Treatment strategy for isolated bile leakage after hepatectomy: Literature review

Abstract

Isolated bile leakage (IBL) after hepatectomy is intractable, and various treatment methods for it have been reported. This review aimed to clarify the treatment strategy for IBL by summarizing studies on IBL after hepatectomy without extrahepatic bile duct resection. Thirty‐three cases of IBL were reported. The incidence of IBL is very low, accounting for 0.1%–1% of all hepatectomy cases. The risk factors for IBL are unclear; however, several reports mention that biliary anomaly is associated with a high risk of IBL, with preoperative and intraoperative confirmation of biliary tree anatomy being the most important preventive strategy. Treatment methods for IBL include liver resection, bilioenteric anastomosis, endoscopic treatment, bile duct ablation, percutaneous transhepatic portal vein embolization (PTPE), transcatheter arterial embolization, and use of fibrin glue. The therapeutic methods should be chosen depending on remnant liver function, amount of bile leakage, and the liver volume causing the bile leakage. When there is bile leakage from less than one segment, non‐surgical treatment is recommended, whereas when there is bile leakage from one or more segments, surgical treatment can be recommended. Nevertheless, recently, non‐surgical treatment such as PTPE, PTPE with bile duct ablation, and endoscopic methods have been considered as effective treatment approaches.

Risk factors for bile leakage: Latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database

“…The bile leakage test and C tube insertion could not prevent "isolated bile leakage" which does not communicate with distal bile ducts. 30 Another preventative method for bile leakage would be to cover the cut liver surface. Erdogan et al 31 reviewed the effects of topical hemostatic agents for bile leakage and concluded that there is no clear proof of their biostatic efficacy for bile leakage.…”

“…Cystic duct tube (C tube) insertion to decompress the bile duct might be another preventative method for bile leakage; however, Nanashima et al 29 reported that the C tube failed to prevent bile leakage. The bile leakage test and C tube insertion could not prevent “isolated bile leakage” which does not communicate with distal bile ducts 30 . Another preventative method for bile leakage would be to cover the cut liver surface.…”

Percutaneous portal vein embolization for intractable hepatic biloma after radiofrequency ablation

“…At present, there is no standard treatment available for such intractable bilomas. Various treatments have been reported for intractable bilomas, including liver resection, bilioenteric anastomosis, endoscopic treatment, bile duct ablation, PTPE, and transcatheter arterial embolization (TAE) [ 6 ]. In our case, biloma was incurable with PCD and antibiotics for more than 3 months until a corresponding portral vein embolization was performed.…”

“…Due to the diverse and extensive involvement of the biloma in segments VI–VII, it was dangerous to perform TAE owing to the high complication rates due to parenchymal infarction. In high-output bilomas (as in our case), treatment ablation using alcohol or NBCA can be insufficient [ 6 ]. Our last non-surgical option was PTPE.…”

Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction

“…With deepening of the understanding of liver diseases and the development of hepatectomy techniques, the indications for liver resection have been continuously expanded, and the incidence of perioperative complications and mortality have been significantly reduced, but the incidence of bile leakage has not changed significantly (3.1 ~ 28.0%) ( 1 ). Miura et al reported in 2016 that the biliary leakage rate of 14,970 patients who underwent more than segment I hepatectomy recorded by the Japanese National Clinical Database from 2011 to 2012 was 8.0% ( 2 ).…”