Background/Aims: Bile leakage after partial liver resection still is a common complication and is associated with substantial morbidity and even mortality. Methods: A total of 234 consecutive liver resections without biliary reconstruction, performed between January 1992 and December 2004, were analyzed for postoperative bile leakage. Results: Postoperative bile leakage occurred in 6.8% of patients (16/234). In univariate analysis, male gender (p = 0.037), major liver resection (p = 0.004), right-sided hepatectomy (p = 0.005), prolonged operation time (p = 0.001), intraoperative blood loss >500 ml (p = 0.009), red cell transfusion (p = 0.02), tumor size (p = 0.026), duration of vascular occlusion (p = 0.03) and surgical irradicality (p = 0.001) were risk factors. No independent risk factors were associated with bile leakage after liver resection. Bile leakage originated from the resection plane in 10 patients (63%). Endoscopic biliary decompression was performed in 9 patients as initial treatment, and percutaneous drainage of the bile collection was used in 4 patients. Bile leakage resolved spontaneously in 3 patients. Conclusions: Bile leakage is a persisting complication and in this study occurred in 6.8% of patients after partial liver resection. Percutaneous drainage of bile collection with or without endoscopic biliary decompression are effective interventions in the management of most cases of bile leakage.

1.
Reed DN Jr, Vitale GC, Wrightson WR, Edwards M, McMasters K: Decreasing mortality of bile leaks after elective hepatic surgery. Am J Surg 2003;185:316–318.
2.
Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T: Criteria for safe hepatic resection. Am J Surg 1995;169:589–594.
3.
Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al: Bile leakage after hepatic resection. Ann Surg 2001;233:45–50.
4.
Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R: Bile leakage and liver resection: where is the risk? Arch Surg 2006;141:690–694.
5.
Bhattacharjya S, Puleston J, Davidson BR, Dooley JS: Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endosc 2003;57:526–530.
6.
Couinaud C: Surgical anatomy of the liver: several new aspects. Chirurgie 1986;112:337–342.
7.
Dinant S, Gerhards MF, Rauws EAJ, Busch ORC, Gouma DJ, van Gulik TM: Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumour). Ann Surg Oncol 2006;13:872–880.
8.
IJitsma AJ, Appeltans BM, de Jong KP, Porte RJ, Peeters PM, Slooff MJ: Extrahepatic bile duct resection in combination with liver resection for hilar cholangiocarcinoma: a report of 42 cases. J Gastrointest Surg 2004;8:686–694.
9.
Vauthey JN, Baer HU, Guastella T, Blumgart LH: Comparison of outcome between extended and nonextended liver resections for neoplasms. Surgery 1993;114:968–975.
10.
Lo CM, Fan ST, Liu CL, Lai EC, Wong J: Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg 1998;133:156–161.
11.
Lam CM, Lo CM, Liu CL, Fan ST: Biliary complications during liver resection. World J Surg 2001;25:1273–1276.
12.
Yanaga K, Kanematsu T, Takenaka K, Sugimachi K: Intraperitoneal septic complications after hepatectomy. Ann Surg 1986;203:148–152.
13.
Matsumata T, Yanaga K, Shimada M, Shirabe K, Taketomi A, Sugimachi K: Occurrence of intraperitoneal septic complications after hepatic resections between 1985 and 1990. Surg Today 1995;25:49–54.
14.
Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J: Hepatic resection for hepatocellular carcinoma: an audit of 343 patients. Ann Surg 1995;221:291–298.
15.
Nagano Y, Togo S, Tanaka K, Masui H, Endo I, Sekido H, et al: Risk factors and management of bile leakage after hepatic resection. World J Surg 2003;27:695–698.
16.
Nanashima A, Yamaguchi H, Shibasaki S, Ide N, Morino S, Sumida Y, et al: Comparative analysis of postoperative morbidity according to type and extent of hepatectomy. Hepatogastroenterology 2005;52:844–848.
17.
Hasegawa K, Yazumi S, Egawa H, Tamaki H, Asada M, Kodama Y, et al: Endoscopic management of postoperative biliary complications in donors for living donor liver transplantation. Clin Gastroenterol Hepatol 2003;1:183–188.
18.
Lau JY, Leung KL, Chung SC, Lau WY: Endoscopic management of major bile leaks complicating hepatic resections for hepatocellular carcinoma. Gastrointest Endosc 1999;50:99–101.
19.
Ijichi M, Takayama T, Toyoda H, Sano K, Kubota K, Makuuchi M: Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg 2000;135:1395–1400.
20.
Kohno H, Nagasue N, Chang YC, Taniura H, Yamanoi A, Nakamura T: Comparison of topical hemostatic agents in elective hepatic resection: a clinical prospective randomized trial. World J Surg 1992;16:966–969.
21.
Binmoeller KF, Katon RM, Shneidman R: Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol 1991;86:227–231.
22.
Marks JM, Ponsky JL, Shillingstad RB, Singh J: Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks. Surg Endosc 1998;12:327–330.
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