Bile leakage after liver resection: A retrospective cohort study

Česká verze

Authors: K. Menclová; F. Bělina; J. Pudil; D. Langer; M. Ryska
Authors place of work: Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN, Praha přednosta: prof. MUDr. M. Ryska, CSc.
Published in the journal: Rozhl. Chir., 2015, roč. 94, č. 12, s. 516-521.
Category: Původní práce

Summary

Introduction:
Many previous reports have focused on bile leakage after liver resection. Despite the improvements in surgical techniques and perioperative care the incidence of this complication rather keeps increasing. A number of predictive factors have been analyzed. There is still no consensus regarding their influence on the formation of bile leakage. The objective of our analysis was to evaluate the incidence of bile leakage, its impact on mortality and duration of hospitalization at our department. At the same time, we conducted an analysis of known predictive factors.

Method:
The authors present a retrospective review of the set of 146 patients who underwent liver resection at the Department of Surgery of the 2^nd Faculty of Medicine of the Charles University and Central Military Hospital Prague, performed between 2010−2013. We used the current ISGLS (International Study Group of Liver Surgery) classification to evaluate the bile leakage. The severity of this complication was determined according to the Clavien-Dindo classification system. Statistical significance of the predictive factors was determined using Fisher‘s exact test and Student‘s t-test.

Results:
The incidence of bile leakage was 21%. According to ISGLS classification the A, B, and C rates were 6.5%, 61.2%, and 32.3%, respectively. The severity of bile leakage according to the Clavien-Dindo classification system – I-II, IIIa, IIIb, IV and V rates were 19.3%, 42%, 9.7%, 9.7%, and 19.3%, respectively. We determined the following predictive factors as statistically significant: surgery for malignancy (p<0.001), major hepatic resection (p=0.001), operative time (p<0.001), high intraoperative blood loss (p=0.02), construction of HJA (p=0.005), portal venous embolization/two-stage surgery (p=0.009) and ASA score (p=0.02). Bile leakage significantly prolonged hospitalization time (p<0.001). In the group of patients with bile leakage the perioperative mortality was 23 times higher (p<0.001) than in the group with no leakage.

Conclusion:
Bile leakage is one of the most serious complications of liver surgery. Most of the risk factors are not easily controllable and there is no clear consensus on their influence. Intraoperative leak tests could probably reduce the incidence of bile leakage. In the future, further studies will be required to improve the perioperative management and techniques to prevent such serious complications. Multidisciplinary approach is essential in the treatment.

Key words:
bile leakage – liver resection – liver complications

Zdroje

1. Kapoor S, Nundy S. Bile duct leaks from the intrahepatic biliary tree: A review of its etiology, incidence, and management. HPB Surg 2012, ID 752932, 9 pages, http://dx.doi.org/10.1155/2012/752932.

2. Zimmitti G, Roses E, Andreou A, et al. Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: An experience with 2,628 Consecutive Resections. JGS 2013;17:57–64.

3. Brooke-Smith M, Figueras J, Büchler M, et al. Prospective evaluation of the International Study Group for Liver Surgery definitiv of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB 2015;17:46–51.

4. Zimmitti G, Vauthey J-N, Shindoh, et al. Systematic use of an intraoperative leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Col Surg 2013;217:1028−37.

5. Nanashima A, Abo T, Shibuya A, at al. Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak? HPB 2013;15:517–22.

6. Langer D, Ryska M, Bělina F, et al. Biliární komplikace po velkých resekcích jater. Rozhl Chir 2011;90:152–5.

7. Yamashita Y, Hamatsu T, Rikimaru T, et al. Bile leakage after hepatic resection. Ann Surg 2001;233:45–50.

8. Koch M, Garden J, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149:680–8.

9. Guillaud A, Pery C, Campillo B, et al. Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB 2013;15:224–9.

10. Clavien P, Barkun J, de Oliveira M, et al. The Clavien-Dindo classification of surgical complications. Five-year experience. Ann Surg 2009;250:187–96.

11. Nagano Y, Togo S, Tanak K, et al. Risk factors and management of bile leakage after hepatic resection. World J Surg 2003;27:695–8.

12. Honoré C, Vibert E, Hoti E, et al. Management of excluded segmental bile duct leakage following liver resection. HPB 2009;11:364–9.

13. Eum Y, Park J, Chun J, et al. Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes. World J Gastroentrol 2014;20:6924−31.

14. Wang H, Yang J, Yang J-Y, et al. Bile leakage test in liver resection: A systematic review and meta-analysis. World J Gastroenterol 2013;19:8420–6.

15. Ito H, Are C, Gonen M, et al. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer. Ann Surg 2008;247:994–1002.

16. Andersson R, Tranberg KG, Bengmark S, et al. Roles of bile and bacteria in biliary peritonitis. Br J Surg 1990;77:36−9.

17. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 2005;12:351–5.

18. Kučera M, Adamec M, Oliverius M, et al. Časné biliární komplikace po transplantaci jater. Rozhl Chir 2011;90:117−21.

19. Erdogan D, Busch OR, van Delden OM, et al. Incidence and management of bile leakage after partial liver resection. Dig Surg 2008;25:60–6.

20. Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy: A planned strategy to treat irresectable colorectal cancer liver metastases. Ann Surg 2000;232:777−85.

21. Gurusamy KS, Pamecha V, Sharma D, et al. Techniques for liver parenchymal transection in liver resection. Cochrane Database of Systematic Reviews 2009; No. 1, Article ID CD006880.

22. Delis SG, Bakoyiannis A, Karakaxas, et al. Hepatic parenchyma resection using stapling devices: peri-operative and long-term outcome. HPB 2009;11:38–44.

23. Sadamori H, Yagi T, Matsuda H, et al. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases. Dig Surg 2012;29:149–56.

24. Ijichi M, Takayama T, Toyoda H, et al. Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg 2000;135:1395–400.