title: Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases.
abstract: OBJECTIVE
  Bile leakage is still a common cause of major morbidity after hepatectomy for hepatocellular carcinoma (HCC). The purpose of this study was to identify characteristics and risk factors for intractable bile leakage after hepatectomy for HCC.
  
  
  METHODS
  Risk factors for bile leakage were analyzed in 359 patients who underwent hepatectomy for HCC between 2001 and 2010. The causes, management and outcomes of intractable bile leakage which needed endoscopic therapy or percutaneous transhepatic biliary drainage were investigated.
  
  
  RESULTS
  A total of 296 patients (82.5%) underwent an anatomic hepatectomy, and a repeat hepatectomy was carried out in 59 patients (16.4%). The prevalence of bile leakage was 12.8%, and 8 patients had intractable bile leakage. An operative time ≥ 300 min was an independent risk factor for bile leakage after hepatectomy for HCC. The main causes of intractable bile leakage were a latent stricture of the biliary anatomy caused by previous treatments for HCC and intraoperative injury of the hepatic duct related to repeat hepatectomy.
  
  
  CONCLUSIONS
  To help prevent intractable bile leakage, a preoperative assessment of the biliary anatomy and surgical procedures to decrease the incidence of major bile leakage should be considered for selected patients with a high risk for intractable bile leakage.
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. sada@md.okayama-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuda
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinoura
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Umeda
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000628:therapy; D001652:Bile Ducts / Q000503:physiopathology*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome