Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study

Brooke-Smith, Mark E.; Figueras, Joan; Ullah, Shahid; Rees, Myrddin; Vauthey, Jean Nicolas; Hugh, Thomas J.; Garden, O. J.; Fan, Sheung Tat; Crawford, Michael; Makuuchi, Masatoshi; Yokoyama, Yukihiro; Büchler, M.; Weitz, Juergen; Padbury, Robert

doi:10.1111/hpb.12322

Cited by 99 publications

(108 citation statements)

References 17 publications

(24 reference statements)

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“…level 1b evidence, 1 study [13] was grade level 2b evidence, and the remaining studies [5,12,[25][26][27] were cohort studies of grade 4 evidence. No ongoing studies could be identified in clinical trial registers.…”

Section: Literature Reviewmentioning

confidence: 99%

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

et al. 2017

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Background: Routine prophylactic abdominal drainage after hepatic surgery is still being debated, as it may be unnecessary, possibly harmful, and uncomfortable for patients. This study evaluated the safety of a no-drain policy after liver resection within an Enhanced Recovery after Surgery (ERAS) programme. Methods: All hepatectomies performed without prophylactic drainage during 2005-2014 were included. Primary end points were resection-surface-related (RSR) morbidity, defined as the presence of postoperative biloma, hemorrhage or abscess, and reinterventions. Secondary end points were length of stay, total postoperative morbidity, the composite end point of liver surgery-specific complications, readmissions, and 90-day mortality. Uni- and multivariate analyses were performed to identify independent risk factors for RSR morbidity. A systematic search was performed to compare the results of this study to literature. Results: A total of 538 resections were included in the study. The RSR complication and reintervention rate was 15 and 12%, respectively. Major liver resection (≥3 segments) was an independent risk factor for the development of RSR morbidity (OR 3.01, 95% CI 1.61-5.62; p = 0.001) and need for RSR reintervention (OR 3.02, 95% CI 1.59-5.73; p = 0.001). Conclusion: RSR morbidity, mortality, and reintervention rates after liver surgery without prophylactic drainage in patients, treated within an ERAS programme, were comparable to previously published data. A no-drain policy after partial hepatectomy seems safe and feasible.

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Section: Literature Reviewmentioning

confidence: 99%

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

et al. 2017

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“…Incisional and organ/space SSIs were diagnosed by the surgeon who performed the postoperative follow-up. Postoperative bile leakage was defined as the identification of macroscopic bile discharge or as the presence of bilirubin concentrations in the drainage fluid 3 times greater than those in the serum after 3 postoperative days [13]. Retrograde drain infection was defined as organ/space SSI without bile leakage or evidence of bacterial infection in the initial drainage fluid culture.…”

Section: Postoperative Carementioning

confidence: 99%

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata

Hasegawa²,

Kobayashi³

et al. 2017

Dig Surg

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Aims: To clarify the clinical impact, risk factors, and preventive methods for surgical site infection (SSI) after hepatectomy for hepatocellular carcinoma (HCC). Methods: We included 879 consecutive patients who underwent hepatectomy for HCC between 2002 and 2011. Univariate and multivariate analyses were conducted to identify the risk factors for incisional and organ/space SSIs. ORs and 95% CIs are reported. Results: The incidences of incisional and organ/space SSIs were 24 (2.7%) and 73 (8.3%), respectively. High body mass index, multiple resections, and organ/space SSI were associated with incisional SSIs, while repeat hepatectomy (OR 2.14, 95% CI 1.27-3.60), ascites (OR 2.97, 95% CI 1.55-5.48), and bile leakage (OR 4.77, 95% CI 2.77-8.11) were independent risk factors for organ/space SSI. Among the cases with bile leakage, lower rates of organ/space SSIs tended to be observed in patients with cystic duct tubes than in patients without such tubes (13.2 vs. 26.5%, p = 0.157). Retrograde drain infections increased when drain placement was prolonged for more than 4 postoperative days. Conclusion: Bile leakage was associated with the greatest risk of organ/space SSI after hepatectomy for HCC. Cystic duct tubes might be useful for preventing bile leakage and subsequent organ/space SSI after procedures that extensively expose Glissonean pedicles.

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“…29 Because of the heterogeneity of definitions in the literature, the true incidence of bile leak complications is difficult to assess. 30 With regard to long-term health problems, most of our patients had minor complaints (eg, minor scar problems). These findings are in line with the present literature.…”

Section: Discussionmentioning

confidence: 91%

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Benzing

Schmelzle²,

Öllinger³

et al. 2018

Exp Clin Transplant

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Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study

Abstract: The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.

Cited by 99 publications

References 17 publications

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

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