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01-12-2008 | original article

Safety of Conservative Management of Bile Leakage after Hepatectomy with Biliary Reconstruction

Authors: Alessandro Ferrero, Nadia Russolillo, Luca Viganò, Enrico Sgotto, Roberto Lo Tesoriere, Marco Amisano, Lorenzo Capussotti

Published in: Journal of Gastrointestinal Surgery | Issue 12/2008

Abstract

Background

The risks associated with the conservative management of bile leakage after hepatectomy and associated cholangiojejunostomy are not well defined.

Aim

The aim of this study was to evaluate incidence and severity of complications associated with bile leakages after liver resection with biliary reconstruction.

Patients and methods

Clinical data from 1,034 consecutive patients who underwent liver resection were prospectively collected and reviewed. Bile leakage occurred in 25 out of 119 patients (21.0%) who underwent hepatectomy with biliary reconstruction (group 1) and in 42 out of 915 patients (4.6%) without biliary anastomosis (group 2; p < 0.001). Serum albumin and bilirubin levels were the only preoperative factors significantly different between the two groups. Lymphadenectomy was more frequently performed in patients of group 1 (88% vs 16.7, p < 0.001).

Results

Mortality rates were similar in the two groups (8% in group 1 vs 2.3% in group 2, p = 0.28). One or more postoperative complications occurred in 68% in group 1 and in 40.4% in group 2 (p = 0.02). The incidence of sepsis (32% vs 7.1%, p = 0.01), intra-abdominal abscess (12% vs 0, p = 0.04), and abdominal bleeding (28% vs 0, p = 0.006) was significantly higher in group 1. Bile leaks spontaneously healed in 52% of patients in group 1 vs 76.2% in group 2 (p = 0.04). In order to identify independent predictive factors for abdominal bleeding, we compared clinical data of patients with abdominal bleeding (seven patients) and without abdominal bleeding (18 patients) after hepatectomy and biliary reconstruction. Stepwise logistic regression analysis identified the number of reconstructed bile ducts as an independent predictive factor of abdominal bleeding (p = 0.038).

Conclusions

Conservative management of bile leakage after liver resection with biliary reconstruction is associated with higher rates of morbidity. The most severe complication is abdominal bleeding, which is related to the number of bile ducts requiring reconstruction.

Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al. Bile leakage after hepatic resection. Ann Surg. 2001;233:45–50. doi:10.1097/00000658-200101000-00008.PubMedCrossRef

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406. doi:10.1097/00000658-200210000-00001.PubMedCrossRef

Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–1206. doi:10.1001/archsurg.138.11.1198.PubMedCrossRef

Ferrero A, Viganò L, Polastri R, Muratore A, Eminefendic H, Capussotti L. Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg. 2007;31:1643–1651. doi:10.1007/s00268-007-9123-2.PubMedCrossRef

Nagano Y, Togo S, Tanaka K, Masui H, Endo I, Sekido H, et al. Risk factors and management of bile leakage after hepatic resection. World J Surg. 2003;27:695–698. doi:10.1007/s00268-003-6907-x.PubMedCrossRef

Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg. 2002;195:484–489. doi:10.1016/S1072-7515(02)01288-7.PubMedCrossRef

Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: where is the risk? Arch Surg. 2006;141:690–694. doi:10.1001/archsurg.141.7.690.PubMedCrossRef

Suzuki Y, Fujino Y, TAnioka Y, Ajiki T, Hiraoka K, Takada M, Takeyama Y, Tominaga M, Ku Y, Kuroda Y. Factors influencing hepaticojejunostomy leak following pancreaticoduodenal resection; importance of anastomotic leak test. Hepatogastroenterology. 2003;50:254–257.PubMed

Antolovic D, Koch M, Galindo L, Wolff S, Music E, Kienle P, et al. Hepaticojejunostomy analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg. 2007;11:555–561. doi:10.1007/s11605-007-0166-3.PubMedCrossRef

10.

de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Laméris JS, van Gulik TM, et al. Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg. 2005;9:1163–1173. doi:10.1016/j.gassur.2005.08.010.PubMedCrossRef

11.

Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Bush OR, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–795. doi:10.1097/00000658-200012000-00007.PubMedCrossRef

12.

Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreaticoduodenectomy: a 20 years experience in 516 patients. Arch Surg. 2004;139:718–725. doi:10.1001/archsurg.139.7.718.PubMedCrossRef

13.

Bottger TC, Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resection. World J Surg. 1999;23:164–171. doi:10.1007/PL00013170.PubMedCrossRef

14.

Nagino M, Nishio H, Ebata Y, Yokoyama Y, Igami T, Nimura Y. Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg. 2007;94:70–77. doi:10.1002/bjs.5531.PubMedCrossRef

15.

