Association between biliary complications and technique of hilar division (extrahepatic vs. intrahepatic) in major liver resections.
BACKGROUND
Division of major vascular and biliary structures during major hepatectomies can be carried out either extrahepatically at the porta hepatic or intrahepatically during the parenchymal transection. In this retrospective study we test the hypothesis that the intrahepatic technique is associated with less early biliary complications.


METHODS
150 patients who underwent major hepatectomies were retrospectively allocated into an intrahepatic group (n = 100) and an extrahepatic group (n = 50) based on the technique of hilar division. The two groups were operated by two different surgical teams, each one favoring one of the two approaches for hilar dissection. Operative data (warm ischemic time, operative time, blood loss), biliary complications, morbidity and mortality rates were analyzed.


RESULTS
In extrahepatic patients, operative time was longer (245 +/- 50 vs 214 +/- 38 min, p < 0.05) while the overall complication rate (55% vs 52%), hospital stay (13 +/- 7 vs 12 +/- 4 days), bile leak rate (22% vs 20%) and mortality (2% vs 2%) were similar compared to intrahepatic patients. However, most (57%) bile leaks in extrahepatic patients were grade II (leaks that required non-operative interventional treatment, while most (70%) leaks in the intrahepatic group were grade I (leaks that resolved and presented two injuries (4%) of the remaining bile ducts (p < 0.05).


CONCLUSIONS
Intrahepatic hilar division is as safe as extrahepatic hilar division in terms of intraoperative blood requirements, morbidity and mortality. The extrahepatic technique is associated with more severe bile leaks and biliary injuries.
Smyrniotis
Vassileios
V
Second Department of Surgery University of Athens School of Medicine, Aretaieion Hospital, Athens, Greece. vsmyrniotis@hotmail.com
Arkadopoulos
Nikolaos
N
Theodoraki
Kassiani
K
Voros
Dionysios
D
Vassiliou
Ioannis
I
Polydorou
Andreas
A
Dafnios
Nikolaos
N
Gamaletsos
Evangelos
E
Daniilidou
Kyriaki
K
Kannas
Dimitrios
D