title: Posthepatectomy bile leakage: how to manage.
abstract: BACKGROUND
  Biliary leakage after liver resection continues to be reported. Management of bile leakage has changed in recent years, with nowadays non-surgical procedures as the preferred treatment.
  
  
  METHODS
  Biliary leakage and management were assessed in 381 patients who underwent liver resection between January 2005 and April 2011.
  
  
  RESULTS
  The overall rate of biliary leakage after liver resection was 5.0%, with a higher incidence in patients who had undergone concomitant hepaticojejunostomy (HJ; 13.6 vs. 3.2%). Hospital stay (p = 0.047), major resections (p = 0.018), operation time (p = 0.011), and relaparotomy (p = 0.002) were risk factors for postoperative bile leakage. Multivariate analysis identified relaparotomy as an independent factor (OR 4.216, p = 0.034). Bile leakage in patients without HJ (n = 10) was managed in 6 patients by percutaneous transhepatic biliary drainage (PTD), and in 3 patients by endoscopic drainage. One patient was treated surgically. All patients with an HJ and postoperative bile leakage (n = 9) underwent PTD.
  
  
  CONCLUSIONS
  The incidence of posthepatectomy biliary leakage has decreased over time, while PTD and endoscopic stenting are effective treatment modalities. PTD is the treatment of choice in bile leakage after resection combined with HJ.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. L.T.Hoekstra@amc.uva.nl
authors.forename: Lisette T
authors.initials: LT
authors.lastname: Hoekstra
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Busch
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy*; D001652:Bile Ducts; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D055815:Young Adult