Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors.
BACKGROUND
Bile leakage is one of the frequent and disturbing complications of hepatic resection.


METHODS
Clinical records of the 363 patients who underwent hepatic resections without biliary reconstruction for hepatic cancers between January 1994 and June 2001 were reviewed. Postoperative bile leakage was defined as continuous drainage with a bilirubin concentration of 20 mg/dL or 1,500 mg/d lasting 2 days. Leakage that continued longer than 2 weeks or that required surgical intervention was defined as uncontrollable. Differences in incidence and frequency of uncontrollable leakage for the different types of hepatic resection, tumors, and underlying liver disease were investigated. Outcomes after treatment for uncontrollable bile leakage were also reviewed.


RESULTS
Postoperative bile leakage occurred in 26 of 363 patients (7.2%). Although the incidence in patients with cholangiocellular carcinoma (3/9 [33%]) was higher (p = 0.03) than in patients with hepatocellular carcinoma, rates of occurrence were similar among the different types of hepatic resection and underlying liver disease. Eight of the 26 patients (31%) had uncontrollable leakage. Two patients required reoperation to control leakage; one of these developed hepatic failure and died 2 months after surgery. Four patients underwent endoscopic nasobiliary drainage 21 to 34 days after hepatectomy, and the leakage resolved within 3 to 21 days. Fibrin glue sealing was effective in two patients whose leaking bile ducts were not connected to the common bile duct.


CONCLUSIONS
Although meticulous surgical technique can minimize the risk of postoperative bile leakage, some instances of leakage are unavoidable. Nonsurgical treatments, such as nasobiliary drainage or fibrin glue sealing, are preferable to reoperation.
Tanaka
Shogo
S
Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Hirohashi
Kazuhiro
K
Tanaka
Hiromu
H
Shuto
Taichi
T
Lee
Sang Hun
SH
Kubo
Shoji
S
Takemura
Shigekazu
S
Yamamoto
Takatsugu
T
Uenishi
Takahiro
T
Kinoshita
Hiroaki
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D001650:Bile Duct Neoplasms / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D018281:Cholangiocarcinoma / Q000601:surgery; D004322:Drainage / Q000379:methods; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation
D015718:Fibrin Tissue Adhesive; D001663:Bilirubin