Background/Aims: Bile leakage frequently causes major complications after hepatic resection. We investigated perioperative risk factors and management of postoperative bile leakage after hepatic resection without extrahepatic biliary resection and reconstruction. Methods: We included 247 consecutive patients who underwent elective hepatic resection without bilioenteric anastomosis at our institution between 2002 and 2009. Perioperative risk factors, including patient and surgical variables, were evaluated using univariate and logistic regression analyses. Results: Postoperative bile leakage occurred in 26 patients (10.5%). The surgical drain was retained in 6 patients (23%); 9 (35%) underwent drain salvage and 11 (42%) underwent percutaneous puncture under computed tomography or ultrasound guidance. Eight patients underwent endoscopic nasobiliary drainage (ENBD) for postoperative bile leakage, and bile leakage healed at a median interval of 19.5 days after ENBD. By univariate analysis, postoperative bile leakage was associated with central bisectionectomy, surgical time and intraoperative blood loss. Logistic regression analysis identified central bisectionectomy as an independent risk factor for postoperative bile leakage (p = 0.0003, odds ratio 16.724). Conclusion: Meticulous procedures are necessary during parenchymal hepatic resection, especially during central bisectionectomy. Drain management should be precise in the case of postoperative bile leakage. We believe ENBD may rapidly cure postoperative major bile leakage.

Keywords:
Bile leak, Hepatectomy, Risk factors, Postoperative complication
1.
Simons JP, Hill JS, Ng SC, Shah SA, Zhou Z, Whalen GF, Tseng JF: Perioperative mortality for management of hepatic neoplasm: a simple risk score. Ann Surg 2009;250:929–934.
2.
Taylor M, Forster J, Langer B, Taylor BR, Greig PD, Mahut C: A study of prognostic factors for hepatic resection for colorectal cancer. Am J Surg 1997;173:467–471.
3.
Tsao JI, Loftus JP, Nagorney DM, Adson MA, Ilstrup DM: Trends in morbidity and mortality of hepatic resection for malignancy: a matched comparative analysis. Ann Surg 1995;220:199–205.
4.
Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, Sugimachi K: Bile leakage after hepatic resection. Ann Surg 2001;233:45–50.
5.
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.
6.
Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F, Bonalumi MG: Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg 1995;82:377–381.
7.
Poon RT, Fan ST, Lo CM Liu CL, Lam CM, Yuen WK, Yeung C, Wong J: Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004;240:698–708.
8.
Kyoden Y, Imamura H, Sano K, Beck Y, Sugawara Y, Kokudo N, Makuuchi M: Value of prophylactic abdominal drainage in 1,269 consecutive cases of elective liver resection. J Hepatobiliary Pancreat Sci 2010;17:186–192.
9.
Sun HC, Qin LX, Lu L, Wang L, Ye QH, Ren N, Fan J, Tang ZY: Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg 2006;93:422–426.
10.
Thompson H, Tompkins RK, Longmire WB: Major hepatic resection: a 25-year experience. Ann Surg 1983;197:247–253.
11.
Anderson R, Tranberg KG, Bengmark S: Role of bile and bacteria in biliary peritonitis. Br J Surg 1990;77:36–39.
12.
Yanaga K, Kanematsu T, Tanaka K: Intraperitoneal septic complications after hepatectomy. Ann Surg 1986;203:148–152.
13.
Terminology Committee of the IHPBA: Terminology of liver anatomy and resection. HPB Surg 2000;2:333–339.
14.
Takayama T, Makuuchi M, Inoue K, Sakamoto Y, Kubota K, Harihara Y: Selective and unselective clamping in cirrhotic liver. Hepatogastroenterology 1998;45:376–380.
15.
Honore C, Vibert E, Hoti E, Azoulay D, Adam R, Castaing D: Management of excluded segmental bile duct leakage following liver resection. HPB (Oxford) 2009;11:364–369.
16.
Lee JG, Choi SB, Kim KS, Choi JS, Lee WJ, Kim BR: Central bisectionectomy for centrally located hepatocellular carcinoma. Br J Surg 2008;95:990–995.
17.
Lo CM, Fan ST, Liu CL, Lai ECS, Wong J: Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg 1998;133:156–161.
18.
Mizumoto R, Suzuki H: Surgical anatomy of the hepatic hilum with special reference to the caudate lobe. World J Surg 1988;12:2–10.
19.
Hashikura Y, Ichida T, Umeshita K, Kawasaki S, Mizokami M, Mochida S, Yanaga K, Monden M, Kiyosawa K; Japanese Liver Transplantation Center: Donor complications associated with living donor liver transplantation in Japan. Transplantation 2009;15:110–114.
20.
Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH, Fisher RA, Emond JC, Koffron AJ, Pruett TL, Olthoff KM; A2ALL Study Group: Donor morbidity after living donation for liver transplantation. Gastroenterology 2008;135:468–476.
21.
Yi NJ, Suh KS, Cho JY, Lee HW, Cho EH, Yang SH, Cho YB, Lee KU: Three-quarters of right liver donors experienced postoperative complications. Liver Transpl 2007;13:797–806.
22.
Nakai T, Kawabe T, Shiraishi O, Shiozaki H: Prevention of bile leak after major hepatectomy. Hepatogastroenterology 2004;51:1286–1288.
23.
Hotta T, Kobayashi Y, Taniguchi K, Johata K, Sahara M, Naka T, Maeda T, Tanimura H: Postoperative evaluation of C-tube drainage after hepatectomy. Hepatogastroenterology 2003;50:485–490.
24.
Figueras J, Llado L, Miro M, Ramos E, Torras J, Fabregat J, Serrano T: Application of fibrin glue sealant after hepatectomy does not seem justified. Result of a randomized study in 300 patients. Ann Surg 2007;245:536–542.
25.
Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM, Poon RT, Wong J: Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg 2004;239:194–201.
26.
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.
27.
Maguchi H, Takahashi K, Katanuma A, Osanai M, Nakahara K, Matuzaki S, Urata T, Iwano H: Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2007;14:441–446.
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2011
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