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Surgical Endoscopy

, Volume 30, Issue 9, pp 3709–3719 | Cite as

Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy

  • François Cauchy
  • David FuksEmail author
  • Takeo Nomi
  • Lilian Schwarz
  • Ajay Belgaumkar
  • Olivier Scatton
  • Olivier Soubrane
  • Brice Gayet
Article

Abstract

Background

Bile leakage (BL) remains a common cause of major morbidity after open major liver resection but has only been poorly described in patients undergoing laparoscopic major hepatectomy (LMH). The present study aimed to determine the incidence, risk factors and consequences of BL following LMH.

Methods

All 223 patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were retrospectively analysed. BL was defined according to the International Study Group of Liver Surgery, and its incidence and consequences were assessed. Risk factors for BL were determined on multivariate analysis.

Results

BL occurred in 30 (13.5 %) patients, and its incidence remained stable over time (p = 0.200). BL was diagnosed following the presence of bile into the abdominal drain in 14 (46.7 %) patients and after drainage of symptomatic abdominal collections in 16 (53.3 %) patients without intra-operative drain placement. Grade A, B and C BL occurred in 3 (10.0 %), 23 (76.6 %) and 4 (13.4 %) cases, respectively. Interventional procedures for BL included endoscopic retrograde cholangiography, percutaneous and surgical drainage in 10 (33.3 %), 23 (76.7 %) and 4 (13.3 %) patients, respectively. BL was associated with significantly increased rates of symptomatic pleural effusion (30.0 vs. 11.4 %, p = 0.006), multiorgan failure (13.3 vs. 3.6 %, p = 0.022), postoperative death (10.0 vs. 1.6 %, p = 0.008) and prolonged hospital stay (18 vs. 8 days, p < 0.001). On multivariable analysis, BMI > 28 kg/m2 (OR 2.439, 95 % CI 1.878–2.771, p = 0.036), history of hepatectomy (OR 1.675, 95 % CI 1.256–2.035, p = 0.044) and biliary reconstruction (OR 1.975, 95 % CI 1.452–2.371, p = 0.039) were significantly associated with increased risk of BL.

Conclusions and relevance

After LMH, BL occurred in 13.5 % of the patients and was associated with significant morbidity. Patients with one or several risk factors for BL should benefit intra-operative drain placement.

Keywords

Bile leakage Laparoscopic major hepatectomy Postoperative complications Abdominal drainage 

Notes

Author contributions

Study concept and design: Soubrane, Fuks, Cauchy, Gayet; Acquisition of data: Nomi, Schwarz, Belgaumkar, Fuks, Cauchy; Analysis and interpretation of data: Cauchy, Fuks, Gayet, Soubrane; Drafting of the manuscript: Cauchy, Fuks, Soubrane, Gayet; Critical revision of the manuscript: Fuks, Cauchy, Soubrane, Gayet, Scatton; Statistical analysis: Cauchy, Fuks, Study supervision: Soubrane, Fuks, Cauchy, Gayet.

Compliance with ethical standards

Disclosures

François Cauchy, David Fuks, Takeo Nomi, Lilian Schwarz, Ajay Belgaumkar, Olivier Scatton, Olivier Soubrane and Brice Gayet have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2015_4666_MOESM1_ESM.docx (125 kb)
Supplementary material 1 (DOCX 124 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • François Cauchy
    • 1
    • 2
  • David Fuks
    • 3
    Email author
  • Takeo Nomi
    • 3
  • Lilian Schwarz
    • 1
  • Ajay Belgaumkar
    • 3
  • Olivier Scatton
    • 1
    • 4
  • Olivier Soubrane
    • 1
    • 2
  • Brice Gayet
    • 3
  1. 1.Department of HPB Surgery and Liver Transplantation – Hôpital Saint AntoineUniversity Pierre et Marie Curie Paris 6ParisFrance
  2. 2.Department of HPB Surgery and Liver Transplantation – Hôpital BeaujonUniversity Denis Diderot Paris 7ClichyFrance
  3. 3.Department of Digestive Disease - Institut Mutualiste MontsourisUniversity René Descartes Paris 5ParisFrance
  4. 4.Department of Digestive and HPB Surgery, Hôpital de la Pitié SalpétrièreUniversity Pierre et Marie Curie Paris 6ParisFrance

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