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Bile Leak Reduction with Laparoscopic Versus Open Liver Resection: A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis

  • Alison A. SmithEmail author
  • Dominique J. Monlezun
  • John Martinie
  • David Iannitti
  • Ioannis Konstantinidis
  • Michael Darden
  • Geoffrey Parker
  • Yuman Fong
  • Joseph F. Buell
Original Scientific Report

Abstract

Introduction

The reported rate of postoperative bile leak is variable between 3 and 33%. Recent data would suggest a minimally invasive approach to liver surgery has decreased this incidence.

Methods

This multi-institutional case–control study utilized databases from three high-volume surgeons. All consecutive open and minimally invasive liver resection cases were analyzed in a propensity score-adjusted multivariable regression. A p value < 0.05 was considered significant.

Results

In 1388 consecutive liver resections, the average age was 56.9 ± 14.0 years, 730 (52.59%) were male gender, and 599 (43.16%) underwent minimally invasive liver resection. Thirty-nine (2.81%) in the series were identified with post-resection bile duct leaks. Leaks were associated with major resections and increased blood loss (p < 0.05). Propensity score-adjusted multivariable regression identified minimally invasive liver resection significantly and independently reduced the odds of bile duct leak (OR 0.48, p = 0.046) even controlling for BMI, ASA, cirrhosis, major resection, and resection year.

Conclusions

Our data suggest the incidence of bile leaks in a large-volume center series is far less than previously reported and that a minimally invasive approach to liver resection reduces the incidence of postoperative bile leak.

Notes

Compliance with ethical standards

Conflict of interest

Dr. Buell, Iannitti, and Fong are paid consultants to Ethicon and Medtronic for work that is outside the scope of this manuscript. Dr. Martinie is a paid consultant to Intuitive Surgical, Ethicon and Medtronic for work that is outside the scope of this manuscript. Drs. Smith, Monlezun, Konstantinidis, Parker, and Darden have no disclosure or financial ties to disclose.

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Copyright information

© Société Internationale de Chirurgie 2020

Authors and Affiliations

  • Alison A. Smith
    • 1
    Email author
  • Dominique J. Monlezun
    • 1
  • John Martinie
    • 2
  • David Iannitti
    • 2
  • Ioannis Konstantinidis
    • 3
  • Michael Darden
    • 4
  • Geoffrey Parker
    • 5
  • Yuman Fong
    • 6
  • Joseph F. Buell
    • 1
  1. 1.Department of SurgeryTulane University School of MedicineNew OrleansUSA
  2. 2.Division of HPB SurgeryCarolinas Medical CenterCharlotteUSA
  3. 3.Texas TechEl PasoUSA
  4. 4.Carey Business SchoolJohns Hopkins UniversityBaltimoreUSA
  5. 5.Thayer School of EngineeringDartmouth CollegeHanoverUSA
  6. 6.City of Hope National Medical CenterLos AngelesUSA

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