The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures

Abstract

Background: Bile leaks are one of the most common complications after liver resection. The International Study Group of Liver Surgery (ISGLS) established a uniform bile leak definition including a severity grading. However, a risk factor assessment according to ISGLS grading as well as the clinical implications has not been studied sufficiently so far. Methods: The incidence and grading of bile leaks according to ISGLS were prospectively documented in 501 consecutive liver resections between July 2012 and December 2016. A multivariate regression analysis was performed for risk factor assessment. Association with other surgical complications, 90-day mortality as well as length of hospital stay (LOS) was studied. Results: The total rate of bile leaks in this cohort was 14.0%: 2.8% grade A, 8.0% grade B, and 3.2% grade C bile leaks were observed. Preoperative chemotherapy or biliary intervention, diagnosis of hilar cholangiocarcinoma, colorectal metastasis, central minor liver resection, major hepatectomy, extended hepatectomy or two-stage hepatectomy, were some of the risk factors leading to bile leaks. The multivariate regression analysis revealed that preoperative chemotherapy, major hepatectomy and biliodigestive reconstruction remained significant independent risk factors for bile leaks. Grade C bile leaks were associated not only with surgical site infection, but also with an increased 90-day mortality and prolonged LOS. Conclusions: The preoperative treatment as well as the surgical procedure had significant influence on the incidence and the severity of bile leaks. Grade C bile leaks were clinically most relevant, and led to significant increased LOS, rate of infection, and mortality.

Perioperative Management of Complex Hepatectomy for Colorectal Liver Metastases: The Alliance between the Surgeon and the Anesthetist

“…Using the definition of the International Study Group of Liver Surgery (ISGLS), the incidence of PHBF ranges from 4.4% to 27.2% [ 95 , 96 ]. Spetzler et al reported that in patients who required neoadjuvant chemotherapy, liver fragility and major hepatectomy are predicted risk factors for PHBF [ 97 ]. Remarkably, these findings are consistent with previous studies [ 98 , 99 , 100 ].…”

ERAS in minimally invasive hepatectomy

“…For major liver resections, the risk of liver failure and bile leak is increased. 52 The liver itself might be cirrhotic, which can predispose to both post-operative ascites and haemorrhage after open hepatectomy. Conversely, in cirrhotic patients undergoing MIS liver resections, there is preservation of porto-systemic shunts with no increase in portal pressure and subsequent reduction of post-operative ascites and bleeding.…”

Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery

“…Patients with low risk of postoperative bile leak such as those undergoing left lateral resections and benign lesions resections would benefit from avoiding routine drains in minimizing retrograde infections and promoting postoperative mobility. 20 Both, PHLF and bile leak are classified into three grades as described in Table 3 .…”