title: Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak?
abstract: BACKGROUND
  In this retrospective study, the effects of cystic duct (C) tube use on the incidence of post-hepatectomy bile leak were assessed.
  
  
  METHODS
  The subjects were 550 patients who underwent a hepatectomy during 1990-2011, with (n = 83) and without (n = 467) C tube drainage. The use of a C tube was based on the surgeon's choice.
  
  
  RESULTS
  Bile leakage was observed in 44 (8%) patients, and its incidence post-operatively correlated with intrahepatic cholangiocarcinoma, parenchymal transection with forceps fracture and tie, a major hepatectomy, prolonged surgery and excessive blood loss (P < 0.050) but not with the use of a C tube. The incidence of an intra-abdominal infection was higher and the hospital stay was longer in the leak (49 days) than non-leak group (21 days, P < 0.001). ISGLS grade B and C bile leak post-hemi-hepatectomy and extended-hepatectomy were more frequent in the non-C than C tube group (P = 0.016). The duration of hospitalization was not different between the two groups; however, 7 patients in the non-C tube group had prolonged hospitalization (> 60 days) compared with none in the C tube group (P = 0.454).
  
  
  CONCLUSIONS
  The usefulness of the C tube in preventing post-hepatectomy bile leak could not be confirmed; however, both bile leak requiring clinical management and long hospitalization after a major hepatectomy could be reduced with C tube use.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. a-nanasm@nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Ayako
authors.initials: A
authors.lastname: Shibuya
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tominaga
authors.forename: Aya
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tou
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunizaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003549:Cystic Duct / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult