Predictive Factors for Bile Leakage After Hepatectomy: Analysis of 505 Consecutive Patients

Abstract

More meticulous management is needed to prevent bile leakage in high-risk patients.

Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections

“…It promotes sepsis, prolongs hospitalization and may increase the cost of care. Recent series of hepatectomies without biliary anastomosis reported a BL incidence of between 3.6% and 10% …”

Posthepatectomy Bile Leakage: How to Manage

“…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.…”

“…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. Bile leakage was also associated with male gender, advanced age, tumor size, major hepatectomy, right-sided hepatectomy, left hepatectomy extended to segment 1, surgical irradicality, duration of vascular occlusion, and red cell transfusion [1,5,11,12,13,14,15,16]. In our study, relaparotomy was the only independent significant risk factor associated with bile leakage, a similar finding as found in the studies of Hayashi et al [12] and Yoshioka et al [16].…”

“…Bile leakage was also associated with male gender, advanced age, tumor size, major hepatectomy, right-sided hepatectomy, left hepatectomy extended to segment 1, surgical irradicality, duration of vascular occlusion, and red cell transfusion [1,5,11,12,13,14,15,16]. In our study, relaparotomy was the only independent significant risk factor associated with bile leakage, a similar finding as found in the studies of Hayashi et al [12] and Yoshioka et al [16]. However, our multivariate analysis is based on small sample sizes (patients with bile leakage), resulting in possible bias.…”

Biliary Leaks and Thoracobiliary Fistula

“…Multivariable analysis identified repeat hepatectomy, a large cut surface area, and intraoperative blood loss as independent predictors for biliary leaks [20]. In 610 patients undergoing liver resection without bile duct resection, peripheral cholangiocarcinoma, left hepatectomy including segment 1, transection plane outside of the main portal scissure, and hepatectomies including the caudate or segment four were independent predictors of biliary leakage.…”