title: Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study.
abstract: BACKGROUND
  The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition.
  
  
  METHODS
  Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally.
  
  
  RESULTS
  Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001).
  
  
  CONCLUSIONS
  The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.
authors: Flinders Medical Centre, Bedford Park, SA, Australia; Flinders University of South Australia, Bedford Park, SA, Australia.
authors: Mark
authors: M
authors: Brooke-Smith
authors: Joan
authors: J
authors: Figueras
authors: Shahid
authors: S
authors: Ullah
authors: Myrddin
authors: M
authors: Rees
authors: Jean-Nicolas
authors: JN
authors: Vauthey
authors: Thomas J
authors: TJ
authors: Hugh
authors: O James
authors: OJ
authors: Garden
authors: Sheung Tat
authors: ST
authors: Fan
authors: Michael
authors: M
authors: Crawford
authors: Masatoshi
authors: M
authors: Makuuchi
authors: Yukihiro
authors: Y
authors: Yokoyama
authors: Marcus
authors: M
authors: Büchler
authors: Juergen
authors: J
authors: Weitz
authors: Robert
authors: R
authors: Padbury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000145:classification* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001208:Asia; D001315:Australia; D001660:Biliary Tract Diseases / Q000145:classification* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005060:Europe; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult