title: Risk factors for central bile duct injury complicating partial liver resection.
abstract: BACKGROUND
  Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct, right or left hepatic duct. This study analysed the incidence, risk factors and consequences of CBDI in liver resection.
  
  
  METHODS
  Patients undergoing liver resection between 1990 and 2007 were included in this study. Those having resection for bile duct-related pathology or trauma, or after liver transplantation were excluded. Characteristics and outcome variables were collected prospectively and analysed retrospectively.
  
  
  RESULTS
  There were 19 instances of CBDI in 462 liver resections (4·1 per cent). One-third of patients with CBDI required surgical reintervention and construction of a hepaticojejunostomy. Resection type (P < 0·001), previous liver resection (P = 0·039) and intraoperative blood loss (P = 0·002) were associated with an increased risk of CBDI. Of all resection types, extended left hemihepatectomy was associated with the highest incidence of CBDI (2 of 9 procedures).
  
  
  CONCLUSIONS
  Patients undergoing extended left hemihepatectomy or repeat hepatectomy were at increased risk of CBDI.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: Boonstra
authors.forename: M T
authors.initials: MT
authors.lastname: de Boer
authors.forename: E
authors.initials: E
authors.lastname: Sieders
authors.forename: P M J G
authors.initials: PM
authors.lastname: Peeters
authors.forename: K P
authors.initials: KP
authors.lastname: de Jong
authors.forename: M J H
authors.initials: MJ
authors.lastname: Slooff
authors.forename: R J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003135:Common Bile Duct / Q000293:injuries*; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult