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Major Complications in Hepatobiliary and Pancreatic Surgery

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The High-risk Surgical Patient

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Abstract

Hepatobiliary surgery represents one of the most challenging fields of surgical practice because it combines’ the need for surgical excellence with that for deep knowledge and understanding of hepatobiliary and pancreatic physiology. It is considered one single specialistic surgery due to the common embryologic genesis of the biliary tree, liver, and pancreas.

Hepatobiliary surgery shares postoperative complications with general abdominal surgery as venous catheter-related infection, incisional infection, pulmonary atelectasis or infection, subphrenic infection, urinary tract infection, intraperitoneal hemorrhage, and gastrointestinal tract bleeding.

In this chapter, we will analyze the most specific and severe complications both for hepatic surgery (vascular complication, bleeding, and thrombosis, biliary complication, specifically bile leak (BL) and, the most dangerous ones, postoperative liver failure) and pancreatic surgery (pancreatic fistula, delayed gastric emptying, vascular thrombosis, postoperative pancreatitis).

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References

  1. Jin S, Fu Q, et al. Management of post-hepatectomy complications. World J Gastroenterol. 2013;19(44):7983–91.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cross AJ, Connor SJ. Hemostasis and thrombosis in major liver resection, vol. 41. Semin Thromb Hemost; 2015. p. 99–107.

    Google Scholar 

  3. Turco L, de Raucourt E, Valla DC, et al. Anticoagulation in the cirrhotic patient. JHEP Rep. 2019;1(3):227–39.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rahbari NN, James Garden O, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB. 2011;13:528–35.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mori A, Arimoto A, et al. Risk factors and outcome of portale vein thrombosis after laparoscopic and open hepatectomy for primary liver cancer: a single-center experience. World J Surg. 2020;44:3093–9.

    Article  PubMed  Google Scholar 

  6. Kubori S, Shimizu H, et al. Incidence, risk factors, and management options for portal vein thrombosis after hepatectomy: a 14-years, single-center experience. Am J Surg. 2015;210:878–85.

    Article  Google Scholar 

  7. Cruz-Ramon V, Chinchilla-López P, et al. Thrombosis of the portal venous system in cirrhotic vs non-chirrotic patients. Ann Hepatol. 2018;17(3):476–81.

    Article  CAS  PubMed  Google Scholar 

  8. Cao MT, Higichi R, Yazawa T, et al. Narrowing of the remnant portal vein diameter and decreases portal vein angle are risk factors for portal vein thrombosis after perihilar cholangiocarcinoma surgery. Langenbecks Arch Surg. 2021;406:1511–9.

    Article  PubMed  Google Scholar 

  9. S. Kapoor, S. Nundy, Bile duct leaks from the intrahepatic biliary tree: a review of its etiology, incidence, and management, HPB Surg, vol. 2012, pp. 1-9, 2012.

    Google Scholar 

  10. Nakagawa K, Tanaka K, et al. Predictive factors for bile leakage after hepatectomy for hepatic tumors: a retrospective multicenter study with 631 cases at Yokohama Clinical Oncology Group (YCOG). J Hepatobiliari Pancreat Sci. 2017;24:33–41.

    Article  Google Scholar 

  11. Donadon M, Costa G, Cimino M, et al. Diagnosis and management of bile leaks after hepatectomy: results of a prospective analysis of 475 hepatectomies. World J Surg. 2016;40:172–81.

    Article  PubMed  Google Scholar 

  12. Koch M, James Garden O, et al. Bile Leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680–8.

    Article  PubMed  Google Scholar 

  13. Kubo N, Shirabe K. Treatment strategy for isolated bile leakage after hepatectomy: literature review. Ann Gastroenterol Surg. 2020;4:47–55.

    Article  PubMed  Google Scholar 

  14. Mansueto G, Gatti FL, et al. Biliary leakage after hepatobiliary and pancreatic surgery: a classification system to guide the proper percutaneous treatment. Cardiovasc Intervent Radiol. 2020;43:312–0.

    Article  Google Scholar 

  15. Mutignani M, Forti E, et al. Endotherapy for bile leaks from isolated ducts after hepatic resection: a long awaited challenge. Digest Liver Dis. 2017;49:893–7.

    Article  Google Scholar 

  16. Catalano OA, Singh AH, et al. Vascular and biliary variants in the liver: implications for liver surgery. Radiographics. 2008;28:359–78.

    Article  PubMed  Google Scholar 

  17. Rahbari NN, James Garden O, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24.

    Article  PubMed  Google Scholar 

  18. Navarro JG, Yang SJ, et al. What are the most important predictive factors for clinically relevant posthepatectomy liver failure after right hepatectomy for hepatocellular carcinoma? Ann Surg Treat Res. 2020;98(2):62–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Madhavan S, Shelat VG, et al. Predicting morbidity of liver resection. Langenbecks Arch Surg. 2018;403:359–69.

