Study of Bilirubin Measurement in Bile Drained from Patients with Obstructive Jaundice.

Kumazawa, Kenichi; Otani, Yoichi; Kubota, Koichi; Asami, Yoshiaki; Shiozawa, Shunichi; Oishi, Toshinori; Haga, Shunsuke; Kajiwara, Tetsuro

doi:10.5833/jjgs.27.1771

Cited by 3 publications

(4 citation statements)

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“…Kumazawa et al 17 reported that LTB was useful for evaluating liver function in patients with obstructive jaundice; it was easy to measure and enabled early assessment because LTB reaches its peak 2–3 days after drainage and plateaus after 1 week. Moreover, LTB of FRL would directly reflect the function of the FRL when the remnant bile duct of FRL is separated from the bile duct of the resected liver.…”

Section: Discussionmentioning

confidence: 99%

“…The daily level of total bilirubin in the bile (LTB, mg/d) was calculated as the volume of the bile per day (dL) multiplied by the density of total bilirubin in the bile (mg/dL). The volume of the bile and density of total bilirubin from the FRL were measured after endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD, Figure 2) 16,17 . ENBD alone, PTBD alone, or both together were performed in 34 (46%), 31 (42%), and nine (12%) patients.…”

Section: Methodsmentioning

confidence: 99%

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Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure

Uemura

Higuchi

Yazawa

et al. 2020

J Hepato Biliary Pancreat

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Background We investigated whether the daily level of total bilirubin in the bile (LTB) excreted from the future remnant liver (FRL) can predict post‐hepatectomy liver failure (PHLF) in patients with obstructive jaundice undergoing hepatectomy. Methods Seventy‐four patients who underwent biliary drainage and collection of bile juice from the FRL before undergoing right hepatectomy or right/left trisectionectomy with bile duct resection were included. The LTB from the FRL (mg/d) was calculated as the volume of the bile (dL) per day multiplied by the density of total bilirubin in the bile (mg/dL). We compared patients' characteristics with or without PHLF, which was defined as the total serum bilirubin level remaining >10 mg/dL after postoperative day 10. Then, pre‐ and intraoperative factors related to PHLF were examined. Results PHLF was observed in six patients. LTB was significantly lower in the PHLF group. The LTB cut‐off value for predicting PHLF, as determined using the receiver operating characteristic curve, was 56 mg/d. On multivariate analysis, LTB was found to be an independent risk factor for PHLF (P = .01, OR 35.88). Conclusions LTB may be a potential functional assessment in jaundiced patients before right hepatectomy and right/left trisectionectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure

Uemura

Higuchi

Yazawa

et al. 2020

J Hepato Biliary Pancreat

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“…On the other hand, in obstructive jaundice patients, the maximum level of indocyanine green excreted in the bile [19] and the daily output of bilirubin in drained bile [20] are thought to be useful for evaluating liver functional reserve. Mitochondrial oxidative phosphorylation in the liver is impaired by cholangitis [21], and sensitivity to endotoxins increases following prolonged jaundice and encephalopathy [22].…”

Section: Discussionmentioning

confidence: 99%

Safe and Permissible Limits of Hepatectomy in Obstructive Jaundice Patients

et al. 2004

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The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function (n = 242); chronic hepatitis (n = 71); liver cirrhosis (n = 64); and liver after relief of obstructive jaundice (n = 39). Hepatectomy was done after the total bilirubin level was reduced below 3 mg/dl by preoperative biliary drainage. Factors influencing the maximum total bilirubin level measured within 2 weeks after hepatectomy were investigated, and this level was taken to reflect the degree of surgical stress. PE was carried out in 18 patients with obstructive jaundice. The maximum total bilirubin, expressed as a logarithm, was significantly correlated with the percent of liver resected in all groups. Hepatectomy followed by a maximum total bilirubin of less than 8.5 mg/dl was accepted as safe, and hepatectomy followed by a bilirubin level of 14.4 mg/dl was deemed the maximum permissible resection. On the basis of these results, the safe and permissible limits of hepatectomy in patients with obstructive jaundice were 48.7% and 71.6%, respectively. PE decreased the maximum total bilirubin from 8.5 mg/dl to 3.9 mg/dl when 48.7% of the liver (a safe proportion in all cases) was resected; PE increased the safe limit of hepatectomy from 48.7% to 67.4% when a maximum posthepatectomy total bilirubin level of 8.5 mg/dl was accepted as safe.

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“…However, once PVE has been performed, right hemihepatectomy is unavoidable because of reduced right liver function and a foreign body in the right portal vein; therefore, the decision to perform PVE should be made carefully and requires proof of no remaining intrahepatic bile duct expansion and bile production of the left liver after PTCD. The level of bilirubin per day in drained bile can be a useful parameter of liver function [ 30 ], and bilirubin levels over 20 mg/dl in concentrated bile drained from PTCD with maintained volume indicated that the left liver function was improving. These stepwise processes permitted the radical cure and safer treatment at an appropriate time.…”

Section: Case Presentationmentioning

confidence: 99%

Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report

et al. 2016

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Laparoscopic cholecystectomy (LC) has been recently adapted to acute cholecystitis. Major bile duct injury during LC, especially Strasberg-Bismuth classification type E, can be a critical problem sometimes requiring hepatectomy. Safety and definitive treatment without further morbidities, such as posthepatectomy liver failure, is required. Here, we report a case of severe bile duct injury treated with a stepwise approach using 99mTc-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging to accurately estimate liver function.A 52-year-old woman diagnosed with acute cholecystitis underwent LC at another hospital and was transferred to our university hospital for persistent bile leakage on postoperative day 20. She had no jaundice or infection, although an intraperitoneal drainage tube discharged approximately 500 ml of bile per day. Recorded operation procedure showed removal of the gallbladder with a part of the common bile duct due to its misidentification, and each of the hepatic ducts and right hepatic artery was injured. Abdominal enhanced CT revealed obstructive jaundice of the left liver and arterial shunt through the hilar plate to the right liver. Magnetic resonance cholangiopancreatography revealed type E4 or more advanced bile duct injury according to the Bismuth-Strasberg classification. We planned a stepwise approach using percutaneous transhepatic cholangiodrainage (PTCD) and portal vein embolization (PVE) for secure right hemihepatectomy and biliary-jejunum reconstruction and employed 99mTc-GSA SPECT/CT fusion imaging to estimate future remnant liver function. The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6 %, respectively. The increase of liver function was higher than that of volume (28.3 vs. 15.8 %). On postoperative day 63, the curative operation, right hemihepatectomy and biliary-jejunum reconstruction, was performed, and posthepatectomy liver failure could be avoided.Careful consideration of treatment strategy for each case is necessary for severe bile duct injury with arterial injury requiring hepatectomy. The stepwise approach using PTCD and PVE could enable hemihepatectomy, and 99mTc-GSA SPECT/CT fusion imaging was useful to estimate heterogeneous liver function.

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Study of Bilirubin Measurement in Bile Drained from Patients with Obstructive Jaundice.

Cited by 3 publications

References 0 publications

Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure

Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure

Safe and Permissible Limits of Hepatectomy in Obstructive Jaundice Patients

Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report

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