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Bile changes after liver surgery: experimental and clinical lessons for future applications
Gianpiero Gravante1, Timothy Knowles, Seok Ling Ong
1Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK. ggravante@hotmail.com
Introduction:
The aim of this review is to summarize the available evidence for changes in bile composition following liver surgery and assess their use in predicting post-operative complications.
Materials And Methods:
A literature search was undertaken for all studies focusing on bile composition, bile volume and analysis. Articles were selected from MEDLINE, Embase and the Cochrane Central Register of Controlled Trials databases up to May 2009.
Results:
Low values of pre-operative bilirubin diglucuronide predict reduced post-operative liver function and the occurrence of jaundice. Low concentrations of hepatocyte growth factor and interleukin-6 in bile following surgery are associated with the subsequent development of liver failure and are probably surrogate markers for situations where the resultant hepatic regeneration is inadequate.
Conclusions:
Analysis of the composition and quality of bile is probably underused as a tool for the pre-operative screening and early post-operative monitoring of patients at high risk of developing liver failure following major hepatobiliary procedures.
