Prevention of bile leak after major hepatectomy.
OBJECTIVE
Bile leak remains a serious complication after major hepatectomy. The usefulness of external biliary drainage to prevent intraperitoneal bile leak was studied.


METHODS
Thirty-nine patients who underwent major hepatectomy from April 1997 through June 2000 were studied. The bile leak test was performed to identify and close leaks following the resection. Patients who still had leakage underwent retrograde transhepatic biliary drainage (RTBD) via a tube inserted through a choledochostomy. Patient's backgrounds, incidence of bile leak, and time until resolution of bile leak were compared between patients who did and did not have an RTBD tube placed.


RESULTS
Nineteen patients had an RTBD tube (48.7%). Bile leak developed in 4 patients with the tube (21.1%), and in 4 patients without the tube (20.0%) (not significant). However, the time until resolution of bile leak was 13.3 days for patients with the tube and 51.3 days for patients without the tube (p<0.05). Two patients developed local peritonitis when the tube was removed.


CONCLUSIONS
Though some patients had bile leakage even with the RTBD tube, use of the RTBD tube decreased the length of time leakage that occurred. RTBD tube drainage should be done routinely with major hepatectomy.
Nakai
Takuya
T
First Department of Surgery, Kinki University School of Medicine, Osaka, Japan. nakai@surg1.med.kindai.ac.jp
Kawabe
Takashi
T
Shiraishi
Osamu
O
Shiozaki
Hitoshi
H
D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D002763:Cholecystectomy; D002768:Choledochostomy; D015179:Colorectal Neoplasms / Q000601:surgery; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D013536:Suture Techniques