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World Journal of Surgery

, Volume 27, Issue 6, pp 695–698 | Cite as

Risk Factors and Management of Bile Leakage after Hepatic Resection

  • Yasuhiko Nagano
  • Shinji Togo
  • Kuniya Tanaka
  • Hidenori Masui
  • Itaru Endo
  • Hitoshi Sekido
  • Kaoru Nagahori
  • Hiroshi Shimada
Original Scientific Reports

Abstract

The aim of this study was to identify the perioperative risk factors for postoperative bile leakage after hepatic resection and to propose a treatment strategy for such leakage when it does occur. Between 1992 and 2000 a total of 313 hepatic resections without choledocojejunal anastomosis were performed at our institute. Risk factors related to bile leakage were identified with univariate analysis, and strategies were evaluated in relation to the findings of postoperative fistulography. Postoperative bile leakage developed in 17 patients (5.4%). Univariate analysis identified high risk factors as advanced age, a wide surface area of the incision (bile leakage group versus no bile leakage group: 102.1 vs. 66.4 cm2, p < 0.05), and exposure of Glisson’s sheath at the cut surface (e.g., central bisegmentectomy, S4, S8 subsegmentectomy). Groupings of patients by their postoperative fistulography results showed that patients with involvement of the proximal bile duct were slower to heal than those with no demonstrable bile duct involvement. The one patient whose fistulogram demonstrated peripheral bile duct involvement had uncontrollable leakage and required reoperation. Hepatectomies with a wide surface area and those that expose the major Glisson’s sheath present serious risk factors for bile leakage. When the fistulogram shows proximal bile duct involvement, endoscopic nasobiliary tube drainage is necessary; when the fistulogram shows peripheral bile duct involvement, reoperation is needed.

Keywords

Bile Duct Hepatic Resection Bile Leakage Postoperative Bile Leakage Proximal Bile Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2003

Authors and Affiliations

  • Yasuhiko Nagano
    • 1
  • Shinji Togo
    • 1
  • Kuniya Tanaka
    • 1
  • Hidenori Masui
    • 1
  • Itaru Endo
    • 1
  • Hitoshi Sekido
    • 1
  • Kaoru Nagahori
    • 1
  • Hiroshi Shimada
    • 1
  1. 1.Second Department of Surgery, School of MedicineYokohama City UniversityYokohamaJapan

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