[Bile leakage after liver resection: A retrospective cohort study]

Area of Science:

• Hepatobiliary Surgery
• Surgical Complications
• Gastroenterology

Background:

• Bile leakage is a frequent complication following liver resection, with increasing incidence despite surgical advancements.
• Predictive factors for bile leakage lack consensus, necessitating further investigation.
• This study evaluates bile leakage incidence, mortality, and hospitalization duration post-liver resection.

Purpose of the Study:

• To assess the incidence of bile leakage after liver resection.
• To analyze the impact of bile leakage on patient mortality and hospitalization duration.
• To identify statistically significant predictive factors for bile leakage.

Main Methods:

• Retrospective review of 146 liver resection patients (2010-2013).
• Bile leakage classification using the International Study Group of Liver Surgery (ISGLS) criteria.
• Severity assessment via the Clavien-Dindo classification system.
• Statistical analysis of predictive factors using Fisher's exact test and Student's t-test.

Main Results:

• Bile leakage incidence was 21%, with 32.3% classified as ISGLS C.
• Clavien-Dindo grades IIIa and V were most frequent (42% and 19.3% respectively).
• Significant predictive factors included: malignancy surgery, major resection, operative time, blood loss, hepaticojejunostomy (HJA), portal venous embolization/two-stage surgery, and ASA score.
• Bile leakage significantly increased hospitalization (p<0.001) and perioperative mortality (23-fold, p<0.001).

Conclusions:

• Bile leakage remains a critical complication of liver surgery with poorly understood risk factors.
• Intraoperative leak tests may reduce bile leakage incidence.
• Further research and multidisciplinary approaches are crucial for improved perioperative management and prevention.