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Preventive Measures for Postoperative Bile Leakage After Central Hepatectomy: A Multicenter, Prospective, Observational Study of 101 Patients

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Abstract

Background

There are no conclusive measures for preventing postoperative bile leakage (POBL).

Methods

First, 310 patients who underwent hepatectomy were analyzed retrospectively to clarify risk factors for POBL. Then, focusing on operations at high risk of POBL, patients who underwent central hepatectomy were recruited prospectively among 18 institutions, to evaluate various preventive measures for avoiding POBL. The primary endpoint was the frequency of POBL.

Results

The retrospective analysis revealed central hepatectomy and repeated hepatectomy to be independent risk factors for POBL. One hundred and one patients undergoing central hepatectomy were enrolled in the prospective study. POBL developed in 13 patients (12.9 %). Intraoperative bile leakage was recognized in 42 of the 101 patients (41.6 %), and 10 of the 42 patients developed POBL (23.8 %). Primary closure of the site of bile leakage and/or biliary drainage tube placement was preferable for preventing POBL in the patients with intraoperative bile leakage. Although 59 patients (58.4 %) did not show intraoperative bile leakage, three patients (5.1 %) developed POBL. In the group without intraoperative bile leakage, treatment with fibrin glue with a polyglycolic acid (PGA) sheet or collagen sheet coated with a fibrinogen and thrombin layer (CSFT) had good results.

Conclusions

Primary closure of the site of bile leakage and/or placement of biliary drainage tubes may be recommended in cases involving intraoperative bile leakage. Treatment with fibrin glue with a PGA sheet and/or CSFT might have preventive effects in patients without intraoperative bile leakage.

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Acknowledgments

We thank all patients for their willingness to participate in the study, and surgeons at the 18 institutes (Kyoto University Hospital, Tenri Hospital, Kyoto-Katsura Hospital, Kitano Hospital, Osaka Red Cross Hospital, Nishi-Kobe Medical Center, Kokura Memorial Hospital, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Hyogo Prefectural Amagasaki General Medical Center, Kobe Medical Center General Hospital, Shiga Medical Center, Otsu Municipal Hospital, Kyoto Medical Center, Shizuoka City Shizuoka Hospital, Kansai Electric Power Company Hospital, Japanese Red Cross Society Wakayama Medical Center, Takamatsu Red Cross Hospital) for their cooperation with case registration. We also thank Ms. Sayaka Tokuda for her great assistance in data management.

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Authors and Affiliations

  1. Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan

    Takamichi Ishii

  2. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan

    Takamichi Ishii, Etsuro Hatano & Shinji Uemoto

  3. Department of Surgery, Tenri Hospital, Tenri, Japan

    Hiroaki Furuyama

  4. Department of Surgery, Kyoto-Katsura Hospital, Kyoto, Japan

    Dai Manaka

  5. Department of Gastroenterological Surgery and Oncology, Kitano Hospital, Osaka, Japan

    Hiroaki Terajima

Authors
  1. Takamichi Ishii
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  2. Etsuro Hatano
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  3. Hiroaki Furuyama
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  4. Dai Manaka
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  5. Hiroaki Terajima
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  6. Shinji Uemoto
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Corresponding authors

Correspondence to Takamichi Ishii or Etsuro Hatano.

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Ishii, T., Hatano, E., Furuyama, H. et al. Preventive Measures for Postoperative Bile Leakage After Central Hepatectomy: A Multicenter, Prospective, Observational Study of 101 Patients. World J Surg 40, 1720–1728 (2016). https://doi.org/10.1007/s00268-016-3453-x

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  • DOI: https://doi.org/10.1007/s00268-016-3453-x

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