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.
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.
This is a preview of subscription content, log in to check access.
Bismuth, H, Chiche, L, Castaing, D 1995Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: experience with 68 hepatic resectionsWorld J. Surg.193541PubMedGoogle Scholar
Miyagawa, S, Makuuchi, M, Kawasaki, S, et al. 1995Criteria for safe hepatic resectionAm. J. Surg.169489594CrossRefGoogle Scholar
Fan, ST, Lai, ECS, Lo, CM, et al. 1996Hepatectomy with an ultrasonic dissector for hepatocellular carcinomaBr. J. Surg.83117120PubMedGoogle Scholar
Shimada, M, Takenaka, K, Fujiwara, Y, et al. 1998Risk factors linked to postoperative morbidity in patients with hepatocellular carcinomaBr. J. Surg.85195198CrossRefPubMedGoogle Scholar
Midorikawa, Y, Kubota, K, Takayama, T, et al. 1999A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver diseaseSurgery126484491CrossRefPubMedGoogle Scholar
Yamanaka, N, Okamoto, E, Kuwata, K, et al. 1984A multiple regression equation for prediction of posthepatectomy liver failureAnn. Surg.200658663PubMedGoogle Scholar
Born, P, Bruhl, K, Rosch, T, et al. 1996Long-term follow-up of endoscopic therapy in patients with post-surgical biliary leakageHepatogastroenterology43477482PubMedGoogle Scholar
Sherman, S, Shaked, A, Cryer, HM, et al. 1993Endoscopic management of biliary fistulas complicating liver transplantation and other hepatobiliary operationsAnn. Surg.218167175PubMedGoogle Scholar
Davids, PHP, Rauws, EAJ, Tytgat, GNJ, et al. 1992Postoperative bile leakage: endoscopic managementGut3311181122PubMedGoogle Scholar
Binmoeller, KF, Katon, RM, Shneidman, R 1991Endoscopic management of postoperative biliary lakes: review of 77 cases and report of two cases with biloma formationAm. J. Gastroenterol.86227231PubMedGoogle Scholar
Ponchon, T, Gallez, J, Valette, P, et al. 1989Endoscopic treatment of biliary tract fistulasGastroenterol. Endosc.35490498Google Scholar