Capussotti L, Muratore A, Ferrero A, Massucco P, Ribero D, Polastri R. Randomized clinical trial of liver resection with and without hepatic pedicle clamping. Br J Surg. 2006;93:685–689. doi:10.1002/bjs.5301.PubMedCrossRef

16.

The Brisbane 2000 Terminology of Liver Anatomy and Resection. Terminology Committee of the International Hepato–Pancreato–Biliary Association. HPB 2000;2:333–339.

17.

Davids PHP, Rauws EAJ, Tytgat GNJ, Huibregtse K. Postoperative bile leakage: endoscopic treatment. Gut. 1992;33:1118–1122. doi:10.1136/gut.33.8.1118.PubMedCrossRef

18.

Sugiyama M, Izumisato Y, Abe N, Yamaguchi Y, Yamato T, Masaki T, et al. Endoscopic biliary stenting for treatment of bile leakage after hepatic resection. Hepatogastroenterology. 2001;48:1579–1581.PubMed

19.

Bhattacharjya S, Puleston J, Davidson BR, Dooley JS. Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endosc. 2003;57:526–530. doi:10.1067/mge.2003.148.PubMedCrossRef

20.

Reed DN, Vitale GC, Wrightson WR, Edwards M, McMasters K. Decreasing mortality of bile leakage after elective hepatic surgery. Am J Surg. 2003;185:316–318. doi:10.1016/S0002-9610(02)01419-8.PubMedCrossRef

21.

Hasegawa S, Ikai I, Fujii H, Hatano E, Shimahara Y. Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg. 2007;31:1256–1263. doi:10.1007/s00268-007-9001-y.PubMedCrossRef

22.

De Oliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma thirty-one year experience with 564 patients at a single institution. Ann Surg. 2007;245:755–762. doi:10.1097/01.sla.0000251366.62632.d3.CrossRef

23.

Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resection of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins. Ann Surg. 2004;240:95–101. doi:10.1097/01.sla.0000129491.43855.6b.PubMedCrossRef

24.

Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo S, Nagino M, et al. Management of hilar cholangiocarcinoma. Comparison of an American and a Japanese Experience. Ann Surg. 2000;232:166–174. doi:10.1097/00000658-200008000-00003.PubMedCrossRef

25.

Capussotti L, Muratore A, Polastri R, Ferrero A, Massucco P. Liver resection for hilar cholangiocarcinoma: in-hospital mortality and long term survival. J Am Coll Surg. 2002;195:641–647. doi:10.1016/S1072-7515(02)01481-3.PubMedCrossRef

26.

Gazzaniga GM, Filauro M, Bagarolo C, Mori L. Surgery for hilar cholangiocarcinoma: an Italian experience. J Hepatobiliary Pancreat Surg. 2000;7:122–127. doi:10.1007/s005340050165.PubMedCrossRef

27.

Tabata M, Kawarada Y, Yokoi H, Higashiguchi T, Isaji S. Surgical treatment for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2000;7:148–154. doi:10.1007/s005340050169.PubMedCrossRef

28.

Cherqui D, Benoist S, Malassagne B, Humeres R, Rodriguez V, Fagniez PL. Major liver resection for carcinoma in jaundice patients without preoperative biliary drainage. Arch Surg. 2000;135:302–308. doi:10.1001/archsurg.135.3.302.PubMedCrossRef

29.

Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, et al. Influence of transfusion on perioperative and long-term outcome in patients following hepatic resection for colorectal metastasis. Ann Surg. 2003;237:860–869. doi:10.1097/00000658-200306000-00015.PubMedCrossRef

30.

Nagino M, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resection for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–155. doi:10.1016/j.surg.2004.06.006.PubMedCrossRef

31.

de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg. 2007;24:259–264. doi:10.1159/000103656.PubMedCrossRef

32.

Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708. doi:10.1097/01.sla.0000143808.63039.51.PubMed

33.

Kitagawa Y, Nagini M, Kamiya J, Uesaka K, Sano T, Yamamoto H, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and para-aortic node dissection. Ann Surg. 2001;233:385–392. doi:10.1097/00000658-200103000-00013.PubMedCrossRef

34.

Ercolani G, Grazi GL, Ravaioli M, Grigioni WF, Cescon M, Gardini A, et al. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239:2002–2009. doi:10.1097/01.sla.0000109154.00020.e0.CrossRef

Title: Safety of Conservative Management of Bile Leakage after Hepatectomy with Biliary Reconstruction
Authors: Alessandro Ferrero
Nadia Russolillo
Luca Viganò
Enrico Sgotto
Roberto Lo Tesoriere
Marco Amisano
Lorenzo Capussotti
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0586-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety of Conservative Management of Bile Leakage after Hepatectomy with Biliary Reconstruction

Abstract

Background

Aim

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Patients and methods

Results

Conclusions

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