Bile leakage and liver resection: Where is the risk?
Lorenzo Capussotti1, Alessandro Ferrero, Luca Viganò
1Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Italy. lcapussotti@mauriziano.it
Hypothesis:
The knowledge of risk factors for bile leakage after liver resection could reduce its incidence.
Design:
Retrospective study.
Setting:
Tertiary care referral center.
Patients:
The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.
Interventions:
Liver resections without biliary anastomoses.
Main Outcome Measures:
Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.
Results:
Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P < .001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.
Conclusions:
Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.