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01-04-2016 | Original Article

Symptomatic Perihepatic Fluid Collections After Hepatic Resection in the Modern Era

Authors: Ioannis T. Konstantinidis, Pedro Mastrodomenico, Constantinos T. Sofocleous, Karen T. Brown, George I. Getrajdman, Mithat Gönen, Peter J. Allen, T. Peter Kingham, Ronald P. DeMatteo, Yuman Fong, William R. Jarnagin, Michael I. D’Angelica

Published in: Journal of Gastrointestinal Surgery | Issue 4/2016

Abstract

Background

Improvements in liver surgery have led to decreased mortality rates. Symptomatic perihepatic collections (SPHCs) requiring percutaneous drainage remain a significant source of morbidity.

Study Design

A single institution’s prospectively maintained hepatic resection database was reviewed to identify patients who underwent hepatectomy between January 2004 and February 2012.

Results

Data from 2173 hepatectomies performed in 2040 patients were reviewed. Overall, 200 (9 %) patients developed an SPHC, the majority non-bilious (75.5 %) and infected (54 %). Major hepatic resections, larger than median blood loss (≥360 ml), use of surgical drains, and simultaneous performance of a colorectal procedure were associated with an SPHC on multivariate analysis. Non-bilious, non-infected (NBNI) collections were associated with lower white blood cell (WBC) counts, absence of a bilio-enteric anastomosis, use of hepatic arterial infusion pump (HAIP), and presence of metastatic disease, and resolved more frequently with a single interventional radiology (IR) procedure (85 vs 46.5 %, p < 0.001) more quickly (15 vs 30 days, p = 0.001).

Conclusions

SPHCs developed in 9 % of patients in a modern series of hepatic resections, and in one third were non-bilious and non-infected. In the era of modern interventional radiology, the need for re-operation for SPHC is exceedingly rare. A significant proportion of minimally symptomatic SPHC patients may not require drainage, and strategies to avoid unnecessary drainage are warranted.

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. Annals of surgery. 2002 Oct;236(4):397–406; discussion −7.

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. Annals of surgery. 2004 Oct;240(4):698–708; discussion −10.

Kyoden Y, Imamura H, Sano K, Beck Y, Sugawara Y, Kokudo N, et al. Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection. Journal of hepato-biliary-pancreatic sciences. 2010 Mar;17(2):186–92.

Zimmitti G, Roses RE, Andreou A, Shindoh J, Curley SA, Aloia TA, 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. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2013 Jan;17(1):57–64; discussion p −5.

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 Nov;138(11):1198–206; discussion 206.

Kingham TP, Correa-Gallego C, D’Angelica MI, Gonen M, DeMatteo RP, Fong Y, et al. Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy. Journal of the American College of Surgeons. 2015 Apr;220(4):471–9.

Belghiti J, Kabbej M, Sauvanet A, Vilgrain V, Panis Y, Fekete F. Drainage after elective hepatic resection. A randomized trial. Annals of surgery. 1993 Dec;218(6):748–53.

Fong Y, Brennan MF, Brown K, Heffernan N, Blumgart LH. Drainage is unnecessary after elective liver resection. American journal of surgery. 1996 Jan;171(1):158–62.

Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM, et al. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Annals of surgery. 2004 Feb;239(2):194–201.

10.

Fuster J, Llovet JM, Garcia-Valdecasas JC, Grande L, Fondevila C, Vilana R, et al. Abdominal drainage after liver resection for hepatocellular carcinoma in cirrhotic patients: a randomized controlled study. Hepato-gastroenterology. 2004 Mar-Apr;51(56):536–40.

11.

Sun HC, Qin LX, Lu L, Wang L, Ye QH, Ren N, et al. Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. The British journal of surgery. 2006 Apr;93(4):422–6.

12.

Gurusamy KS, Samraj K, Davidson BR. Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev. 2007 (3):CD006232.PubMed

13.

Hirokawa F, Hayashi M, Miyamoto Y, Asakuma M, Shimizu T, Komeda K, et al. Re-evaluation of the necessity of prophylactic drainage after liver resection. The American surgeon. 2011 May;77(5):539–44.

14.

Rahbari NN, Elbers H, Koch M, Kirchberg J, Dutlu M, Mehrabi A, et al. Bilirubin level in the drainage fluid is an early and independent predictor of clinically relevant bile leakage after hepatic resection. Surgery. 2012 Nov;152(5):821–31.

15.

Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: Where is the risk? Arch Surg. 2006 Jul;141(7):690–4; discussion 5.

16.

Sadamori H, Yagi T, Matsuda H, Shinoura S, Umeda Y, Fujiwara T. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases. Digestive surgery. 2012;29(2):149–56.CrossRefPubMed

17.

Hoekstra LT, van Gulik TM, Gouma DJ, Busch OR. Posthepatectomy bile leakage: how to manage. Digestive surgery. 2012;29(1):48–53.CrossRefPubMed

18.

Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, 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 May;149(5):680–8.

19.

Burt BM, Brown K, Jarnagin W, DeMatteo R, Blumgart LH, Fong Y. An audit of results of a no-drainage practice policy after hepatectomy. American journal of surgery. 2002 Nov;184(5):441–5.

20.

Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D’Angelica MI, et al. Changes in the management of benign liver tumours: an analysis of 285 patients. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2013 Feb;15(2):156–63.

21.

Kooby DA, Jarnagin WR. Surgical management of hepatic malignancy. Cancer Invest. 2004;22(2):283–303.CrossRefPubMed

22.

D’Amico FE, Allen PJ, Eaton AA, DeMatteo RP, Fong Y, Kingham TP, et al. Vascular inflow control during hemi-hepatectomy: a comparison between intrahepatic pedicle ligation and extrahepatic vascular ligation. HPB (Oxford). 2013 Jun;15(6):449–56.

23.

Poon RT, Fan ST, Wong J. Liver resection using a saline-linked radiofrequency dissecting sealer for transection of the liver. Journal of the American College of Surgeons. 2005 Feb;200(2):308–13.

24.

Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui AM, Sano K, et al. Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg. 2001 Aug;136(8):922–8.

25.

Saiura A, Yamamoto J, Koga R, Sakamoto Y, Kokudo N, Seki M, et al. Usefulness of LigaSure for liver resection: analysis by randomized clinical trial. Am J Surg. 2006 Jul;192(1):41–5.

26.

Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. Journal of hepato-biliary-pancreatic surgery. 2005;12(5):351–5.CrossRefPubMed

27.

Martin RC, 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Annals of surgery. 2002 Jun;235(6):803–13.

Title: Symptomatic Perihepatic Fluid Collections After Hepatic Resection in the Modern Era
Authors: Ioannis T. Konstantinidis
Pedro Mastrodomenico
Constantinos T. Sofocleous
Karen T. Brown
George I. Getrajdman
Mithat Gönen
Peter J. Allen
T. Peter Kingham
Ronald P. DeMatteo
Yuman Fong
William R. Jarnagin
Michael I. D’Angelica
Publication date: 01-04-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 4/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-015-3041-7

At a glance: The STEP trials

Springer Medicine

Symptomatic Perihepatic Fluid Collections After Hepatic Resection in the Modern Era

Abstract

Background

Study Design

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Study Design

Results

Conclusions

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