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Posthepatectomy bile leakage: how to manage
Lisette T Hoekstra1, Thomas M van Gulik, Dirk J Gouma
1Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. L.T.Hoekstra@amc.uva.nl
Digestive Surgery
|March 24, 2012
Summary
Biliary leakage after liver resection occurs in 5.0% of cases. Non-surgical treatments like percutaneous transhepatic biliary drainage (PTD) are effective, especially after hepaticojejunostomy (HJ).
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical outcomes
Background:
- Biliary leakage remains a complication following liver resection.
- Non-surgical management is now the preferred approach for bile leaks.
Purpose of the Study:
- To assess the incidence and management of biliary leakage after liver resection.
- To identify risk factors and effective treatments for posthepatectomy bile leaks.
Main Methods:
- Retrospective analysis of 381 patients undergoing liver resection from January 2005 to April 2011.
- Evaluation of biliary leakage rates, management strategies, and risk factors.
Main Results:
- The overall incidence of biliary leakage was 5.0%, significantly higher in patients with hepaticojejunostomy (HJ).
- Risk factors included longer hospital stay, major resections, longer operation time, and relaparotomy.
- Relaparotomy was an independent risk factor (OR 4.216).
- Percutaneous transhepatic biliary drainage (PTD) and endoscopic drainage were effective non-surgical treatments.
Conclusions:
- The incidence of posthepatectomy biliary leakage has decreased.
- PTD and endoscopic stenting are effective treatment modalities for bile leaks.
- PTD is the preferred treatment for bile leakage following liver resection with HJ.
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