    Article  PubMed  Google Scholar 

  20. Guo T, Xiao Y, et al. The impact of intraoperative vascular occlusion during liver surgery on postoperative peak of ALT levels: A systematic review and meta-analysis. Int J Surg. 2016;27:99–104.

    Article  PubMed  Google Scholar 

  21. Balzan S, Belghiti J, et al. The “50-50 criteria” on postoperative day 5. Ann Surg. 2005;6:824–9.

    Article  Google Scholar 

  22. Rassam F, Olthof PB, et al. Current modalities for the assessment of future remnant liver function. Visc Med. 2017;33:442–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Soereide JA, Deshpande R. Post hepatectomy liver failure (PHLF)—Recent advances in prevention and clinical management. Eur J Surg Oncol. 2021;47:216–24.

    Article  Google Scholar 

  24. Lui SA, Bonney GK, et al. Standard formulae in predicting liver volumes: a South East Asian series of adult living donors. J Transplant Technol Res. 2016;6(1):1–4.

    Google Scholar 

  25. Cauchy F, Soubrane O, Belghiti J. Liver resection for HCC: patient’s selection and controversial scenarios. Best Pract Clin Gastroenterol. 2014;28:881–96.

    Article  Google Scholar 

  26. Hoffmann K, Hinz U, et al. Risk assessment for liver resection. Surgery. 2018;164:998–1005.

    Article  PubMed  Google Scholar 

  27. Gasperi AD, Mazza E, Prosperi M. Indocyanine green kinetics to assess liver function: Ready for clinical dynamic assessment in major liver surgery? World J Hepatol. 2016;8(7):355–67.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Berzigotti A, Reig M. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology. 2015;61(2):526–36.

    Article  PubMed  Google Scholar 

  29. Hackl C, Schlitt HJ, et al. Liver surgery in cirrhosis and portal hypertension. World J Gastroenterol. 2016;22(9):2725–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tariq R, Singal AK. Management of hepatorenal syndrome: a review. J Clin Transl Hepatol. 2020;8(2):192–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thorsen T, Solheim JM, et al. Liver transplantation as a lifesaving procedure for posthepatectomy liver failure and iatrogenic liver injuries. Langenbecks Arch Surg. 2019;404:301–8.

    Article  PubMed  Google Scholar 

  32. Lermite E, Sommacale D, et al. Complications after pancreatic resection: diagnosis, prevention and management. Clin Res Hepatol Gastroenterol. 2013;37:230–9.

    Article  PubMed  Google Scholar 

  33. Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;132(12):1310–4.

    Article  Google Scholar 

  34. Bassi C, Marchegiani G, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91.

    Article  PubMed  Google Scholar 

  35. Petrova E, Suurmeijer A, et al. Outcome of pancreatic anastomosies during pancreatoduodenectomy in two national audits. Surgery. 2021;170:1799–806.

    Article  PubMed  Google Scholar 

  36. Mazzaferro V, Virdis M, Sposito C, et al. Permanent pancreatic duct occlusion with neoprene-based glue injection after pancreatoduodenectomy at high risk of pancreatic fistula: a prospective clinical study. Ann Surg. 2019;270(5):791–8.

    Article  PubMed  Google Scholar 

  37. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH)—An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142(1):20–5.

    Google Scholar 

  38. Pang TCY, Maher R, et al. Peripancreatic psudoaneurysms: a management-based classification system. Surg Endosc. 2014;28:2027–38.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ansari D, Ansorge C, et al. Portal venous system thrombosis after pancreatic resection. World J Surg. 2013;37:179–84.

    Article  PubMed  Google Scholar 

  40. Robbins AJ, Skube ME, et al. Portal vein thrombosis after total pancreatectomy and islet autotransplant: prophylaxis and graft impact. Pancreas. 2019;48(10):1329–33.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Khan A, Kleive D, et al. Portal vein stent placement after hepatobiliary and pancreatic surgery. Langenbecks Arch Surg. 2020;405:657–64.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ikenaga N, Ohtsuka T, et al. Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy. Surgery. 2021;169:732–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Anna Mariani, Matteo Tripepi & Iacopo Mangoni

  2. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

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  1. Anna Mariani
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  2. Matteo Tripepi
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  3. Iacopo Mangoni
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  4. Paolo Aseni
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Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Mariani, A., Tripepi, M., Mangoni, I., Aseni, P. (2023). Major Complications in Hepatobiliary and Pancreatic Surgery. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_44

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  • DOI: https://doi.org/10.1007/978-3-031-17273-1_44

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17272-4

  • Online ISBN: 978-3-031-17273-1

  • eBook Packages: MedicineMedicine (R0)

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