Bile leak after hepatectomy: predictive factors of spontaneous healing.
BACKGROUND
Bile leakage after hepatectomy usually has spontaneous healing, but some patients require interventional procedures. To identify early predictive factors of conservative management failure.


METHODS
This study focused on patients with bile leak after hepatectomy without extrahepatic biliary resection from 1996 through 2006.


RESULTS
Bile leakage occurred in 34 of 593 patients (5.7%). Conservative management was successful in 26 patients (76.5%). At univariate analysis overall associated resections, vascular associated resections, and drainage output on days 1, 3, and 10 from leak onset were significant negative predictors of spontaneous healing. At multivariate analysis drainage output greater than 100 mL on day 10 was the only independent prognostic factor of conservative management failure (relative risk, 55.985; P = .008) with 80% sensitivity, 93.3% specificity, and 90% accuracy.


CONCLUSIONS
Wait-and-see treatment is successful in most cases. Patients with drainage output greater than 100 mL 10 days after bile leakage diagnosis should be scheduled for interventional treatments.
Viganò
Luca
L
Department of Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62-10128 Torino, Italy. lucavigano@libero.it
Ferrero
Alessandro
A
Sgotto
Enrico
E
Tesoriere
Roberto Lo
RL
Calgaro
Marco
M
Capussotti
Lorenzo
L
D000328:Adult; D000368:Aged; D001646:Bile; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014945:Wound Healing