.002) were risk factors for postoperative bile leakage. Multivariate analysis identified relaparotomy as an independent factor (OR 4.216, p = 0.034). Bile leakage in patients without HJ (n = 10) was managed in 6 patients by percutaneous transhepatic biliary drainage (PTD), and in 3 patients by endoscopic drainage. One patient was treated surgically. All patients with an HJ and postoperative bile leakage (n = 9) underwent PTD. Conclusion: The incidence of posthepatectomy biliary leakage has decreased over time, while PTD and endoscopic stenting are effective treatment modalities. PTD is the treatment of choice in bile leakage after resection combined with HJ.

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

“…More recent small series have shown that PTC and subsequent drainage for a variety of indications can be feasible in patients with nondilated bile ducts as well; the technical success rates were similar to those in patients with dilated bile ducts (91-100%) [17,19,20,21,22,23,24,25,26]. Several studies have described the management of biliary leakage both after hepaticojejunostomy or post-hepatectomy, however a PTBD was performed in the minority of patients [27,28]. To our knowledge, we report the largest study on only PTBD procedures for biliary leakage in a group of exclusively postoperative patients.…”

Hepaticojejunostomy leak after pancreaticoduodenectomy

“…The reported bile leak rate for this procedure was higher than the liver resection alone, and major hepatectomy and lymphadenectomy were considered as risk factors. 12,13 In our center the hepatoduodenal ligament lymph node dissection was performed routinely for malignancy and the extrahepatic biliary duct was skeletonized, which would destroy the blood supply of common hepatic duct partially. Meanwhile liver resection, especially for right hepatectomy, would make a further diminution of blood supply and prevent the healing of HJ anastomoses.…”

CT diagnosis of an iatrogenic bile duct injury

“…Leak rates following laparoscopic cholecystectomy are now around 0.2% and so similar to the open area 10. Although less commonly performed operations, the rates of biliary leaks following liver resection and transplantation are reported to be in the order of 5% and 2–25% respectively 11 12…”