title: Bile leakage and liver resection: Where is the risk?
abstract: OBJECTIVE
  The knowledge of risk factors for bile leakage after liver resection could reduce its incidence.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  The study included 610 patients who underwent liver resection from January 1, 1989, through January 31, 2003.
  
  
  METHODS
  Liver resections without biliary anastomoses.
  
  
  METHODS
  Bile leakage incidence and its correlation to preoperative and intraoperative patient characteristics.
  
  
  RESULTS
  Postoperative bile leakage occurred in 22 (3.6%) of 610 patients. Univariate analysis showed that cirrhosis (P = .05) or intraoperative use of fibrin glue (P = .01) was associated with a lower incidence of bile leakage. Moreover, the following factors were significant predictors of bile leakage: peripheral cholangiocarcinoma (P < .001), major hepatectomy (P = .03), left hepatectomy extended to segment 1 (P < .001), extension of transection out of the main portal scissure (P = .006), and hepatectomy including segment 1 (P = .001) or segment 4 (P = .003). At multivariate analysis, use of fibrin glue was an independent protective factor (relative risk = 0.38, P = .046), whereas peripheral cholangiocarcinoma (relative risk = 5.47, P = .02) and resection of segment 4 (relative risk = 3.10, P = .02) were independent risk factors for bile leakage.
  
  
  CONCLUSIONS
  Hepatectomies including segment 4, especially if performed for peripheral cholangiocarcinoma, lead to a high risk for postoperative bile leakage. Intraoperative use of fibrin glue may reduce the risk of postoperative bile leakage.
authors.affiliation: Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Italy. lcapussotti@mauriziano.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.forename: Luca
authors.initials: L
authors.lastname: Viganò
authors.forename: Enrico
authors.initials: E
authors.lastname: Sgotto
authors.forename: Andrea
authors.initials: A
authors.lastname: Muratore
authors.forename: Roberto
authors.initials: R
authors.lastname: Polastri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure