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T-drain reduces the incidence of biliary leakage after liver resection

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Abstract

Biliary leakage is a serious complication after liver resection and represents the major cause of post-operative morbidity. In spite of already identified risk factors, little is known about the role of intra-biliary pressure following liver surgery in the development of biliary leakage. Biliary decompression may have a positive impact and reduce the incidence of biliary leakage at the parenchymal resection site. 397 patients undergoing liver resection without bilioenteric anastomosis were included in the retrospective analysis of the risk factors for the development of biliary leakage focusing on the intra-operative reduction of the biliary pressure by T-tube and liver histology. Among 397 analyzed patients after parenchymal resection, biliary leakage occurred in 39 cases (9.8 %). The extent of parenchymal resection was not associated with the total occurrence of biliary leak (p = 0.626). Lower incidence of biliary leakage from the resection surface was significantly associated with the use of T-tube (4.9 vs. 13.2 %; p = 0.006). In the subgroup analysis, insertion of a T-tube was not associated with a reduction of biliary leakage after anatomical hemihepatectomies (p = 0.103) and extraanatomical liver resection (p = 0.676). However, a high statistical significance could be detected in patients with extended hemihepatectomies (58.3 vs. 3.8 %; p < 0.001). Once biliary leak occurred without T-tube, median hospitalization duration significantly increased compared to patients with biliary decompression and without biliary leak (p < 0.001). The results of our retrospective data analysis suggest a significant beneficial impact of the T-tube on the development of biliary leakage in patients undergoing extended liver surgery.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany

    Dennis Eurich, S. Henze, S. Boas-Knoop, J. Pratschke & D. Seehofer

  2. Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany

    Dennis Eurich, S. Henze, S. Boas-Knoop, J. Pratschke & D. Seehofer

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  1. Dennis Eurich
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  2. S. Henze
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  4. J. Pratschke
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  5. D. Seehofer
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Correspondence to Dennis Eurich.

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The authors of this manuscript have no conflicts of interest to disclose as described.

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The study was performed retrospectively according to the Professional Code of the German Medical Association (article B.III.§15) based on the World Medical Association´s Declaration of Helsinki.

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The study is retrospective and for this type of study formal consent is not required.

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Eurich, D., Henze, S., Boas-Knoop, S. et al. T-drain reduces the incidence of biliary leakage after liver resection. Updates Surg 68, 369–376 (2016). https://doi.org/10.1007/s13304-016-0397-5

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  • DOI: https://doi.org/10.1007/s13304-016-0397-5

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