Risk Factors and Management of Postoperative Bile Leakage after Hepatectomy without Bilioenteric Anastomosis

Ishii, Hiromichi; Ochiai, Toshiya; Murayama, Yasutoshi; Komatsu, Shuhei; Shiozaki, Atsushi; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Okamoto, Kazuma; Kokuba, Yukihito; Sonoyama, Teruhisa; Otsuji, Eigo

doi:10.1159/000324042

Cited by 44 publications

(58 citation statements)

References 47 publications

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“…However, there is a possible bias because bile leakages may have resolved spontaneously without having been noted during admission. Non-surgical treatment is becoming the preferred approach in the management of postoperative bile leakage [11]. This is confirmed by the results of this study, in which all patients with bile leakage were successfully treated by percutaneous or endoscopic drainage between 2005 and 2011.…”

Section: Discussionsupporting

confidence: 77%

“…The risk factors for bile leakage have been already extensively described in several studies [1,5,11,12,13,14,15,16]. Reported independent factors that were correlated with the occurrence of bile leakage were: (1) exposure of Glisson’s sheath on the cut surface (caudate lobectomy, central bisectionectomy, and right anterior sectionectomy); (2) resection of segment 4; (3) a cut surface area ≥57.5 cm 2 ; (4) repeated hepatectomy; (5) intraoperative blood loss ≥775 ml; (6) intraoperative bile leakage; (7) prolonged operative time ≥300 min; (8) peripheral cholangiocarcinoma, and (9) preoperative chemoembolization.…”

Section: Discussionmentioning

confidence: 99%

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Posthepatectomy Bile Leakage: How to Manage

et al. 2012

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Posthepatectomy Bile Leakage: How to Manage

et al. 2012

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“…Biliary leakage is one of the most frequently reported intra-abdominal complications after liver resection [30,45,[56][57][58] . The rate of bile leakage in the literature after liver resection has been reported to range from 0% to 11% [23,46,47,[59][60][61] .…”

Section: Discussionmentioning

confidence: 99%

“…In hepatectomy without bilioenteric anastomosis, the principal causes of bile leakage are bile oozing from the transected liver surface and intraoperative biliary injury. There are reports that identified central hepatectomy as an independent risk factor for bile leakage because of the presence of two transection planes and exposure of the hepatic hilum [30,56] . In the 4 comparative studies comparing CH vs lobar or extended hemihepatectomies, there were no statistically significant differences in bile leak.…”

Section: Discussionmentioning

confidence: 99%

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Lee¹

2014

WJH

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AIM:To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not. METHODS:A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy. RESULTS:A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle's maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION:Based on current literature, CH is a promising option for anatomical parenchymal-preserving procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.

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“…Bile leakage is an important complication occurring after liver surgery and its reported incidence ranges between 4.8%-7.6% in large series [89][90][91][92][93][94][95] and is less common in surgery for CRLM than for HCC or CCA. The International Study Group of Liver Surgery has recently proposed a uniform definition of bile leakage and a grading system according to severity, which is based on drain fluid bilirubin concentration of greater than three times the serum despite early attempted correction with clotting factors; (3) abdominal ascites (drainage volumes > 500 mL/d); and (4) encephalopathy with hyperbilirubinemia and exclusion of other acute confusional states [36] .…”

Section: Bile Leaksmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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Risk Factors and Management of Postoperative Bile Leakage after Hepatectomy without Bilioenteric Anastomosis

Cited by 44 publications

References 47 publications

Posthepatectomy Bile Leakage: How to Manage

Posthepatectomy Bile Leakage: How to Manage

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

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