Bile leakage and Liver resection: Where is the Risk?

Institute for Cancer Research and Treatment, Torino, Piedmont, Italy
Archives of Surgery (Impact Factor: 4.93). 07/2006; 141(7):690-4; discussion 695. DOI: 10.1001/archsurg.141.7.690
Source: PubMed


The knowledge of risk factors for bile leakage after liver resection could reduce its incidence.
Retrospective study.
Tertiary care referral center.
The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.
Liver resections without biliary anastomoses.
Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.
Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P < .001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.
Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.

Download full-text


Available from: Andrea Muratore, Jul 24, 2014
  • Source
    • "patients had residual tumor tissue at the proximal bile duct. Thus, IPBL did not originate from the cut surface of the liver, central bile duct lesions, or from tumor infiltration of the hepaticojejunostomy at the proximal bile duct, which are usually responsible for the high rate of bile leaks after hilar resections for cholangiocarcinoma [19] [20]. There was no association between postoperative bile leaks and the operation that was performed, although the rate of postoperative bile leaks was high in patients who had a redo procedure. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: After pancreatectomy, an isolated bile leak from the hepaticojejunostomy is a severe surgical complication that is underrepresented both, in the literature and in the awareness of pancreatic surgeons. The goal of this study was to analyze the incidence and outcome of isolated bile leaks after pancreatectomy. Material and methods: A retrospective study of patients who underwent duodenopancreatectomy or total pancreatectomy at a single-center institution was performed, which analyzed incidence and course of patients with postoperative bile leaks from the hepaticojejunostomy. Results: During a period of 42 months, 209 patients underwent pancreatic head resection or total pancreatectomy. Bile leaks occurred in 4% (8/209) and were more common in patients with distal bile duct cancer. Bile leaks led to longer hospital stay and were associated with abscess formation and other infectious complications. Unlike expected, most postoperative bile leaks occurred in the late postoperative period. Three patients required relaparotomy for biliary peritonitis or delayed visceral hemorrhage, while the other five patients underwent conservative management, including CT drainage and antibiotic therapy. One patient with a postoperative bile leak died due to delayed visceral hemorrhage. Conclusion: In contrast to recently published data, isolated postoperative bile leaks after pancreatectomy often occur in the late postoperative period and more frequently require a relaparotomy than the literature suggests. The presented study results may sensitize surgeons for this often disregarded topic and activate the discussion on treatment options.
    Journal of Investigative Surgery 05/2014; 27(5). DOI:10.3109/08941939.2014.916368 · 1.16 Impact Factor
  • Source
    • "The extent and type of resection have also been reported to be related to the incidence of leaks. The incidence is higher after a central hepatectomy involving segments 4, 5, and 8, right anterior sectionectomy (segments 5 and 8), left trisectionectomy, isolated segment 4 resection, and caudate lobe resections [6] [7] [9] [10]. In addition, left hepatectomy is associated with higher bile leaks probably due to drainage "
    [Show abstract] [Hide abstract]
    ABSTRACT: Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.
    HPB Surgery 05/2012; 2012(4):752932. DOI:10.1155/2012/752932
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bile leakages due to interruption of the intrahepatic bile duct after hepatectomy are often intractable. We herein report a case where portal vein embolization (PVE) decreased the bile production from the embolized part of the liver, which lead to healing of this type of bile leakage. A 77-year old man who had undergone an anterior segmentectomy of the liver for hepatocellular carcinoma 3 years prior was admitted to our hospital for an abscess in the right subphrenic space, and underwent percutaneous drainage. Fluoroscopy using a contrast medium from the drainage tube revealed that the root of the posterior branch of the bile duct was completely interrupted. The hilar side of the interrupted bile duct was closed, and all the bile from the posterior segment continued to be discharged at a rate of 100–150 ml/day for 2 months. The posterior branch of the portal vein was then embolized with fibrin glue by percutaneous transhepatic approach. After the PVE, the volume of discharge gradually decreased, and the drainage tube was removed 2 weeks after the PVE. Three months later, the patient was afebrile and doing well. PVE might be a useful method for treating interrupted type postoperative bile leakages.
    Clinical Journal of Gastroenterology 08/2012; 5(4). DOI:10.1007/s12328-012-0319-0
Show more