Safety of conservative management of bile leakage after hepatectomy with biliary reconstruction.
BACKGROUND
The risks associated with the conservative management of bile leakage after hepatectomy and associated cholangiojejunostomy are not well defined.


OBJECTIVE
The aim of this study was to evaluate incidence and severity of complications associated with bile leakages after liver resection with biliary reconstruction.


METHODS
Clinical data from 1,034 consecutive patients who underwent liver resection were prospectively collected and reviewed. Bile leakage occurred in 25 out of 119 patients (21.0%) who underwent hepatectomy with biliary reconstruction (group 1) and in 42 out of 915 patients (4.6%) without biliary anastomosis (group 2; p < 0.001). Serum albumin and bilirubin levels were the only preoperative factors significantly different between the two groups. Lymphadenectomy was more frequently performed in patients of group 1 (88% vs 16.7, p < 0.001).


RESULTS
Mortality rates were similar in the two groups (8% in group 1 vs 2.3% in group 2, p = 0.28). One or more postoperative complications occurred in 68% in group 1 and in 40.4% in group 2 (p = 0.02). The incidence of sepsis (32% vs 7.1%, p = 0.01), intra-abdominal abscess (12% vs 0, p = 0.04), and abdominal bleeding (28% vs 0, p = 0.006) was significantly higher in group 1. Bile leaks spontaneously healed in 52% of patients in group 1 vs 76.2% in group 2 (p = 0.04). In order to identify independent predictive factors for abdominal bleeding, we compared clinical data of patients with abdominal bleeding (seven patients) and without abdominal bleeding (18 patients) after hepatectomy and biliary reconstruction. Stepwise logistic regression analysis identified the number of reconstructed bile ducts as an independent predictive factor of abdominal bleeding (p = 0.038).


CONCLUSIONS
Conservative management of bile leakage after liver resection with biliary reconstruction is associated with higher rates of morbidity. The most severe complication is abdominal bleeding, which is related to the number of bile ducts requiring reconstruction.
Ferrero
Alessandro
A
Department of Surgery, Ospedale Mauriziano Umberto I, Largo Turati, 62-10128, Turin, Italy. aferrero@mauriziano.it
Russolillo
Nadia
N
Viganò
Luca
L
Sgotto
Enrico
E
Lo Tesoriere
Roberto
R
Amisano
Marco
M
Capussotti
Lorenzo
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome