title: Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery.
abstract: BACKGROUND
  Despite the potentially severe impact of bile leakage on patients' perioperative and long-term outcome, a commonly used definition of this complication after hepatobiliary and pancreatic operations has not yet been established. The aim of the present article is to propose a uniform definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy.
  
  
  METHODS
  An international study group of hepatobiliary and pancreatic surgeons was convened. A consensus definition of bile leakage after hepatobiliary and pancreatic operative therapy was developed based on the postoperative course of bilirubin concentrations in patients' serum and drain fluid.
  
  
  RESULTS
  After evaluation of the postoperative course of bilirubin levels in the drain fluid of patients who underwent hepatobiliary and pancreatic operations, bile leakage was defined as bilirubin concentration in the drain fluid at least 3 times the serum bilirubin concentration on or after postoperative day 3 or as the need for radiologic or operative intervention resulting from biliary collections or bile peritonitis. Using this criterion severity of bile leakage was classified according to its impact on patients' clinical management. Grade A bile leakage causes no change in patients' clinical management. A Grade B bile leakage requires active therapeutic intervention but is manageable without relaparotomy, whereas in Grade C, bile leakage relaparotomy is required.
  
  
  CONCLUSIONS
  We propose a simple definition and severity grading of bile leakage after hepatobiliary and pancreatic operative therapy. The application of the present proposal will enable a standardized comparison of the results of different clinical trials and may facilitate an objective evaluation of diagnostic and therapeutic modalities in the field of hepatobiliary and pancreatic operative therapy.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Robert
authors.initials: R
authors.lastname: Padbury
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Michael
authors.initials: M
authors.lastname: Crawford
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Christopher
authors.initials: C
authors.lastname: Christophi
authors.forename: Simon
authors.initials: S
authors.lastname: Banting
authors.forename: Mark
authors.initials: M
authors.lastname: Brooke-Smith
authors.forename: Val
authors.initials: V
authors.lastname: Usatoff
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Paul
authors.initials: P
authors.lastname: Greig
authors.forename: Myrddin
authors.initials: M
authors.lastname: Rees
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000378:metabolism / Q000503:physiopathology*; D001660:Biliary Tract Diseases / Q000601:surgery*; D001663:Bilirubin / Q000378:metabolism; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007391:International Cooperation; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012720:Severity of Illness Index
chemical_list: D001663:Bilirubin